Kick-Off Presentation - July 30, 2009


Published on

1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • - PPO and NPOS in every state. NPOS uses the best available contract with the doctor and hospital. For example, if we have the doctor contracted on an HMO and a PPO, the NPOS network will use the HMO negotiated fee in place of the PPO for claims. HPN available where noted HMO available where noted
  • Industries have educated consumers to move along a “ sophistication” spectrum of products and services When the movement happens it’s barely noticed because it happens over time and then is ingrained-- ATM’s, cell phones, lap tops Because movement takes place in so many areas, one area influences others-- lattes and sushi (new higher-end foods) What does migration mean to the consumer? Better products, greater value, new ways to get things done, and options/choice/control
  • Integration is key.
  • SCRIPT: There are three simple steps, or phases to implement SmartResults. Let’s look at those three steps in a little more detail: Chose the strategy you and your employees are comfortable with Over the three years, you can stay in one category, or move toward better trend mitigation by embracing consumerism. In setting your claims cost guarantee, we will apply a trend factor to set your next year's claims cost target. Based on the plan chosen and how well you rate on your Scorecard employee/employer participation levels, your trend factor is capped at a particular percentage. For instance, if you are a SmartSuite group and you meet your Scorecard participation levels, your trend factor is capped at 6%. And if your actual claims projection considering the behavior change credit is lower than the claims projection using 6% trend, then the actual claims projection prevails. Be rest assured you will always benefit from the lowest claim projection. Partner with us for engagement and improved health outcomes which involves three key elements: Health Risk Data Obtaining health risk data for earlier intervention includes collecting the information that helps identify those with chronic health conditions. Data collection includes: For new employers -- providing an electronic file of pharmacy claims data for new 1000+ accounts, Clinical programs participant list from previous carrier Completion of disclosure forms for large claims and high-cost conditions, Encouraging employees and spouses to complete Humana Health Assessment Employee Participation Getting employees actively involved leads to better health benefit choices and health improvement. Participation includes: Providing valid phone numbers for employees, using Humana’s communications package, and allowing Humana to contact employees directly, Supporting Humana’s clinical programs and encouraging employees to switch to lower-cost Rx when applicable for employees, Consider buying-up to Humana core wellness offerings for employees Ongoing Partnership Humana is seeking a partnered approach with you and your broker to deliver healthier outcomes and keep costs in line for everyone. This means agreeing to a three-year program commitment, purchasing Humana’s full spectrum of products – no carve-outs for mental health, pharmacy, etc., and having face-to-face meetings with your broker and Humana. 3. Review results with Humana and your broker, using the Scorecard As we work together we will track and review your progress through a scorecard. Based on the scorecard results, we’ll work together to make any needed changes to the action plan. The scorecard is delivered periodically, avoiding surprises late in the year.
  • Ultimately, what does all this mean for Humana’s customers? We reach over 14% of members with our focused / nursing interventions. This 14% represent about 64% of medical spending. This does not mean that those members that represent the remaining 36% of spend are not supported. For these lower utilization members, Humana offers a wealth of tools and information through the personalized website, MyHumana. Additionally, the new Smart Summary connects with members on the individual level, allowing for tailored clinical messaging. Through the use of the focused programs and services, Humana is able to reduce the total costs of medical services by around 5%. This is money taken off the table, as members have better outcomes and use the health care system more efficiently. Bottom line – Humana saves $11-$15 per member per month. This is not a per participant number… but per Member . These calculations were based across the fully insured commercial book of business. Particular savings and participation levels may differ depending on product selection (HMOs often see more financial savings than PPOs), demographic of population, proper contact information, etc.
  • Lisa had been diagnosed with asthma, a chronic disease, about 10 years ago. She recently worked with a Personal Nurse to get her asthma under control. Before being insured by Humana, Lisa had a partial knee replacement of her left knee. Her doctor recently told her she needed a replacement of the right knee. Lisa shared this information with her Personal Nurse. When Lisa expressed interest in a second opinion, the PN showed Lisa how to access My Humana to find a physician in her network, and then helped Lisa compile a list of questions for the doctor. The PN started pre-service guidance, then referred Lisa to a Case Manager for assistance getting post-op rehab. After the surgery, Lisa resumed working with her PN on her return to full mobility and a healthy life.
