Evalu8 72009

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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

    1. 1. Integrating Value-Based Benefit Design eValue8 User Meeting July 15, 2009
    2. 2. About Journal Communications <ul><li>4,000 employees, 1,200 pre-Medicare and Medicare-eligible participants nationally. </li></ul><ul><li>Our strategic plan focuses on providing quality benefits while maintaining shareholder value. </li></ul><ul><li>Like other employers, we struggle with managing: </li></ul><ul><ul><li>Affordable coverage (employer and retiree) </li></ul></ul><ul><ul><li>The impact of medical inflation on our budget; </li></ul></ul><ul><ul><li>The health status of medical plan participants. </li></ul></ul>
    3. 3. 5 years ago… <ul><li>4 benefit plans </li></ul><ul><ul><li>Copays for doctor appointments and pharmacy </li></ul></ul><ul><ul><li>Low deductibles </li></ul></ul><ul><li>Cost per employee per year – 30% above the Midwest average! </li></ul><ul><li>Attitude of entitlement. Very passive, little engagement </li></ul>
    4. 4. 2004: Our Concerns <ul><li>Employer concerns: </li></ul><ul><ul><li>How to afford exponential increases year over year. </li></ul></ul><ul><ul><li>Participants did not understand how their benefits worked or how much procedures cost. </li></ul></ul><ul><ul><li>Many had chronic disease driving frequent hospitalizations, ER visits and prescription drug use. </li></ul></ul><ul><ul><li>High utilizers often non-compliant and driving up medical costs. </li></ul></ul><ul><li>Member concerns: </li></ul><ul><ul><li>Participants did not know how expensive their care was; no money saved. </li></ul></ul><ul><ul><li>Patients did not understand benefits and relied on physician to steer. </li></ul></ul><ul><ul><li>Patients with medication management needed more “touch” than plan would allow. </li></ul></ul>
    5. 5. Question <ul><li>What can we can do today, to improve the health status of our participants today AND tomorrow? </li></ul>
    6. 6. Strategy for all – Actives and retirees <ul><li>Improve the health status of the participants </li></ul><ul><li>Provide access to qualified providers; </li></ul><ul><li>Offer medical plans that require engagement of participants; </li></ul><ul><li>Reduce the barriers to preventive care; </li></ul><ul><li>Give participants with chronic diseases tools and support to manage their condition; </li></ul><ul><li>Increase compliance for disease-specific medications; </li></ul><ul><li>Introduce wellness program that provides feedback and </li></ul><ul><li>Communicate, communicate, communicate… </li></ul>
    7. 7. Step 1: Promote the right provider <ul><li>Implemented a Narrow PPO Network in SE Wisconsin </li></ul><ul><li>Online Transparency Tools </li></ul><ul><ul><li>Compare providers </li></ul></ul><ul><ul><li>Quality and Safety – following safety practices developed by the Leapfrog group. </li></ul></ul><ul><li>Promote and provide incentives for patients to use cost-efficient providers within the network </li></ul><ul><ul><li>MRIs, CT Scans, Colonoscopies </li></ul></ul><ul><ul><li>Commodity rebate of $100 </li></ul></ul><ul><li>Use plan design to steer participants </li></ul>
    8. 8. Step 2: Reduce Barriers to Care <ul><li>Integrated EAP (5 visits) </li></ul><ul><li>Updated Mental Health Benefits (Parity) </li></ul><ul><li>Implemented Transparency Tools, Nurse Line, Personal Nurse </li></ul><ul><li>Preventive Care and Wellness: </li></ul><ul><ul><li>Provide 100% coverage (deductible waived) for all preventive care </li></ul></ul><ul><ul><li>HSA Plans - Waive the medical deductible for “preventive” prescription drugs </li></ul></ul><ul><ul><li>Send wellness reminders to medical plan participants </li></ul></ul><ul><ul><li>Offer free flu shots at all locations for employees, participants and spouses </li></ul></ul>
