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Whole health then v4

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  • <number>
  • The Blue denotes those variables where there’s difference between the planned and the actual counts
  • Target - Infrequent users
    9 urban
    11 rural
    Actual- Infrequent users
    3 urban
    2 rural
    9 suburban
    Target- BC
    10 urban
    10 rural
    Actual – BC
    5 urban
    3 rural
    6 suburban
    2 outlying urban
  • Transcript

    • 1. Introducing… Whole Health Original concept 1
    • 2. Whole Health PPO – concept description Whole Health PPO is plan that allows members to tailor their health coverage to their personal health style or situation, combining coverage for traditional and alternative health practices. A high deductible plan combined with a free health style basket provides first dollar benefit for consumers. The concept was intended to be tested in a small geographical area, where the network could be quickly assembled and managed, and utilization measured. 2
    • 3. Overall concept – core intentions One health style basket is included in the basic plan, with the cost covered through an increased deductible. Additional baskets can be added for $30 per month. + The premium covers: High-deductible PPO + 1 health basket + Additional baskets can be added at $30 PMPM The plan’s intention is that the higher deductible for the PPO plan will cover the cost of the one “free” basket. The basket price was intentionally set at ~$30, a figure the focus groups found attractive and “worth it.” 3
    • 4. Care baskets – core intentions The core of the Whole Health offer are four baskets tailored to health styles and situations. Over time, more baskets will be developed. The baskets were conceived with a compelling core benefit that was ‘free.’ This benefit was surrounded with thematically similar services provided as a covered benefit or as a discount. The mix of these services were intended to help utilization. 4
    • 5. My Health portal – core intentions The My Health portal is a personalized website with personal coverage and health information. It links to memberselected Whole Health wellness programs and to an on-line health store, where members can purchase prescriptions, supplements, vitamins and herbs. The core intention behind the portal is to allow members to manage and interact with their coverage (to stay actively engaged in their health) and to frequent the online store where they can purchase prescriptions, herbs, vitamins, etc. The original idea was for the site to be the portal for all BCC members, not just for Whole Health, leveraging the development investment. 5
    • 6. Concept specifics… 6
    • 7. Plan details The concept was meant to target consumers with a high level of engagement with their own health. The “menu” items (or care baskets) were tested with consumers and subsequently refined. The concept can be a model for many BCC offerings, and the original idea centered on the Power HealthFund as a good candidate for piloting the concept. In later stages, replicating the architecture and leveraging resources to ISG and possibly beyond was the goal. The plan had four levels of coverage, with simple and logical differences in deductible, copay, co-insurance, out-of-pocket maximum and pharmacy benefit. The intention was for straightforward communication and easy-to-understand benefits. The people who were the target for this plan were already involved in the activities covered by the plan, and would likely “do the math” in order to justify the plan. Therefore, clear and tangible benefits were important. Discounts were not seen in testing as a sufficient benefit on their own. Initial pricing for the pilot was meant to be competitive with other high deductible plans. The medical and utilization experience data would help adjust baskets and pricing for the actual launch. 7
