HealthCheck360 Medical Cost Gap Analysis

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HealthCheck360 Medical Cost Gap Analysis

  1. 1. Medical Plan Cost Gap Analysis AWellness Solution April, 2014 HEALTHCHECK360.COM Direct Phone: 563.587.5415 Roy.Lines@HealthCheck360.com Presented By: Roy Lines, CFP®, CRPS®
  2. 2. Business stakeholders have a choice: “Pay now through wellness programs or pay much more in health care costs later…”
  3. 3. How does HealthCheck360° effectively limit rising health care costs? Through a Performance – Based Health Management Program A systematic way – to keep healthy employees healthy, improve the health of the unhealthy and enables better care compliance for those with chronic conditions.
  4. 4. Our system has three broad categories of benefits to business clients and prospects: 1. Cost Effectiveness 2. Ease of Administration 3. Verifiable & Manageable Results 4 How to Set Up HealthCheck360°’sValue Proposition
  5. 5. True or False? All growth oriented business owners are continuously searching for a competitive edge to increase shareholder value. and; You want to be the one to share it with them. 5 How to Set Up HealthCheck360°’sValue Proposition
  6. 6.  I thought of you while working on a medical cost reduction strategy for another good client of mine. I’ve done some additional analysis on your plan and I’d like to show you a business financial strategy that is showing some really good results in reducing health care spend and improve operational efficiency by increasing employee productivity at little or no cost to you? It’ll only take about 8 minutes of your time. 6 How to Set Up HealthCheck360°’sValue Proposition
  7. 7. HealthCheck360°Trend Cost Gap Analysis Plan information needed for HC360° to perform (medical plan cost) trend gap analysis & show HC360 impact. 1. # of plan eligible EE’s 2. Type of Plan (Self/Partially/Fully Funded-PPO/POS, HMO etc.) 3. Medical trend rate for the past 3 years 4. Average plan cost/employee 5. Industry/Region 6. Type of HM program currently in place (if any)
  8. 8. WHY HAVE A HEALTHCHECK360° WELLNESS PROGRAM ? $8,852 $9,054 $8,365 $8,967 $8,823 $8,247 $7,429 $7,861 $8,334 $9,033 $9,730 $10,346 0 2,000 4,000 6,000 8,000 10,000 12,000 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 To Reduce Health Plan Medical Costs per Covered Employee HC360 Actual Mercer Large Employers Trend Question: Why are their health costs continuing to go up? Answer: Traditional wellness programs are not financially focused 8 Source: Mercer National Survey of Employer Sponsored Health Plans 2012 (Page 17)
  9. 9. $14,616 $16,808 $13,455 $14,625 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 2014 2015 (estimated) ABC Costs vs. Mercer Benchmark ABC Mercer 500 WHY IS THIS CLIENT AT A COMPETITIVE DISADVANTAGE? ANALYZE HEALTH COST TREND $232,200 $436,600 N=200 9
  10. 10. $14,616 $16,808 $19,330 $22,229 $25,563 $13,455 $14,626 $15,898 $17,281 $18,785 $- $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 2014 2015 2016 2017 2018 ABC Co. Trend (15%) vs. Mftg. Industry Average (8.7%) ABC Mercer 500 CONTINUE WITH A DO NOTHING STRATEGY 10
  11. 11. $- $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 Year 1 Year 2 Year 3 Year 4 Year 5 HC360 Cost of Program + Health Plan Cost per Employee HC360 Program Cost Cost Per Employee OR INVEST IN HEALTHCHECK360° 11 N=450
  12. 12. IS IT COST EFFECTIVE? $- $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 Year 1 Year 2 Year 3 Year 4 Year 5 HC360 Plan: Cost Reduction by 1% per Year ABC + HealthCheck 360 Mercer 500 ABC Savings: Year 2: $29,232 Year 3: $100,266 Year 4: $228,276 Year 5: $431,219 12