  • NATIONAL CALL QUALITY: As we continue on our journey towards Perfect Service, we see our roles and our tasks with a new and enhanced perspective. We now see them through the view provided by the Perfect Service Filter. When we apply the Perfect Service characteristics to the things we do every day, we see opportunities to improve the way we work and to improve our valued customers’ experience with Humana. To adapt to this new Perfect Service perspective, we enhanced our National Call Quality measurements and realigned them with Perfect Service as shown in the new Call Quality form. ECHO: To help us ‘ hear ’ the voice of our customer, Humana will be implementing a great tool called Echo. Echo is a program that will provide a random outbound-automated survey to our members. Echo provides an opportunity to listen to the voice of our customer and to gauge their experience with Humana. Our customers are asked a series of questions about their experience on their call with Humana and they can record comments about their experience. REACH: We received feedback from associates that the REACH (Rewarding Excellence for Associate Contributions to Humana) incentive program and our Perfect Service and Guidance strategies were not in alignment. For example, it became clear that the average handle time (AHT) metric prevented associates from guiding the customer to call resolution, and that it put too much emphasis on the number of calls taken and not enough on the number of calls resolved. In 2007, we will roll out a modified version of REACH that rewards associates for applying Perfect Service to what they do. The program recognizes that providing guidance and perfect service to all our consumers requires a balance of quality and time. The new REACH plan will help us realign and ensures that we’re rewarding Perfect Service experiences.
  • 2007 Humana finished 2nd to last in the Midwest and South Regions Humana Satisfaction Results: 512,000 additional satisfied/very satisfied members 2008 vs 2007
  • Use voluntary benefits to complement existing employer paid plans Insure coverage gap and enhance family coverage Benefit decisions in the hands of the employee Mitigate employee dissatisfaction with reduction of employer sponsored benefits Maximize value added services that typically accompany voluntary benefits enrollments
  • For 1,000+ and renewals, discounts applied at underwriter’s discretion. For voluntary benefits products, discounts are subject to minimum participation requirements. Discounts are not applicable to DHMO or Advantage Plus products.
  • At this point in the Sales Onboarding presentation, stop and do the interactive activity. Divide the room into three groups and assign each group one of the following benefit designs: Rx3, Rx4, RxImpact. Ask each group to discuss the following 3 questions about the benefit design that was assigned to them: What are the advantages of the benefit design? How does it work? Why would employer offer it? Ask one person in the group to be the speaker. Give them about 15 minutes to discuss and ask each group to present. After each group answers the questions, go through the related slides and highlight what, if anything, they missed. Don’t forget to give Sales Bucks to the presenters! At the end of the activity, review HDHP and “Do they work”.
  • While most plans group drugs by generic, preferred brand, non-preferred brand and specialty, this is not sophisticated enough given the variance in the gap between generic and brand drug pricing. Rx4, Humana Pharmacy’s first consumer driven product, groups drugs by cost. Drugs are assigned to four levels, with member cost increasing as the level increases: Level 1: Lowest-cost generic and brand-name drugs. Some examples include Lanoxin and Atenolol. Level 2: Higher-priced generic and brand-name drugs. One example is Minocycline. Level 3: High-cost brand drugs with less expensive alternatives. Examples include Accupril, Lasix, and Lovenox, as well as all cold and cough (both brand and generic). Level 4: Specialty drugs. Examples are Arava, Infergen, Nutropin, and Sandostatin.
  • RxImpact is a revolutionary benefit design that groups drugs according to: Their ability to lower overall medical cost The timeframe in which they impact medical care All drugs within a class (e.g., antidepressants, proton-pump inhibitors, etc.), both brand and generic, are categorized in the same group. This is different from a traditional benefit design that would separate drugs by generic/preferred/non-preferred. RxImpact is designed as an allowance benefit structure – for each group of drugs, the plan pays a specific allowance amount and members pay the drug-cost balance, if any, instead of the traditional copayment structure. The allotted allowance amounts decrease from Group A to Group D and there is a maximum out-of-pocket protection per prescription and a yearly maximum out-of-pocket protection for Groups A-C. RxImpact is designed to generate year-over-year savings and eliminate the need to introduce new prescription drug benefits annually.
  • In conjunction with Corphealth, a wholly owned subsidiary, a leader in the behavioral health field.
