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    2 45   wayne de veydt 2 45 wayne de veydt Presentation Transcript

    • Navigating the Health Insurance Landscape: What to Expect and What Surprises are in Store Annual Insurance Executive Conference Wayne DeVeydt Executive Vice President, Chief Financial Officer December 17, 2013
    • A Health Benefits Leader BC or BCBS plans in 14 states and Medicaid presence in 19 states ` Diverse customer base of 36 million medical members Medicare FEP Medicaid 13% 4% 4% Individual  5% National  Accounts 19% BC or BCBS licensed plans BC or BCBS licensed plans + Medicaid presence  Medicaid presence Local Group BlueCard 41% 14% 2
    • Projected Sources of Insurance Coverage 2012-2021 32 50 30 65 65 Exchanges Medicaid Medicare +20% +30% 126 Employer 54 140 -38% 2021 52 Uninsured 2012 -10% Source: Analysis of Avalere / Booze & Co. / McKinsey / WellPoint Enrollment Models; Assumes 15 states opt out  of Medicaid expansion: AK, AL, GA, IA, ID, IN, LA, MS, NE, NC, OK, SC, TX, VA, WI 3
    • Federal and State Exchange Enrollment ACA Medicaid Expansion Eligibility Determinations 365,000 23% 227K 2.3M State Total Determined Eligible  for Medicaid 12% 65% 138K Federal Total October November State HIX Federal HIX State Agency 4 Source:  HHS Enrollment Update; December 11, 2013
    • Consumer Landscape: Empowered Consumers Drive New Demands % of Consumers who expect these personalized services: 70% of healthcare  consumers want  physicians to: Health Tips 35% Cost Saving Tips • Be more accessible by phone/e‐mail 44% Personalized Care Plan 50% • Coordinate care with other providers • Coach them about staying healthy Social Media Tools 72% Sources: Left: 2011 EBRI/MGA Consumer Engagement in Health Care Survey  Right: National Business Group on Health: Consumer Health Mindset Survey (2011); PwC Health  Research Institute (2012) 5
    • Americans without access to primary care Consumer Landscape: 60 Supply & Demand of Physicians million 925 PCPs accepting new patients 20.3 days 49.8 875 Physicians (in 000s) Average wait for non-emergency appointment Demand Supply 825 775 725 % National Association of Community Health Centers. March 2009. Primary Care Access: An  Essential Building Block of Health Reform; Merritt Hawkins and Associates: 2009 Survey of  Physician Appointment Wait Times; Center for Studying Health System Change: 2008  Health Tracking Physician Survey 675 2008 2010 2015 2020 2025 Source:  American Academy of Medical Colleges  6
    • Consumer Landscape: Preference for Less Expensive Plans & Narrower Networks Numbers are rounded; Source: McKinsey Consumer Exchange Simulation 2011‐2013 7
    • Provider Landscape: National Trend Towards Provider Consolidation Hospital employment of physicians is increasing nationwide 78% of hospitals are consolidating or exploring consolidation 80% 70% 60% 2,542 2,606 2,668 2,755 2,868 2,941 2,373 2,321 2,251 2,172 2,142 2,044 2000 2002 2004 2006 2008 2010 50% 40% 30% 20% 10% 0% 2002 03 04 05 06 Physician owned 07 08 09 10 2011 Hospital Owned Source: Hospital and Health Networks; Physician Compensation and Production Survey, Medical  Group Management Survey, 2002‐012; Merritt Hawkins 2012 Review of Physician Recruiting  Incentives; Dealogic Independent Hospitals In Health Systems Source: Avalere Health. (2010. analysis of American Hospital  Association Annual Survey) 8
    • 94% 0.6% Increase in Nurse Practitioner Jobs Projected by 2025 Decrease in healthcare workforce productivity 1992-2012 2010 Physician Assistants by Specialty Average Annual Growth over 20 Years 2% Primary Care Internal Medicine 19% 31% Pediatrics General Surgery 11% Surgical Specialties 10% 23% Emergency Medicine Other Specialties 3% 1% Source: 2010 AAPA Physician Assistant Census Report Unknown 9
    • Provider Landscape: Blurring Lines Between Providers & Payers Accountable Care Preparedness 7% 14% 14% 53% 63% 71% 40% 23% 16% Population health Performance management measurement Not at all Prepared Source: Hospital and Health Networks; Physician Compensation and Production  Survey, Medical Group Management Survey, 2002‐12; Managing care coordination Somewhat Prepared Numbers are rounded.  Source: Executive Survey on Hospital and  Physician Affiliation Strategies, Sponsored by McKesson. Very Prepared 10
    • Employer Landscape: ACA Impact on Small Businesses Challenges Facing Small Business Owners 49% Impact of ACA Over‐Regulation 44% Economic Uncertainty 44% 40% American Debt & Deficit 33% High Taxes High Energy/Gas prices Lack of Qualified Employees 13% 11% 50% Will cut hours to reduce full  time employees or replace  with part time employees 24% Will reduce hiring to stay  under 50 employees 71% Say the ACA makes it more  difficult to hire   30% Were prepared for the law’s  requirements Source:  US Chamber of Commerce Q2 Small Business Survey 11
    • As a Result of the ACA, Two Out of Every Five Employers… Have conducted ACA cost analysis for 2014 % of Employers Increasing Employee Share of Healthcare Costs 43% 33% 33% Are developing multiyear approach to  address impact of reform 31% Are increasing emphasis on  wellness initiatives & health incentives Are considering action to  avoid 2018 excise tax Source: Int’l Foundation of Employee Benefits Plans; “2013 Employer‐ Sponsored Health Care: ACA’s Impact” Share of  Premiums Dependent  Coverage Costs In‐Network  Deductible Source: US. Chamber of Commerce / Int’l Franchise Association:  September‐October 2013 Survey Out‐of‐Pocket  Limits 12
    • Employer Landscape: Interest in Private Exchanges Percent of employers who would consider switching to a private exchange Projected Public vs. Private Exchange Annual Enrollment 45 80% 40 70% 35 60% 50% 62% 57% 55% 49% 40% 30% Enrollment (millions) 90% 40 30 30 30 31 27 25 19 20 15 15 10 9 9 20% 10% 20% 26% 26% 23% 5 1 0 2014 0% 10 to 50 51 to 100 101 to 3000 2015 2016 2017 2018 >3,000 # of employees Would consider switching as long as they saw savings of at least 10% Public Exchange Private Exchange Would consider switching for no savings Source: Private Exchange: Accenture analysis, based on data from: U.S. Census, Bureau of Labor and Statistics, Kaiser Employer Health Benefits 2012 Annual Survey. Calculations exclude post‐65 retirees and individuals. Public Exchange: Congressional Budget Office 2013 Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage, CBO’s February 2013 Baseline, depicts average monthly enrollment, including  spouses and dependents for individual and SHOP. 13