  13. 13. VERIFIABLE RESULTS $6,000 $6,500 $7,000 $7,500 $8,000 $8,500 $9,000 $9,500 $10,000 $10,500 $11,000 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 $8,852 $9,054 $8,365 $8,967 $8,823 $8,247 $7,588 $8,107 $8,506 $9,012 $10,221 $10,581 $7,429 $7,861 $8,334 $9,033 $9,730 $10,346 Health Plan Costs per Covered Employee Actual Manufacturing Large Employers A health plan competitive cost disadvantage of $1,264 per employee has been transformed into a competitive advantage of $2,334 per employee N=2,000 HC360 Manufacturing Client 13
  14. 14. HC360° PROCESS: IDENTIFYTHE ROOT PROBLEM IFYOU CAN MEASURE ITYOU CAN MANAGE IT 14 Biometric Screening Findings • 111 with glucose in diabetic range • 580 with glucose in pre-diabetic range • 549 individuals with elevated systolic and diastolic blood pressure readings • 815with elevated cholesterol • 883 with BMI readings > 30, of which 396 (44.8%) are also pre- diabetic Claims Information • 50 individuals have claims with diabetes or pre-diabetes • 78 individuals have claims with hypertension • 98 individuals at risk of a heart attack N = 1,750 Manufacturing Firm Management may already know… What if they knew…
  15. 15. QUANTIFY HEALTH RISK INYOUR POPULATION 15 0 20 40 60 80 100 120 140 160 180 40% 20% 35% 31% 19% Projected Health Risks in ABC Population # Health Risks N=450
  16. 16. 12 4 16 4 16 4 100 Points All of these health conditions can be modified by a combination of an employer’s decision on financial incentives, health behavior intervention & compliance management programming. Most importantly, by the employee’s health decisions! 16 28 16 Scoring Model
  17. 17. CORRELATE RISK LEVELSTO HEALTH SCORE HealthCheck360° Scorecard Risk Level Correlated to HC360° Health Score Ideal ≥ 86 Low 71-85 Moderate 61-70 High 51-60 Very High ≤ 50 HealthCheck360° has an easy to interpret scoring system that translates biometric values into a simple to understand score that is highly correlative to health risk factors. Ease of interpretation for both participants and company reports for analysis and planning. Financial incentive strategies easily integrate with this progressive scoring system and simplifies the reasonable alternative process.
  18. 18. TRANSLATE HEALTH RISKS INTO AN ACTION PLAN (POPULATION HEALTH DISPERSION) 30.70% 31.10% 18.90% 10.20% 9.10% Ideal (85+) Low Risk (71-84) Moderate Risk (61-70) High Risk (51-60) Very High Risk (<60) HC360 Sample Population Study: N=10,262 2012 18 Keep this Group Healthy Improve this Group’s Health Drive Behavior Change & Manage Care Compliance
  19. 19. 24.1% 32.6% 21.0% 10.3% 12.0% Ideal (18.5-24.9) Low Risk (25-29.9) Moderate Risk (30.0-34.9) High Risk (35.0-39.9) Very High Risk (40+) ABILITYTO DRILL DOWNTO DETERMINE SPECIFIC HEALTH RISKS EXAMPLE: BMI POPULATION DISPERSION HC360 Sample Population Study: N=10,262 2012 19 Keep Up the Good Work Eat Healthy Exercise Program Weight Management Program
  20. 20. ESTABLISH YEAR 1 BASELINE TO SHOW Y-O-Y POPULATION HEALTH IMPROVEMENT R² = 0.9662 R² = 0.8815 66 68 70 72 74 76 78 80 82 84 20 25 30 35 40 45 50 55 60 65 HRATotalScore Age HC360 Repeat Participants vs Baseline Baseline HC360 Participants 20 HC360 Sample Population Study, Baseline N = 38,000 2012
  21. 21. CORRELATING CLAIMS COSTSTO RISK LEVELS HealthCheck360° Risk Level Cost Ideal $1680.35 Low $2279.46 Moderate $2855.74 High $3040.94 Very High $3879.80 Competitor Risk Level Cost “Best” $2260.85 “Moderate” $2676.97 “Poor” $3012.15 HealthCheck360° includes two additional levels of stratification to accurately identify health risk levels. This gives consultants and business owners more accurate data to create targeted interventions resulting in a much higher probability for cost reduction.