  • Kick-Off Presentation - July 30, 2009

    1. 1. Get in the game with Humana! Broker Kick Off Event - Thursday, July 30 Let’s huddle up to discuss Humana’s integration with Cariten Healthcare! 1
    2. 2. Game Plan Welcome & Humana Overview - Evans Looney Integration Update - Tim Moorhead Products, Solutions and Quote Processes – Large Group & Specialty - Tim Moorhead – Small Business & Specialty - Bryan Wenger Q&A 2
    3. 3. Welcome & Humana Overview Evans Looney 3
    4. 4. National Snapshot Fortune 100 company with revenues of approximately $30 billion, employing 29,000 associates One of the nation’s largest publicly traded health benefits companies; founded in 1961 as nursing home and later evolved to hospital operator 10.4 million medical members nationwide More than 5 million specialty product members 110 hospital system clients; largest single industry Integrated national networks with 450,000+ providers First health benefits company awarded ISO 9000 Ranked #6 among all U.S. companies in all sectors for technology leadership Offer full spectrum of consumer-choice solutions Industry-leading clinical, network, eHealth, service and technology solutions 4
    5. 5. Integration Update Tim Moorhead 5
    6. 6. Integration Journey Where we have been… Acquired Cariten/PHP on October 31, 2008 Developed an integration plan to leverage strengths of both organizations Aligned Cariten teams within Humana structure Combined Cariten’s regional network with Humana’s national network to increase provider access and employer savings Added Open Access HMO and NPOS products to Humana- Tennessee’s portfolio of Traditional and Consumerism solutions 6
    7. 7. Commercial Network Strategy Humana Provider Networks PPO Cariten Provider Networks ChoiceCare ChoiceCare + Preferred PPO PPO HMO HMO HMO Premier POS HMO Select POS Expansion to Preferred POS - OA national & NPOS-OA regional NPOS-OA+ network solutions 7
    8. 8. Network Strength Highly stable networks and positive provider relationships Humana ranked #1 in annual PayerView rankings by Phyisician’s Practice magazine Leading the industry to streamline claims process, simplifying back office systems for doctors’ offices In short – providers prefer us and that means fewer network disruptions for members 8
    9. 9. Our Medical Networks Tri-Cities Knoxville National PPO & NPOS Networks HMO (Most Competitive Cost of Care) Humana Preferred Networks (HPN) 9
    10. 10. Commercial Product Strategy Humana Portfolio • PPOs Cariten Portfolio • HDHP & HRA Plans • PPOs • Gated HMO • HDHPs • Open Access HMO • Gated HMO Planful transition • National POS • POS to Humana • CoverageFirst • Sevier First solutions as • SmartSuite • Vendor RX Support business renews • SmartResults • HumanaRewards • HumanaRX Solutions • HumanaOne • Humana Specialty 10
    11. 11. Commercial Branding Transition Branding Starting TODAY 11
    12. 12. Integration Journey Where are we going… New Humana Product Portfolio with Enhanced Network Quote new business starting 8/1/09 for 9/1/09 and later effectives Offer Humana renewals to existing business starting 12/1/09 Create a Superior Experience … Broker and employer education sessions Provider communications and education sessions Member communications 12
    13. 13. New Business Quotes Quoting & Effective Dates – Medical Products – Quoting August for effective dates of September and later – Dental, Life, Disability, Voluntary, Stop Loss and Worksite Products – Already in place Get a Quote! – Small Business – Contact your sales representative for 2-99 eligible employee groups – Go online to Easy Rate at for single-location, 2-50 groups – Call Easy Rate at 1-800-327-9728 or 1-800-243-6827 for 2-99 groups – Fax to 1-800-344-3294 or 1-800-432-4805 for 2-99 groups – Email for 2-99 groups – Large Group – Contact your sales representative for 100-999 eligible employee groups – Contact Barry Boster at 615.221.2155 ext. 1030610 for 1000+ groups 13
    14. 14. Integration of Cariten Producer Compensation Maintain (i.e., “grandfather”) existing commission schedules on customers initially sold Cariten plans, even after migration to Humana products and platform All new business sold with a September or later effective date will be compensated based on Humana commission schedule and our Volume Growth bonus programs (Cariten had no volume-based program. We will credit all Cariten medical production, in force prior to 2009 and new in 2009, towards Humana's bonus(es) and Leader's Club criteria.) Leaders Club Concierge service to handle your claims, billing, and enrollment, as well as customer service issues HumanaWatch, a daily e-mail with news coverage about Humana, our competitors, and the healthcare industry Preferred quote and new case processing Invitation to special events with Humana leaders Free continuing education courses 14