    9. 9. Step 3: Manage Chronic Disease and Increase Prescription Compliance <ul><li>Traditional Disease Management in 2004 </li></ul><ul><li>Pharmacy compliance in 2008 ( Based on Asheville Project ) </li></ul><ul><ul><li>Members with a personal health coach (from a network of local pharmacists); </li></ul></ul><ul><ul><li>Coordination with the patient’s physician or other healthcare providers to help effectively manage their Condition: </li></ul></ul><ul><ul><ul><li>Diabetes </li></ul></ul></ul><ul><ul><ul><li>High Blood Pressure </li></ul></ul></ul><ul><ul><ul><li>Cholesterol </li></ul></ul></ul><ul><ul><li>Medication and supplies at no cost / reduced cost </li></ul></ul><ul><li>Partners: Mirixa and Piedmont Pharmaceutical Network </li></ul>
    10. 10. Coordination and Support for the Patient
    11. 11. Patient Incentives – Diabetes & Cardiovascular <ul><li>Face-to-face coaching </li></ul><ul><ul><li>Improved reliability via direct observation </li></ul></ul><ul><ul><li>Interpersonal connection </li></ul></ul><ul><ul><li>Strengthens the patient-physician relationship </li></ul></ul><ul><li>HSA Medical plan deductible waived for preventive RX </li></ul><ul><ul><li>100% coverage diabetes medication, test strips and supplies </li></ul></ul><ul><ul><li>Reduce copays by 50% for medication </li></ul></ul><ul><ul><ul><li>Cholesterol </li></ul></ul></ul><ul><ul><ul><li>Blood Pressure </li></ul></ul></ul><ul><li>Free Glucometers & Insulin Pumps </li></ul>
    12. 12. A word about incentives <ul><li>Incentives are used in the beginning to get participants to engage </li></ul><ul><li>Participants don’t stay in the program because of the incentives…they stay because: </li></ul><ul><ul><li>More knowledge about their disease </li></ul></ul><ul><ul><li>Improved Health </li></ul></ul><ul><ul><li>Improved sense of well-being </li></ul></ul>
    13. 13. 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.
    14. 14. Better Outcomes – Participant <ul><li>With weight management, exercise and better diet and medication compliance: </li></ul><ul><li>Control blood sugar </li></ul><ul><li>Control blood pressure </li></ul><ul><li>Control of blood lipids (“good” and “bad” cholesterols) </li></ul><ul><li>Care of feet, eyes, kidneys </li></ul><ul><li>Live a healthy, active lifestyle </li></ul>
    15. 15. Better Outcomes –Plan <ul><li>Reduced costs to employer for health care: </li></ul><ul><li>Lowers hospital admissions, length of stay as well as ER visits </li></ul><ul><li>Reduced risk of serious disease events (prevent complications) </li></ul><ul><li>Participants are more knowledgeable about self-care </li></ul><ul><li>Increased medication expense (compliance) </li></ul><ul><li>Collaboration with patient’s physician </li></ul>
    16. 16. Step 4: Integrate Wellness <ul><li>Partnered with Quality Health Solutions </li></ul><ul><li>Health Risk Assessment that measures: </li></ul><ul><ul><li>health status, </li></ul></ul><ul><ul><li>readiness to change (Prochaska model) </li></ul></ul><ul><ul><li>personal health history and </li></ul></ul><ul><ul><li>health care utilization data </li></ul></ul><ul><li>Coaching </li></ul><ul><li>On-site health screenings (glucose, triglycerides, blood pressure and BMI) </li></ul><ul><li>On-line wellness tools (includes biometrics) </li></ul>
    17. 17. Putting it all together
    18. 18. Putting it all together
    19. 19. Keys to success??? <ul><li>Partner with a TPA that can/will support your initiatives. </li></ul><ul><li>Find a trusted resource to assist with managing eligibility of plans to maintain HIPAA compliance. </li></ul><ul><li>Integrate the data from all of your resources: </li></ul><ul><ul><li>Sick time/LOA/FMLA </li></ul></ul><ul><ul><li>Disability </li></ul></ul><ul><ul><li>Wellness </li></ul></ul><ul><ul><li>Medical </li></ul></ul><ul><li>Take the time to create links between processes. </li></ul><ul><li>Make sure the communication is relevant. </li></ul>
