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Evalu8 72009

Evalu8 72009



Chicago Presentation on Value-based benefits

Chicago Presentation on Value-based benefits



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  • Journal Communications – in combination with BHCG reviewed claims history and results – noticed there were some providers that were more effective than others.
  • Asheville project principle Requires partnership of Employer, Pharmacist and participant!

Evalu8 72009 Evalu8 72009 Presentation Transcript

  • Integrating Value-Based Benefit Design eValue8 User Meeting July 15, 2009
  • About Journal Communications
    • 4,000 employees, 1,200 pre-Medicare and Medicare-eligible participants nationally.
    • Our strategic plan focuses on providing quality benefits while maintaining shareholder value.
    • Like other employers, we struggle with managing:
      • Affordable coverage (employer and retiree)
      • The impact of medical inflation on our budget;
      • The health status of medical plan participants.
  • 5 years ago…
    • 4 benefit plans
      • Copays for doctor appointments and pharmacy
      • Low deductibles
    • Cost per employee per year – 30% above the Midwest average!
    • Attitude of entitlement. Very passive, little engagement
  • 2004: Our Concerns
    • Employer concerns:
      • How to afford exponential increases year over year.
      • Participants did not understand how their benefits worked or how much procedures cost.
      • Many had chronic disease driving frequent hospitalizations, ER visits and prescription drug use.
      • High utilizers often non-compliant and driving up medical costs.
    • Member concerns:
      • Participants did not know how expensive their care was; no money saved.
      • Patients did not understand benefits and relied on physician to steer.
      • Patients with medication management needed more “touch” than plan would allow.
  • Question
    • What can we can do today, to improve the health status of our participants today AND tomorrow?
  • Strategy for all – Actives and retirees
    • Improve the health status of the participants
    • Provide access to qualified providers;
    • Offer medical plans that require engagement of participants;
    • Reduce the barriers to preventive care;
    • Give participants with chronic diseases tools and support to manage their condition;
    • Increase compliance for disease-specific medications;
    • Introduce wellness program that provides feedback and
    • Communicate, communicate, communicate…
  • Step 1: Promote the right provider
    • Implemented a Narrow PPO Network in SE Wisconsin
    • Online Transparency Tools
      • Compare providers
      • Quality and Safety – following safety practices developed by the Leapfrog group.
    • Promote and provide incentives for patients to use cost-efficient providers within the network
      • MRIs, CT Scans, Colonoscopies
      • Commodity rebate of $100
    • Use plan design to steer participants
  • Step 2: Reduce Barriers to Care
    • Integrated EAP (5 visits)
    • Updated Mental Health Benefits (Parity)
    • Implemented Transparency Tools, Nurse Line, Personal Nurse
    • Preventive Care and Wellness:
      • Provide 100% coverage (deductible waived) for all preventive care
      • HSA Plans - Waive the medical deductible for “preventive” prescription drugs
      • Send wellness reminders to medical plan participants
      • Offer free flu shots at all locations for employees, participants and spouses
  • Step 3: Manage Chronic Disease and Increase Prescription Compliance
    • Traditional Disease Management in 2004
    • Pharmacy compliance in 2008 ( Based on Asheville Project )
      • Members with a personal health coach (from a network of local pharmacists);
      • Coordination with the patient’s physician or other healthcare providers to help effectively manage their Condition:
        • Diabetes
        • High Blood Pressure
        • Cholesterol
      • Medication and supplies at no cost / reduced cost
    • Partners: Mirixa and Piedmont Pharmaceutical Network
  • Coordination and Support for the Patient
  • Patient Incentives – Diabetes & Cardiovascular
    • Face-to-face coaching
      • Improved reliability via direct observation
      • Interpersonal connection
      • Strengthens the patient-physician relationship
    • HSA Medical plan deductible waived for preventive RX
      • 100% coverage diabetes medication, test strips and supplies
      • Reduce copays by 50% for medication
        • Cholesterol
        • Blood Pressure
    • Free Glucometers & Insulin Pumps
  • A word about incentives
    • Incentives are used in the beginning to get participants to engage
    • Participants don’t stay in the program because of the incentives…they stay because:
      • More knowledge about their disease
      • Improved Health
      • Improved sense of well-being