    15. 15. Large Group Solutions (100 or more eligible employees) Tim Moorhead 15
    16. 16. Our Approach A comprehensive approach to help members manage their health through behavior change and improve their experiences in choosing, financing and using their benefits •Engages consumers in sustainable behavior change •Involves action and participation of all parties • Employers, members, providers, brokers, and Humana •Results in improved health status for employees and an improved bottom line for employers 16
    17. 17. The Humana Guidance Solution Product and Network Design 2000 Clinical Programs and Forecasting • Traditional plans • Disease Management • Transplant Management • Utilization Management • Concurrent Review Product and Clinical • Case Management Network Programs and • HumanaBeginnings Design Forecasting • HumanaFirst® The Humana Guidance Solution Consumer Education Financial Analysis and Forecasting Consumer Financial Education Analysis and Forecasting 17
    18. 18. The Humana Guidance Solution Product and Network Design 2008 Clinical Programs and Forecasting • Traditional plans • Disease Management • Real-time operating platform • Transplant Management • SmartSuite® • Utilization Management • CoverageFirst® PPO • Concurrent Review • HumanaAccessSM card • Case Management • RxImpact • HumanaBeginnings • Wellness programs Product and Clinical Programs • HumanaFirst® • Medical spending accounts Network and Forecasting • Humana Health Assessment Design • Personal Nurse® • HDHP with Health Savings Account • Humana Preferred The • MyHumana personal web page • 90-Days-at-Retail Program • Maximize Your Benefit • RightSourceSM Humana • Predictive modeling • SmartResultsSM Guidance • Health Agent • Pharmacy MEDS Team Solution Consumer Education Financial Analysis and Forecasting Consumer Financial • Online Enrollment Center and Wizard Education Analysis and Forecasting • SmartStart • MyHumana personal Web page • Customer Reporting Package • Physician Finder Plus • Benefit Utilization Director for brokers • Transparency tools • Employer portal tools • Healing Kitchen • RxCalculatorSM • Family Health Budget • Pharmacy Repricing and Formulary • Comparative Pricing by Pharmacy • Verisight Analysis • YourHumana Handbook • MD Consultation • SmartSummarySM 18
    19. 19. Product: A Multi-Year, Phased Approach Premise #1: 12 months does not make a trend Smart Products and Population Premise #2: Consumers want choice Health Management Premise #3: There is no silver bullet • 3-6 plans (min. of 2 CDHPs) • Defined contribution strategy • Reduce risk/cost variability • Moderate cost trends over time High Traditional Plans and Value of Benefits Strategy • Behavior change via actionable Disease Management information/transparency, clinical • Reduce acute illness costs outreach/guidance and wellness/ • No consumer engagement workplace productivity initiatives Transitional Plan Strategy Single & Dual and Clinical Guidance • Triple option, incl. a CDHP Option Traditional • “Bridge” contribution strategy Plans Only • Reduce acute illness and chronic condition costs • Early-stage impact on cost trend via initial consumer engagement No/Low Low Employer/Employee Engagement High 19
    20. 20. SmartResultsSM In Three Easy Steps • Offer Humana HMO • Include a CDHP • Offer SmartSuite or PPO plan 1 Traditional Transitional SmartSuite Employer chooses the plan strategy • Trend factor • Trend factor •Trend factor as low as 9% as low as 7.5% as low as 6.0% 2 Health risk data for Employee participation Ongoing partnership earlier intervention in for better choices and with long-term Partnered approach health conditions better health impact for employee engagement Review Scorecard progress during 3 Track service level consultative sessions performance Employer, broker & Humana monitor View progress on participation goals progress against targets Detailed program participation data 20
    21. 21. Member Guidance: Humana Pharmacy Solutions We employ over 1,600 employees and approximately 160 pharmacists We process over 250 million prescriptions and over $13 billion in spend, approximately $11.5 billion is Humana’s risk One of the first PBMs to earn the URAC Pharmacy Benefit Management Accreditation Products: Rx3, Rx4, RxImpact and Mail-Order Rx (RightSource) Humana Pharmacy manages its book of business using a “net cost management” approach versus a “rebate maximization approach” In 2007, Reden & Anders compared our Rx claims data against their benchmark database (Caremark, ESI, Medco, United, etc.) Reden & Anders Comparison Humana Benchmark Difference Total PMPM 55.56 59.82 -7.10% Cost/Day 2.43 2.52 -3.60% Utilization 274.5 284.41 -3.50% 21