    • 8. Basket details The baskets were conceived to have a clear and compelling core benefit completely covered, surrounded by related services provided with limits or at a discount. The additional services raise the perceived value of the basket, while avoiding adverse selection. As people are already spending money on many of these activities (one estimate showed this spending to be ~$34 Billion), the increased baskets would enhance WP revenues. The core benefits of each basket are currently popular health-related activities. The additional basket elements are to complement the core, making the overall appeal of the basket stronger. New baskets will be developed as new activities become popular, and as experience data became available. The baskets or bundling of benefits are key to managing the risk of the plan. However, the value of the experience data will be beneficial to all WP plans, and might allow for lower margins on some benefits. 8
    • 9. My Health portal – intentions of basic portal functions My Health Records Coverage, health history, reminders for appointments and contacts Simplifies the ongoing management of healthcare activities, offloading calls to BCC. 1 2 3 4 My Expenses Tracking of expenses, payments and deductibles make ongoing account management simpler, offloading calls to BCC. Health Store On-line source for health and wellness products. This helps drive traffic to the site, while helping to increase utilization of PrecisionRx. News Personalized medical news scours the web for relevant stories, and help bring members back to the website. 9
    • 10. My Health portal – details There is a high correlation between the target market for Whole Health and online research regarding health issues. For this reason, the website – if it contains rich and useful information – will be one of the key channels through which members interact with BCC and their health information. The key information for the site was found to be plan management (timely enrollment, provider listings, claims tracking, levels of deductible, FSA status, health history and resume), tailored health news and information (as news to healthy individuals, and as disease management information to members with chronic or acute conditions). With a “critical mass” of content, the retail part of the site can capitalize through convenient one-click ordering of prescriptions, vitamins, herbs and other health-related products and services etc. 10
    • 11. Original rollout plan 11
    • 12. Phase 1 Goal To enhance existing offerings with insights from the consumer experience project, while gaining insights on consumer ‘appetite’ for the broader health related concept. The ambition at this stage is to design expanded and improved coverage offerings while leveraging existing resources. By selecting existing offerings (e.g.Power Health Fund, Precision Rx), we can achieve quick wins and grow the concept quickly. 12
    • 13. Phase 1: integrate existing pieces WellPoint Benefits My Health Experience Portal • Offer tailorable, personalized interactions • Shift and channel spending to Precision Rx • Capture a portion of CAM spend • Facilitate avoidance of hazardous drug interactions Whole Health PPO Wellness Promotion Programs • Attract new members • Integrate existing services • Capture a portion of out of pocket health expenditures • Build extended network (ASHN+) • Augment and accelerate appeal of existing products (Power HealthFund) 13
    • 14. Phase 1: integrate existing pieces Member Benefits My Health Experience Portal Whole Health PPO • Personalized and simplified • Reduce out of pocket expenses for non-traditional interactions • Reliable information on health related activities health concerns and coverage • Convenience of shopping through one channel for drugs and CAM • Guidance on herbs and supplement choices • Drug interaction notification 14
    • 15. Phase 2 Goal To gain regulatory approval and extend the concept to other groups within BCC while augmenting the consumer offer through increasing coverage and available services. The ambition at this stage is to gain significantly greater share of member’s health spending. 15
    • 16. Phase 2: create platform WellPoint Benefits My Health Experience Portal • Increase interactions with members • Proactively push information to members • Reduce call center loads • Expand CAM and DME offerings • Collection of herb and supplement data Whole Health PPO • Implement new care baskets to attract additional potential members • Extend network • Capture actuarial data on nontraditional health activities • Extend product to ISG 16