  • Testimonial I signed up for HealthMapRx for Diabetes because the medications were free. I had no idea how much this decision would impact my life. I have lost 70 pounds…I am eating better, I am walking and my A1C shows my diabetes is in control! I feel better, I have more energy and now I can keep up with my grandchildren! Brenda (my coach) is great! I’ve learned so much from her! Thank you so much for offering this program.
  • Better Outcomes – Participant
    • With weight management, exercise and better diet and medication compliance:
    • Control blood sugar
    • Control blood pressure
    • Control of blood lipids (“good” and “bad” cholesterols)
    • Care of feet, eyes, kidneys
    • Live a healthy, active lifestyle
  • Better Outcomes –Plan
    • Reduced costs to employer for health care:
    • Lowers hospital admissions, length of stay as well as ER visits
    • Reduced risk of serious disease events (prevent complications)
    • Participants are more knowledgeable about self-care
    • Increased medication expense (compliance)
    • Collaboration with patient’s physician
  • Step 4: Integrate Wellness
    • Partnered with Quality Health Solutions
    • Health Risk Assessment that measures:
      • health status,
      • readiness to change (Prochaska model)
      • personal health history and
      • health care utilization data
    • Coaching
    • On-site health screenings (glucose, triglycerides, blood pressure and BMI)
    • On-line wellness tools (includes biometrics)
  • Putting it all together
  • Putting it all together
  • Keys to success???
    • Partner with a TPA that can/will support your initiatives.
    • Find a trusted resource to assist with managing eligibility of plans to maintain HIPAA compliance.
    • Integrate the data from all of your resources:
      • Sick time/LOA/FMLA
      • Disability
      • Wellness
      • Medical
    • Take the time to create links between processes.
    • Make sure the communication is relevant.
  • Partner with your TPA
    • Spend time to determine what your TPA can do for you. Find out what they are doing for other customers. (Products, initiatives, plan design)
    • Share your plan initiatives with your TPA so they can support you.
    • Analyze your experience. Ask what will make the biggest impact.
    • Leverage economies of scale when it makes sense.
    • Don’t be afraid to ask for assistance.
    • Don’t be intimidated by the answer “no.”
  • Outsourced Eligibility Administrator
    • Protect confidentiality/PHI
    • Manage eligibility of all H&W plans
      • Employee enrollment
      • Online feeds to vendors
      • Liaison between employer/vendor/health plan
    • Provide service center for questions/concerns
    • Send communications to participants under company brand “focus on opportunity”
    • Manage employee appeal process
  • Integrate your data - make it work for you!
    • Ask your vendors to share data with each other.
    • Find benchmarks that show improvement toward your goals.
    • Create a report card and share with your vendors, staff and E-team.
    • Use this data to help provide timely connections.
    Medical Plan Wellness Biometrics Disease Mgmt Prescriptions Disability Personal Nurse Leave Management Preventive Care HRA Rewards EAP
  • Getting to the right place at the right time
    • Educate your vendors so that they understand all of the resources you offer to employees.
    • Make sure they refer patients to the best resource.
    • Patients should feel helped, not threatened.
    • Help them learn so they can stay engaged.
  • Communication is key
    • Show executive buy-in
    • Communicate often
    • Provide multiple ways to learn
      • Print
      • Teleconference/Webinar
      • On-line resources
      • Video
      • E-mail
    • Make it relevant
  • Still more to do…
    • Expand beyond HealthMapRx TM for Diabetes and CV Health :
      • Depression
      • Asthma
    • Develop more value-based purchasing opportunities
    • Continue to create incentives for patients to use efficient providers
  • Our Goal – Improving Health
    • Encourage patient to work with MD to tailor and monitor medication regimen, promote adherence.
    • Use HRA to help the patient assess, identify key issues. Guide them to the correct resource so they may develop working plan of care.
    • Provide coaching to motivate, inspire toward better behaviors: develop mutually agreeable goals, provide support in meeting them, rewards for achievement
    • Provide tools and advocates – guide, provide assistance with coordination, navigation, integration of overall care of key resources.
  • Resources - Connections
    • Center for Health Value Innovation
      • Cyndy Nayer 314-422-4385, [email_address]
    • Mirixa (HealthMapRx)
      • Cindy Schaller, 703.865.2035, [email_address]
      • www.HealthMapRx.com
    • Piedmont Pharmaceutical Care Network
      • Larry S. Long RPh, 336-202-7146, [email_address]
    • Quality Health Solutions
      • Brian J. Thomas, 888-747-0708 ext 102, [email_address]
  • Questions?
    • Christine Reichardt
    • [email_address]
    • 414-224-2069