    22. 22. Clinical: The Guidance Solution Delivers Better health outcomes – Health promotion and disease prevention – Condition management – Increases productivity Better opportunity for cost savings – Enhanced identification and engagement – Focus on major clinical conditions / cost drivers Better health benefits experience – for everyone – Member support, whether ill or healthy – High employee satisfaction – Ease of administration (HumanaFirst) The bottom line • Commercial members engaged 14% • Total costs engaged with Health Resources 64% • Total cost savings 4-6% • Savings PMPM $11-$15 22
    23. 23. Consumer: Tailoring Guidance Consumer Segment Change Stage Condition Channel Cultural Identity 23
    24. 24. Consumer: Health & Wealth Guidance Click Here 24 Click Here
    25. 25. Wellness Designed to Fit A Continuum of Wellness Solutions Core Wellness Package Wellness Plus Package Custom Wellness (a la carte) • Self-help web content • Tailored Web Program • Wellness Consulting (MyHumana) • Telephonic Health • Onsite Wellness Programs • Wellness Monthly Coaching • Print Collateral Calendar (Tobacco Cessation, Stress Management, Back Care, Weight • Physical Activity Incentive • Preventive Reminders Management, Physical Activity, and Reward Program • Humana Health Nutrition) Assessment (HHA) Humana’s CareHub •Complete integration of infrastructure and data (2008) •A single view of the member HumanaFirst Personal Nurse Case Management HumanaBeginnings Disease Management Transplant Management NICU Case Management (CAD, HF, Cancer, Asthma, CKD, ESRD, Utilization Management Behavioral Health Management Diabetes, Rare Diseases) Employee Assistance Programs 25
    26. 26. Virgin HealthMiles The first-of-its-kind incentive program for physical activity Engagement and communications to promote increased activity and track results – Members log exercise, count steps, measure results: BMI, body fat percentage, and blood pressure using the LifeZone web site, GoZone pedometer, and HealthZone kiosk Flexible Incentive fulfillment platform – Accumulate HealthMiles for effort, measurement, and achievement, then redeem miles for rewards at over 40 leading U.S. retail partners 26
    27. 27. Our Results: Behavior Change and Improved Health Smoking Smoking Weight Mgmt/ Weight Mgmt/ Stress Stress Nutrition Nutrition Back Care Back Care Cessation Cessation Physical Activity Physical Activity Management Management Over 52% Over 57% lost 95% have Over 56% Over 47% remained weight made a decreased improved and smoke free positive personal better manage Of those with a after 180 days change in their symptoms of back pain BMI of >30: of beginning eating habits stress after 29% lost more the program enrolling in the than 5% of program their body weight 10% lost more than 10% 27
    28. 28. Humana Innovations Get Moving!!! 28
    29. 29. What is Perfect Service? What Perfect Service means to Humana Delivering unexpected value and quality Providing guidance on complex needs Going beyond satisfaction Creating engagement with those we serve. Building a proactive culture. Making what’s most important to those we serve, most important to us An aspirational journey – that changes as those we serve and as we ourselves change. 29
    30. 30. Member Service How we measure performance: National Call Quality Enhanced our National Call Quality processes and measurements are aligned with Perfect Service in a new Call Quality form. Implemented - January 2007 ECHO – Voice of the Customer Provides a random outbound-automated survey to our members, helping us ‘hear’ real opinions of their experience with Humana. Implementation – Pilot in progress REACH New version rewards CCS for using the Perfect Service filter in what they do every day by a changed weighting system that better balances quality and time. Implemented - January 2007 30
    31. 31. Member Service: Customer Satisfaction Technology Customer Rep knows that Customer Rep knows that in the past 30 days almost in the past 30 days almost 94% of her customers 94% of her customers have been satisfied or have been satisfied or very satisfied with the very satisfied with the service she provides. service she provides. Rep can Rep can access access specific specific information by information by clicking on clicking on any of these. any of these. CCS = Customer Care Specialist 31
    32. 32. How do we measure up? Just released for 2009, J.D. Power ranks Humana # 1 in overall satisfaction and service delivery among all national health plans! 2009 Overall Plan Rankings & Satisfaction Score 1. Humana 718 2. Wellpoint 708 3. CIGNA 706 4. Aetna 698 5. United 696 SOURCE: JD Power 2009 Commercial Health Insurance Plan Study High = top 25th percentile, Medium = middle 50th percentile, Low = bottom 25th percentile 32