  22. 22.  HealthCheck360° is unique because we provide a progressive program that integrates participatory, activity-based and outcome- based programming into one effective program.  Over 90% of our clients migrate towards outcome-based incentive structures within 2-3 years.  HC360° can (and often does) integrate our Condition Management (disease and compliance management) programming. 22 Why is HealthCheck360° Unique?
  23. 23. HEALTHCHECK360° 5-STEP BEST PRACTICES • Objective biometric collection process – Identify & measure health risks • remove subjective predispositions from self-reported HRA • Superior scoring algorithm – Translate lab values into an easy to understand health score • correlated to established benchmarks that are highly predictive of health costs • Flexible and effective incentive management – Motivate participation with flexible design that evolves with program • Reward progress not perfection while maintaining HIPAA & ACA compliance • Mitigate known and unknown health risks – Multimedia engagement programs driven by individual biometric data • Health coaching & Condition management programming • Manage to maximize results – Participation analysis, Engagement levels & Risk migration • Claims integrated client specific reporting 23
  24. 24.  HealthCheck360° is not just another wellness provider.  HealthCheck360° has a financially focused, easy to adopt 5-step best practices health management program that is unique, cost effective and delivers verifiable results to enable company stakeholders to effectively mitigate and manage health care costs while at the same time improve the health and productivity of their employees. 24 HealthCheck360°’sValue Proposition
  25. 25. HealthCheck360°sValue Proposition  HealthCheck360° provides stakeholders with an easy to adopt and implement five step best practices health management system.  Our system is unique, cost effective, delivers verifiable result and reduces the administrative burden of doing it alone saving both time and money.  When integrated with a well designed health plan, our results driven system leads to healthier and more productive employees resulting in increased operational efficiency and a reduction in total health care costs.  Provide management with insightful and actionable information. 25
  26. 26. BENEFITS GAINED  Effectively manage your wellness program – • like you manage your business; with employee accountability, goal achievement and more predictable outcomes  A systematic way to achieve better health outcomes – • which will mitigate your health spend while increasing productivity resulting in higher operational efficiency and profitability  Expert consultation enables you to set realistic goals and benchmarks – • Enables management, employee benefits team, consultants and providers to effectively monitor, measure & manage for program success  Saves you valuable time in the strategic planning process – • results in developing an evolving program that is congruent with your corporate goals and initiatives  Effectively analyze your population’s health risk migration – • and correlate to claims data; better enabling predictive modeling alignment with ROI expectations  Program is designed to be cost neutral – • program hard costs will have minimal impact on cash flow if implemented as recommended  Program is administratively simple and efficient – • Saving you both soft & hard dollars on administering your wellness program  With access to an employee’s Personal Health Information – • we are in the best possible position to influence a shared vision of good health and healthy habits 26
  27. 27. BENEFITS GAINED  Expertise with HIPAA and HITECH regulations – • compliance oversight maintains your program integrity and reduces time and cost for staff  Expert consultation on prudent financial incentive strategies – • that are intuitive and member specific programming will foster high participation and engagement; ensuring program sustainability and overall goal achievement  Empowering employees to take more personal responsibility – • Over their health increases their confidence in the program resulting in sustainability  A trusted partner – • you can depend on HealthCheck360° for world class customer service and support  A systematic way – • to keep your healthy employees healthy, improve the health of the unhealthy and enables better care compliance for those with chronic conditions 27
  28. 28. HEALTHCHECK360° CONTACT 28 For a meeting, webinar or plan proposal call or email: Roy C. Lines, CFP®, CRPS® Sales Executive Office 563.587.5415 | Cell 563.599.2844 | Fax: 563.587.6602 www.HealthCheck360.com | Roy.Lines@HealthCheck360.com HealthCheck360° 800 Main Street | PO Box 1475 | Dubuque, IA 52004-1475

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