    • 17. Phase 2: create platform Member Benefits My Health Experience Portal • Reliable breaking news and information pertinent to individual health concerns and interests • Link to FSA/HRA accounts (ISG) and FSA tracker and alerts • Expanded information on PPO providers (through HealthScope) Whole Health PPO • Expanded non-traditional coverage and discounts with new and refined care baskets • Benefits enjoyed by ISG as well as Large Group members 17
    • 18. Phase 3 Goal To open the platform to other groups and regions, while continuing to extend the consumer offer and make the provider offer compelling. The ambition at this stage is to leverage the platform and architecture throughout WellPoint to achieve improved margins and enhanced member satisfaction. 18
    • 19. Phase 3: extend platform WellPoint Benefits My Health Experience Portal • Extend website across WP, other regions and products • Support and foster WellPoint’s relationship with providers • Expedited transactions with My Health debit/credit and stored value cards Whole Health PPO • Potentially lowering medical expenses • Utilize actuarial data to refine care basket proposition and offer new ones • Potential licensing or network renting opportunity 19
    • 20. Phase 3: extend platform Member Benefits My Health Experience Portal • Seamless integration of health information and health spending Whole Health PPO • Additional baskets provide a broader array of choices for coverage of non-traditional health activities 20
    • 21. Appendix 21
    • 22. Phase 2 research overview 22
    • 23. Phase 2 research Goal: To gather insured (individual & group), uninsured customers’ and breast cancer survivors’ reactions to the Whole Health product concept (n=20). Objectives: • Assess consumers’ reactions to the basic concept. Questions explored how consumers’ attitudes and behaviors influence their interest in the concept; • Determine how compelling the Balanced Meal concept, web portal, and breast cancer components are terms of value to consumers versus their current healthcare coverage; • Explore consumers’ receptivity to each of the four traditional healthcare coverage options and six care basket choices; • Explore consumer price sensitivity as well as uncover potential ways to make the concept more financially attractive; • Gather information on consumers’ perceptions of their overall health, associated health goals, and interest in and use of complementary and alternative healthcare options. 23
    • 24. Phase 2 research screening This behavioral health style model was used to screen participants for Phase 2 concept testing. It was intended as a starting point to map people’s approaches to dealing with their health in maintain and monitor modes. Multi-focus Challenged maintainer Active maintainer Generally feels healthy and works to maintain this state Primarily internal motivators Striver Goal oriented – e.g. wants to lose weight, or run a marathon Has a difficult time keeping health indicators like weight, cholesterol or blood pressure at acceptable levels Primarily external motivators Water-treader Experiences chronic health conditions such as asthma, or IBS Single focus 24
    • 25. Phase 2 research screening, continued All participants: • Had at least minimal interest in Complementary/Alternative medicine • Where medium to high health information seekers • Were comfortable being interview in English 25
    • 26. Research methods: Phase 2 In-depth interviews Goal: To understand consumer reactionsto the base components of the Whole Health concept. Gender Insured (12) Actual 12 Age Income Race WP coverage Geo Male (6) 25-36 (4) 4 Mixed Yes (8) 8 So. Cal (6) 6 Female (6) 37-49 (4) 4 35K-55K (4) 4 Caucasian 9 No (4) 4 No. Cal (6) 6 NA So. Cal (2) 2 50-60 (4) 4 Uninsured (4) Male (2) 2 Actual 4 Female(2) 2 56K-75K (4) 4 Other 3 76K+ (4) 4 Mixed 25-36 (3) 37-49 (1) Mixed 35K-55K (1) 2 No. Cal (2) 2 Caucasian 3 Other 1 56K-75 (2) 1 76K+ (1) 1 Breast cancer survivors (4) Actual 4 NA 25-36 (1) 3 35K-55K (1) 3 Cauc. (2) 2 Yes (2) 2 So. Cal (2) 2 37-49 (2) 1 56K-75 (2) 1 Other (2) 2 No (2) 2 No. Cal (2) 2 50-60 (1) 0 76K+ (1) 0 26