    33. 33. Large Group Client Support Team Report/ Implement Serve/ Serve Renew Lisa Johnson Director, Melissa Trelfa Melissa Trelfa Account Management Director, Director, Account Services Account Services (Plan build oversight) (Escalated service issue Sales Executive Account Advisor oversight) (OE meeting (Escalated service oversight) issue owner/liaison) TBA Account Implementation Account Executive Manager or Coordinator (Overall client (Plan build project manager) relationship owner) Corporate Resources Market Resources Corporate Resources 33
    34. 34. Specialty Benefits 34
    35. 35. Enhancing Our Product Portfolio 30+ years of experience 18 years of experience 50 years of experience Dental, life and vision Dental and vision services Single source solution for services 4.8M members ancillary services and 2.9M members Broad dental and vision voluntary benefits Broad dental and vision networks Well-respected TPA networks 1.1M members Specialty Benefits 35
    36. 36. Options to Fit Your Clients’ Needs You can offer employer-sponsored or voluntary funding options to clients of all sizes. Dental Vision Health & productivity PPO Vision Care Plan Employee assistance Traditional Preferred Advantage, Focus, & work-life Advantage Plus Optimum Wellness / healthcare DHMO Preventive Plus coaching Disability Short-term income Behavioral health Life protection Basic term Long-term disability Voluntary term Level term AD&D Accident Whole life Critical illness Lifestyle – Care Life and Critical Life Supplemental health 36
    37. 37. Add Specialty Benefits and Save 37
    38. 38. Small Group Solutions (2 to 99 or more eligible employees) Bryan Wenger 38
    39. 39. Sales Support and Service You’ll receive exceptional sales support and service to sell and keep more business, and to maximize your earnings: Local Humana sales executive helps you sell new business Retention executives and online resources help Other benefits include: you renew cases • Centralized billing and enrollment Dedicated Small Business Customer Care team to • Group-dedicated serve your clients billing representative • State-specific plan change and service teams 39
    40. 40. Our Business Is to Help You Grow Yours Here’s what you can expect: Exceptional sales support and service Online resources to quote, enroll, and manage your business Broad product portfolio Direct access to underwriters Convenient, fast quotes Welcome calls to all new groups Wellness and employee assistance programs Plan utilization reports Comprehensive renewal reports Competitive commission and recognition programs 40
    41. 41. Our Broad Product Portfolio With Humana’s broad product portfolio, you can deliver an even more competitive benefits package to your customers. We offer employer-sponsored and voluntary benefits including: • Medical • Disability • Dental • Critical Illness • Vision • Supplemental Health • Accident • Life 41
    42. 42. Humana Product Continuum Traditional benefits with a wide range of out-of-pocket options First step toward consumer-directed plans Innovative, cost-saving solutions with banking arrangements 42
    43. 43. P0S Product Small Business POS: Cariten to Humana Plan Design In-Network Out of Pocket (excludes deductible) • 100/60 to 100/70 • $750 to $2000 • 90/70 to 90/60 • $1000 to $1000 (90% plan) • 80/60 to 80/50 • $1000 to $2000 (70% and 80% plan) • 70/50 to 80/50 • $1500 to $2000 • $1750 to $2000 ER Copay • $2000 to $2000 • $100 to $150 • $2250 to $3000 • $3000 to $3000 In-Network Copay • $3500 to $4000 • $20/$35 to $20/$40 • $4000 to $4000 • $25/$40 to $30/$50 • $5000 to $4000 • $30/$45 to $30/$50 • $5500 to $4000 • $35/$50 to $30/$50 • $40/$55 to $30/$50 In-Network Deductible Additional Deductible Options: • $250 to $250 $3000 • $500 to $500 $4000 • $750 to $1000 $5000 • $1000 to $1000 $6000 • $1500 to $1500 $7000 • $2000 to $2000 $8000 • $2500 to $2500 43
    44. 44. PPO Product Small Business PPO: Cariten to Humana Plan Design In-Network Out of Pocket (excludes deductible) • 100/60 to 100/70 • $750 to $2000 • 90/70 to 90/60 • $1000 to $1000 (90% plan) • 80/60 to 80/50 • $1000 to $2000 (70% and 80% plan) • 70/50 to 70/50 • $1500 to $2000 • $1750 to $2000 ER Copay • $2000 to $2000 • $100 to $150 • $2250 to $3000 • $2500 to $3000 In-Network Copay • $3000 to $3000 • $20 to $25 • $3500 to $4000 • $25 to $25 • $4000 to $4000 • $30 to $35 • $4500 to $4000 • $35 to $35 • $5000 to $4000 • $40 to $35 • $5500 to $4000 In-Network Deductible Additional Deductible Options: • $250 to $250 $3000 • $500 to $500 $4000 • $750 to $1000 $5000 • $1000 to $1000 $6000 • $1500 to $1500 $7000 • $2000 to $2000 $8000 • $2500 to $2500 44
    45. 45. Standard PCA (HRA) A coinsurance PPO plan combined with a personal healthcare spending account Positively engage consumers — generates long-term savings Employer funded HumanaAccess card 45
