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  • 1. Health Plan Initiatives, Trends and Research in Consumer-Driven Care National Consumer Driven Health Summit October 20, 2008 Maureen E. Sullivan Senior Vice President
  • 2. Market Enrollment in CDHPs Sources: American Association of Preferred Provider Organizations, Blue Cross and Blue Shield Association Blue CDHP Profile
    • Blues serve approximately 4.4 million CDHP enrollees, up more than 50% from a year ago
      • 2.9 million covered by HSA-qualified plans
      • 1.5 million members in HRA-based products
    10.0 12.5 Members Enrolled in Millions Launched as a way to increase consumer engagement, CDHP enrollment is up more than 25% in the last year
  • 3. CDHP Offer and Uptake Rates Percentage of Consumers Offered a CDHP Option CDHP Uptake for Consumers with a Choice of a CDHP Product Sources: 2005, 2007 and 2008 BCBSA CDHP Member Experience Surveys HRA HSA-eligible Growth is being driven by increased employer and health plan offerings of CDHP products
  • 4. CDHP Demographics Age Distribution CDHP members increasingly mirror non-CDHP population 18-29 30-44 45-54 55-64 HSA-eligible Non-CDHP Income Distribution HSA-eligible Non-CDHP Sources: 2005, 2007 and 2008 BCBSA CDHP Member Experience Surveys Less than 25K 25K-50K 50K-75K 75K-100K 100K+
  • 5. CDHP & Consumer Engagement Are we creating a more savvy shopper?
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
    Non-CDHP HSA-eligible Engaged Consumer
  • 6. Rewards and Incentives Percentage of Enrollees Examples of Rewards/Incentives
    • Cash
    • Contributions to account
    • Lower premiums, copays and deductibles
    • Points redeemable for merchandise
    * Statistically different from non-CDHP results at a 95% confidence level Sources: 2008 BCBSA CDHP Member Experience Survey Consumers Receiving Incentives or Rewards for Health and Wellness Participation HSA-eligible enrollees are offered more incentives
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 7. Opening Rates of Health Savings Accounts More employees open HSAs when offered incentives HSA-eligible Consumers Opening Accounts Percentage of Enrollees
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
    * Statistically different from ‘Without Contribution’ results at a 95% confidence level Sources: 2008 BCBSA CDHP Member Experience Survey
  • 8. Consumer Attitudes Percentage of Enrollees HSA-eligible enrollees want more control over costs, utilization * Statistically different from non-CDHP results at a 95% confidence level Sources: 2008 BCBSA CDHP Member Experience Surveys Consumer Attitudes
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
    Non-CDHP HSA-eligible w/ Account HSA-eligible w/o Account
  • 9. HSA-eligible consumers more cost-conscious and cost-driven * Statistically different from non-CDHP without Account results at a 95% confidence level Sources: 2008 BCBSA CDHP Member Experience Survey Percentage of Enrollees Behaviors Considered Because of Cost Cost-Sensitive Behaviors
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 10. Healthcare Financial Behaviors HSA-eligible enrollees are more actively engaged in tracking and estimating their healthcare costs * Statistically different from non-CDHP results at a 95% confidence level Sources: 2008 BCBSA CDHP Member Experience Survey Percentage of Enrollees Healthcare Financial Behavior
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 11. Health and Wellness HSA-eligible enrollees more engaged in health and wellness *Statistically different from HSA-eligible results at a 95% confidence level Note: Participation among those offered health or wellness program Sources: 2008 BCBSA CDHP Member Experience Survey Percentage of Enrollees Participation in Health or Wellness Programs
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 12. Healthcare Utilization HSA-eligible enrollees use more preventive services, and their use of necessary care mirrors non-CDHP population * Statistically different from non-CDHP results at a 95% confidence level Sources: 2008 BCBSA CDHP Member Experience Survey Percentage of Enrollees Healthcare Utilization
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 13. Healthcare Utilization: Study *Statistically different from Traditional PPO - Choice results at a 95% confidence level + Statistically different from Traditional PPO – Full Replacement results at a 95% confidence level Note: CDHC study population restricted to a subset of 1,364 members from an original CDHC enrollment base of 57,365 members in 2006 Sources: Blue Cross Blue Shield of Tennessee, CDHC Impact on Utilization, Costs, & Quality, June 2008 Savings due to reduced utilization are observed in CDHPs, however, CDHP enrollees are not foregoing needed care Savings Due to Reduced Utilization Member Healthcare Compliance Full Replacement Chronic Compliance Preventive Compliance Choice Full Replacement Choice
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 14. Successes Non-CDHP HSA-eligible CDHPs appear to be successfully aligning incentives and engaging consumers around cost and health decisions Engaged Consumer
  • 15. Information Needs HSA users want more cost information, and their interest in quality information is on par with non-CDHP enrollees * Statistically different from non-CDHP results at a 95% confidence level Sources: 2008 BCBSA CDHP Member Experience Survey Percentage of Enrollees Information Useful When Making Healthcare Decisions
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
    HSA-eligible w/Account HSA-eligible w/o Account Non-CDHP
  • 16. Quality Information Key National Blue Distinction program created to educate consumers and engage them based on quality
    • Blue Distinction Centers for Cardiac Care®
    • Blue Distinction Centers for Bariatric Surgery®
    • Blue Distinction Centers for Transplants®
    • Blue Distinction Centers for Complex and Rare Cancers SM
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
    Source: BCBSA WA OR CA AK HI TX NM AZ UT NV ID MT ND SD NE WY CO KS OK AR LA MS AL GA FL SC NC TN KY MO IL IA MN WI MI IN OH WV VA PA NY ME VT NH RI MA CT NJ DE MD PR
  • 17. Quality Information Key Blue Distinction facilities delivering better quality results Note: All cardiac and cardiac related readmissions during the initial admission through 90 days, 90 day eligibility required for patient cohort Source: HealthCore Analysis of WellPoint Data, July 2008 n = 1741 3584 32% 14.2% 18.7%
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
    Percentage of Patients Readmitted in 90 Days BDC Other
  • 18. Likelihood to Recommend Percentage of Enrollees Member recommendations starting to reflect the increased maturity of the product *Statistically different from non-CDHP results and HRA results for 2008 at a 95% confidence level Note: 2005 and 2007 non-CDHP results include 4 largest carriers only Sources: 2005, 2007 and 2008 BCBSA CDHP Member Experience Surveys Likelihood to Recommend Coverage
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 19. Drivers of Recommendation HSA-eligible enrollees require more health plan support HSA-eligible Enrollees Non-CDHP Enrollees Out-of-pocket cost Primary Drivers Secondary Drivers Tertiary Drivers Information on health plan benefits Claims payment Network Help to manage healthcare costs Service Website Out-of-pocket cost Access to preventive care Information on health plan benefits Network Claims payment Sources: 2008 BCBSA Member Experience Survey Drivers of Recommendation
    • Offer Incentives
    • Encourage Value Purchasing
    • Motivate Healthy Behavior
    • Educate and Support Decision Making
  • 20. Consumer Engagement HSA-eligible HSA users are more savvy shoppers, and HSA learnings can be leveraged to better engage all consumers Engaged Consumer