    • 27. Research methods: Phase 2 In-depth interviews Goal: To understand insured consumer reactions, by behavior categories, to the base components of the Whole Health concept Age Income 25-36 (1) 0 35K-55K (1) 0 37-49 (1) 2 56K-75K (1) 2 50-60 (1) 1 76K+ (1) 1 M (1) 2 25-36 (1) 2 35K-55K (2) 1 F (2) 1 37-49 (1) 0 56K-75K (1) 1 50-60 (1) 1 76K+ (1) 0 M (1) 2 25-36 (1) 0 35K-55K (1) 0 Cauc. (2) 3 F (2) 1 37-49 (2) 2 56K-75K (1) 1 Other (1) 0 50-60 (1) 1 76K+ (1) 2 M (1) 2 25-36 (1) 2 35K-55K (1) 1 Cauc. (2) 1 F (2) 1 37-49 (1) 1 56K-75K (1) 1 Other (1) 2 50-60 (1) 0 76K+ (1) 1 Gender Male (1) 0 Active Maintainer (3) Female (2) 3 Actual 3 Challenged Maintainer (3) 3 Striver (3) 3 Water Treader (3) 3 Race WP coverage Cauc. (2) 2 Yes:(1)grp1 Other (1) 1 (1) ind. 1 No (1) 1 Cauc. (2) 3 Yes: (1)grp 1 Other (1) 0 (1) ind. 1 No (1) 1 Geo So. Cal (1) 1 No. Cal (2) 2 So. Cal (2) 2 No. Cal (1) 1 Yes: (1)grp 2 So. Cal (2) 2 (1) ind. 0 No. Cal (1) 1 No (1) 1 Yes: (1)grp 0 So. Cal (1) 1 (1) ind. 2 No. Cal (2) 2 No (1) 1 27
    • 28. Phase 2 Research findings: medical coverage options Preferred coverage option across all participants (including uninsured): Preferred coverage option by type of current coverage: Premium: Preferred: Standard: Basic: Those with Group coverage: Premium: 100% Preferred: 0% Standard: 0% Basic: 0% 85% 10% 0% 5% Preferred coverage option across participants with health insurance only: Premium: Preferred: Standard: Basic: 76% 12% 0% 5% Those with Individual coverage: Premium: 66% Preferred: 22% Standard: 0% Basic: 11% 28
    • 29. Phase 2 Research findings: medical coverage by behavioral category Premium Active Maintainers: 100% Challenged Maintainers: Water Treaders: Strivers: Uninsured Breast Cancer Survivors Other Preferred Active Maintainers: 0% Challenged Maintainers: Water Treaders: Strivers: Uninsured Breast Cancer Survivors Other 33% 66% 100% 100% 100% 100% Standard Active Maintainers: 0% Challenged Maintainers: Water Treaders: Strivers: Uninsured Breast Cancer Survivors Other 0% 0% 0% 0% 0% 0% 33% 33% 0% 0% 0% 0% Basic Active Maintainers: 0% Challenged Maintainers: Water Treaders: Strivers: Uninsured Breast Cancer Survivors Other 33% 0% 0% 0% 0% 0% 29
    • 30. Phase 2 Research findings: care basket preferences Most to least liked (by rank) 1. Rejuvenation 2. Alternative (therapy) 3. Enhanced health 4. Integrative care 5. Elder caregiver support 6. Family support 30
    • 31. Phase 2 Research findings: web portal components Participant ranking of web portal components they would use most regularly**: 1. Automated Reminders (especially if they could be uploaded to a PDA) 2. Provider Ratings 3. Health Resume (doctor forms) 4. Automated Health History 5. Health Expense Tracking (for both pre and post-tax health expenses) Overall, the web portal received 108 points out of a possible 140 total. ** Regularly was self-defined by each participant. 31
    • 32. Phase 2 Research findings: breast cancer support Breast cancer research participants: • Liked the overall concept as it demonstrated an intuitive understanding of what breast cancer patients endure. • Found the five steps and sub-points accurately captured the issues and questions that they had as breast cancer patients. • Stated it is an informational resource they would have used, if it had been available at the time of their diagnosis. • Suggested that the language be as positive and empowering as possible (e.g., change “coping with the bad news” to “coping with the news.”). • Suggested that a sub-point be added to Step 2 called “Understanding your treatment plan, or something that reflects planning one’s course of treatment with the doctor. • Stated the need to have this resources available via telephone as well as on-line. 32
    • 33. High-level financials 33