    46. 46. Personal Care Account (PCA) How does it work? You use funds to pay for eligible medical and pharmacy expenses PCA funds can be applied to the deductible Once all the funds are spent, you must satisfy the deductible and pay the specified coinsurance amount You always have protection against medical expenses for catastrophic illness or injury Simple plan design: – Preventive covered 100% – Exception endoscopic services for Small Business – Everything else coinsurance after deductible 46
    47. 47. Humana HDHP 08 With Optional HSA An HSA qualified HDHP plan available with or without an HSA Preventive care at 100 percent Medical and pharmacy—integrated deducible HSA covers medical plan deductible, coinsurance, and other qualified services HSA offered through UMB Bank Both integrated and embedded family deductibles available 47
    48. 48. Humana CoverageFirst 08 The easy first step toward consumer-choice plans No banking arrangements All the benefits of a full PPO plus an up-front allowance of $500 Allowance built in to the plan design Motivates employees to use their benefits wisely Guides employees in becoming informed consumers of health care 48
    49. 49. CoverageFirst Product Details $500 allowance covers: – Doctor’s office visits – Routine outpatient labs and x-rays – Hospital services, emergency room services and outpatient surgery – Other services such as home health care, physical therapy and hospice care Allowance does not cover: – Prescription drugs – Mental health treatments (unless mandated) – only until 11/1/09 due to Federal Mental Health Parity – Copayments – Services from non-participating providers Unused funds do not carry-over from year to year 49
    50. 50. CoverageFirst Positioning Feels like traditional PPO plans – Par/Nonpar providers – Copayments for some benefits; ded/coins for others First dollar coverage – $500 per member – Allowance is used for expenses prior to paying the deductible Allowance promotes financial involvement and incentives – Members see allowance as “their” money – Members more apt to take active role in decision-making and budgeting – Encourage utilization from participating providers Preventive covered at 100% after copay NOT a lower price alternative, but a baby step into consumerism 50
    51. 51. Benefit Design Solutions for Today and Tomorrow Provide guidance with choice and flexibility Traditional benefit designs – Rx4: Tiered by cost, more sophisticated Value-based benefit designs – RxImpact: Unique 51
    52. 52. Rx4 Most plans group drugs by generic, preferred brand, non-preferred brand and specialty – This is not sophisticated enough given the variance in the gap between generic and brand drug pricing Humana’s Rx4 groups drugs by cost – Tier 1 – lowest cost brands and generics – Tier 2 – higher priced brands and generics – Tier 3 – high cost (mostly) brands with less expensive alternatives – Tier 4 – Specialty drugs Some drugs have been moved to less expensive tiers due to proven medical efficacy (e.g., Procrit and Lovenox) 52
    53. 53. RxImpact Drugs grouped based on: – Medical efficacy – ROI – Timeframe for “medical payoff” Each drug in a class is in the same level Group A Evidence-based short-term effectiveness (acute) (asthma, infections, juvenile diabetes, antidepressants) Group B Evidence-based long-term effectiveness (chronic) (cancer, heart disease, MS) Group C Drugs that provide symptom relief (antihistamines, anti-inflammatory, antacids) Group D Drugs that may impact lifestyle (sexual dysfunction, cosmetic, obesity, smoking cessation) Turns the member into the ultimate consumer 53
    54. 54. RxImpact Example Each tier has an allowance assigned to it – Members pay the difference between the allowance and the discounted cost of the drug – Members had $0 expenses 65% of the time Retail Plan Drug name Quantity Allowance Member Pay Cost Pays Fluoxetine 20mg 30 $14.99 $30.00 14.99 $0.00 Lexapro 20mg 30 $89.99 $30.00 $30.00 $59.99 Cymbalta 30mg 30 $130.32 $30.00 $30.00 $100.32 Drug price source:, 10/01/2008 54
    55. 55. Pharmacy Choices Rx Impact Rx4 Employers save 2 to 5 percent Eliminate unexpected charges on premium at the pharmacy About 60 percent of prescriptions Drugs are grouped into four levels, each have no out-of-pocket cost to with corresponding copayment amounts employees 85 percent of prescriptions filled are those If there is a cost to the employee, the average is $16 with the lowest copayments—those in the first two levels Out of pocket protection – $100 cap per prescription – $2,500 annual maximum (groups A, B, C) 55
    56. 56. Fast, Convenient Quotes Receive medical, dental, and life quotes in easy-to-use Excel and PDF formats. You can: • Quickly compare health plan choices • See market popular plans • Filter data to view specific plans and benefit options • Model premium costs for your clients and their employees 56