    20. 20. Partner with your TPA <ul><li>Spend time to determine what your TPA can do for you. Find out what they are doing for other customers. (Products, initiatives, plan design) </li></ul><ul><li>Share your plan initiatives with your TPA so they can support you. </li></ul><ul><li>Analyze your experience. Ask what will make the biggest impact. </li></ul><ul><li>Leverage economies of scale when it makes sense. </li></ul><ul><li>Don’t be afraid to ask for assistance. </li></ul><ul><li>Don’t be intimidated by the answer “no.” </li></ul>
    21. 21. Outsourced Eligibility Administrator <ul><li>Protect confidentiality/PHI </li></ul><ul><li>Manage eligibility of all H&W plans </li></ul><ul><ul><li>Employee enrollment </li></ul></ul><ul><ul><li>Online feeds to vendors </li></ul></ul><ul><ul><li>Liaison between employer/vendor/health plan </li></ul></ul><ul><li>Provide service center for questions/concerns </li></ul><ul><li>Send communications to participants under company brand “focus on opportunity” </li></ul><ul><li>Manage employee appeal process </li></ul>
    22. 22. Integrate your data - make it work for you! <ul><li>Ask your vendors to share data with each other. </li></ul><ul><li>Find benchmarks that show improvement toward your goals. </li></ul><ul><li>Create a report card and share with your vendors, staff and E-team. </li></ul><ul><li>Use this data to help provide timely connections. </li></ul>Medical Plan Wellness Biometrics Disease Mgmt Prescriptions Disability Personal Nurse Leave Management Preventive Care HRA Rewards EAP
    23. 23. Getting to the right place at the right time <ul><li>Educate your vendors so that they understand all of the resources you offer to employees. </li></ul><ul><li>Make sure they refer patients to the best resource. </li></ul><ul><li>Patients should feel helped, not threatened. </li></ul><ul><li>Help them learn so they can stay engaged. </li></ul>
    24. 24. Communication is key <ul><li>Show executive buy-in </li></ul><ul><li>Communicate often </li></ul><ul><li>Provide multiple ways to learn </li></ul><ul><ul><li>Print </li></ul></ul><ul><ul><li>Teleconference/Webinar </li></ul></ul><ul><ul><li>On-line resources </li></ul></ul><ul><ul><li>Video </li></ul></ul><ul><ul><li>E-mail </li></ul></ul><ul><li>Make it relevant </li></ul>
    25. 25. Still more to do… <ul><li>Expand beyond HealthMapRx TM for Diabetes and CV Health : </li></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Asthma </li></ul></ul><ul><li>Develop more value-based purchasing opportunities </li></ul><ul><li>Continue to create incentives for patients to use efficient providers </li></ul>
    26. 26. Our Goal – Improving Health <ul><li>Encourage patient to work with MD to tailor and monitor medication regimen, promote adherence. </li></ul><ul><li>Use HRA to help the patient assess, identify key issues. Guide them to the correct resource so they may develop working plan of care. </li></ul><ul><li>Provide coaching to motivate, inspire toward better behaviors: develop mutually agreeable goals, provide support in meeting them, rewards for achievement </li></ul><ul><li>Provide tools and advocates – guide, provide assistance with coordination, navigation, integration of overall care of key resources. </li></ul>
    27. 27. Resources - Connections <ul><li>Center for Health Value Innovation </li></ul><ul><ul><li>Cyndy Nayer 314-422-4385, [email_address] </li></ul></ul><ul><li>Mirixa (HealthMapRx) </li></ul><ul><ul><li>Cindy Schaller, 703.865.2035, [email_address] </li></ul></ul><ul><ul><li>www.HealthMapRx.com </li></ul></ul><ul><li>Piedmont Pharmaceutical Care Network </li></ul><ul><ul><li>Larry S. Long RPh, 336-202-7146, [email_address] </li></ul></ul><ul><li>Quality Health Solutions </li></ul><ul><ul><li>Brian J. Thomas, 888-747-0708 ext 102, [email_address] </li></ul></ul>
    28. 28. Questions? <ul><li>Christine Reichardt </li></ul><ul><li>[email_address] </li></ul><ul><li>414-224-2069 </li></ul>

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