    • 34. Preliminary financial analysis • • • • • • • • Key assumptions: Income tax = 40% Premium increase = 5% per year Broker commission = 5.60% (based on total BCC) Discount rate = 12.50% One time costs: – Development costs = estimated at $4M (rounded up from the first year of PHF at $3.9M) – Launch and marketing costs = estimated at $2M – Infrastructure costs = estimated at $1.5M Investment income = average 3% (from PHF) Premiums = average of $250 PMPM (average of LG rates supplied) Underwriting margin = average 12% (from PHF) Using these assumptions, the concept would need 16,667 members to break-even 34
    • 35. Preliminary financial analysis Members Growth rate Member months (assumes 1/1 enrollment) Base revenue PMPM Premium Increase MCR Premium Revenue Claims Expense U/W Margin Broker commissions U/W Margin after Broker One time costs Development Launch Total Infrastructure costs Total costs Pretax Income Income tax Net Income NPV Year 1 ---- Year 2 2,000 -24,000 Year 3 4,000 100% 48,000 Year 4 7,000 75% 84,000 $250 -88% ------ $4,000,000 $2,000,000 $6,000,000 $1,500,000 $7,500,000 ($7,500,000) ($3,000,000) ($4,500,000) $54,477 Year 5 10,500 50% 126,000 Year 6 13,125 25% 157,500 $250 -88% $6,000,000 $5,280,000 $720,000 $336,000 $384,000 $262.50 5% 88% $12,600,000 $11,088,000 $1,512,000 $705,600 $806,400 $275.63 5% 88% $23,152,500 $20,374,200 $2,778,300 $1,296,540 $1,481,760 $289.41 5% 88% $36,465,188 $32,089,365 $4,375,823 $2,042,051 $2,333,772 $303.88 5% 88% $47,860,559 $42,117,292 $5,743,267 $2,680,191 $3,063,076 -----$564,000 $225,600 $338,400 -----$1,184,400 $473,760 $710,640 -----$2,176,335 $870,534 $1,305,801 -----$3,427,728 $1,371,091 $2,056,637 -----$4,498,893 $1,799,557 $2,699,336 35
    • 36. Concept details 36
    • 37. Traditional coverage levels Small group $5000 deductible 30% co-insurance up to out of pocket maximums of $7500 per person 4 provider visits per year for a $40 copay Full hospital coverage MyHealth™ web portal $500 deductible 40% co-insurance up to out of pocket maximums of $7500 per person 4 provider visits per year for a $40 copay Full hospital coverage MyHealth™ web portal $2500 deductible 30% co-insurance up to out of pocket maximums of $6000 per person 12 provider visits per year for a $30 copay Pharmacy coverage (after a $250 deductible) Full hospital coverage MyHealth™ web portal $500 deductible 30% co-insurance up to out of pocket maximums of $6000 per person 12 provider visits per year for a $30 copay Pharmacy coverage (after a $250 deductible) Full hospital coverage MyHealth™ web portal $1500 deductible 30% co-insurance up to out of pocket maximums of $5000 per person Provider visits at $25/visit Full pharmacy coverage Full hospital coverage MyHealth™ web portal Basic Individual $250 deductible 20% co-insurance up to out of pocket maximums of $5000 per person Provider visits at $20/visit Full pharmacy coverage Full hospital coverage MyHealth™ web portal $500 deductible 30% co-insurance up to out of pocket maximums of $4000 per person Provider visits at $10/visit Full pharmacy coverage Full hospital coverage MyHealth™ web portal $250 deductible 10% co-insurance up to out of pocket maximums of $4000 per person Provider visits at $10/visit Full pharmacy coverage Full hospital coverage MyHealth™ web portal Standard Preferred Premium 37
    • 38. Potential pricing of Whole Health PPO for Individual Number of baskets selected 1 3 4 basic Traditional medical coverage 2 $115 $145 $175 $205 standard $150 $180 $210 $240 preferred $205 $235 $265 $295 premium $290 $320 $350 $380 38
    • 39. Potential pricing of Whole Health PPO for Small Group Number of baskets selected 1 3 4 basic Traditional medical coverage 2 $205 $235 $265 $295 standard $245 $275 $305 $335 preferred $285 $315 $345 $375 premium $330 $360 $390 $420 39
    • 40. Potential pricing of Whole Health PPO for Large Group Southern CA: LA Northern CA: SF Ranges from: Ranges from: $268.14 - $238.77 $344.21 - $306.15 Includes one basket Includes one basket 40
    • 41. Thank you! Access the Doblin client website at: http://clientweb.doblin.com username: WellPoint password: innovate Doblin Inc. One IBM Plaza 330 North Wabash Avenue Suite 1300 Chicago IL 60611 312 443 0800 phone 312 443 0567 fax www.doblin.com 41

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