    57. 57. Talk Directly to Your Underwriter Humana’s underwriters provide you with the support you need to sell more cases, both new and existing business: Direct access to underwriters Local expertise to ensure your clients receive the best fit in products and rates Meet face-to-face with your underwriting team during Underwriting Days – Next session: September 16t and 17 Express underwriting/phone, fax and e-mail, or produce a quote request online and receive a firm risk rate, in most cases, within 48 hours 57
    58. 58. See How Your Clients Used Their Benefits Using Humana’s exclusive Benefit Utilization Director (BUD)*, you can view how often employees: • Visit their doctors • Purchase prescription drugs • Meet deductibles and out-of-pocket maximums Knowing how health benefits are Plus, create a customized packet used will help you build more effective to share with your clients. strategies for your clients. * Available for groups with 5 - 99 employees 58
    59. 59. Easily Explain Your Clients’ Renewals The Renewal Center provides transparency of the renewal process and helps you clearly explain your clients’ renewals. The Renewal Center contains: • Client renewal letters • Renewal rates and rate details • Census information and health status • Alternate quote summaries • Enrollment and plan change forms You can view the data the way you prefer: e-mail, paper, or Web. 59
    60. 60. Communicate With Employers Humana works closely with you to help your clients manage their plans and control healthcare costs. We provide: Welcome calls to all new groups Employer welcome kit sent to every new group HealthMatters, which offers ideas on how to control healthcare costs and tips for managing their plan Humana Health Plan Guide, which shows employers how their employees use their benefits 60
    61. 61. Help Members Choose, Use and Finance Their Benefits We help employees manage their plan, take control of their health, and better understand their healthcare costs by offering: Member enrollment kit Member welcome kit Educational materials on Humana’s wellness resources SmartSummarySM, a quarterly statement to help employees keep track of their healthcare spending MyHumana, a password-protected personal page on 61
    62. 62. Humana’s Health Resources Your 2 - 99 clients automatically receive a comprehensive health and wellness program that includes: • Humana Health Assessment • Personal health coaching • Discounts on health products and gym memberships • Employee assistance program Healthier employees use fewer healthcare dollars, • Disease management / clinical programs and have fewer claims, miss less work, and are more productive. 62
    63. 63. Quote, Enroll and Manage Your Business Online The agent section on has resources to help you do business with us, and service your clients. You can: • Order marketing materials If you haven’t registered yet, go to and • Submit a quote click on “Agents” and • View utilization reports “Register Today.” • Access comprehensive renewal information, including rate detail and census information • Perform administrative functions on behalf of your clients • Get details about our compensation, bonus, and Leaders Club recognition programs 63
    64. 64. Producer Partnership Plan Strong first-year and renewal commissions for all lines of coverage – 2-3 lives per case 5% – 4-25 lives per case 7% – 26-50 lives per case 5% – Paid on base premium Quarterly bonuses for growing block of business with Humana 64
    65. 65. Leaders Club Become a member of Leaders Club and enjoy the beauty of San Francisco, along with other rewards such as: 20th Anniversary of Humana’s Leaders Club Concierge service to handle your claims, The Ritz-Carlton Half billing, and enrollment, as well as customer Moon Bay, California service issues May 2-7, 2010 HumanaWatch, a daily e-mail that links news coverage about Humana, our competitors, and the healthcare industry Preferred quote and new case processing Invitation to special events with Humana leaders Free continuing education courses 65
    66. 66. Summary 100 percent of our small business products are distributed through you, our valued broker partners We help you educate your clients on solutions to control their healthcare costs We give you information so you can recommend the most appropriate, cost-effective healthcare plan We listen to you and act on your feedback 66
    67. 67. Q&A TN Management Team 67
    68. 68. Kick-Off Contest First three producers who place Humana medical product sale (8/1 and later quote date) will receive Garmin GPS devices Producer who places first multi-line sale (8/1 and later quote date) will receive: 8 tickets and use of skybox UT vs. Auburn Game October 3, 2009 Medical + Dental / Life / Voluntary / Worksite 68
    69. 69. Get in the game with Humana! Thanks for attending! 69