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Strategies & Opportunities to Lower Your Healthcare Costs in 2012 Presented by Randy Gomez, FSA www.nyhart.com Copyright 2011. All Rights Reserved.
Randy Gomez, FSA Senior Healthcare Actuary randy.gomez@nyhart.com| (317) 845-3595 Qualifications or certifications:Enrolled Actuary; Society of Actuaries Fellow; Member of the American Academy of Actuaries.    
Agenda ,[object Object]
Cost Based Strategies
Design Based Strategies,[object Object]
What causes higher medical costs?
Best Practices for Ongoing Analytical Services ,[object Object]
Information on cost and clinical outcomes
Action steps,[object Object]
Evaluation of administrative expenses
What is your data telling you?
Raise employee contributions,[object Object]
Administrative Expenses
Prescription Drug Contracting
[object Object]
What happened?
How isyour compliance with preventive screenings and medications?
Key questionsWhat is your data telling you?
Raise employee contributions ,[object Object]
Incorporate wellness incentives
Surcharges for working spouses
Incremental contributions for multiple options,[object Object]
What are your experiences?
Utilization Based Strategies ,[object Object]
Eligibility
Preventive approaches,[object Object]
Value Based Strategies

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Healthcare Benefit Cost Strategies for 2012

Editor's Notes

  1. High claim years are going to happenShow chart and stats
  2. Network discounts Goal is to compare the cost for the same service at the same facility by the same providerNeed a fair representation of servicesInpatient facilityPrimary care and specialist services (surgeons, anesthesiologist, radiology, oncology)Many problems with vendor responsesProvide average cost within areaProvided lowest cost of all providers in areaMay not reflect severity of illnessConfidential informationIndependent audit to verify accuracy
  3. Network discounts Goal is to compare the cost for the same service at the same facility by the same providerNeed a fair representation of servicesInpatient facilityPrimary care and specialist services (surgeons, anesthesiologist, radiology, oncology)Many problems with vendor responsesProvide average cost within areaProvided lowest cost of all providers in areaMay not reflect severity of illnessConfidential informationIndependent audit to verify accuracy
  4. Newer contracts are less generous to PBMMore transparency
  5. What do you know about your risk pool?High risk: diabetes, high blood pressure, obese, smokersIndustry and age implicationsWhat happened?Heart attack Knee replacementHow is compliance with preventive screenings and medications?
  6. Plan designHigh deductible plansValue based designsTargeted limitationsEligibilitySpousal carve-outs for working spousesDependent auditsPreventive approachesIdentify potential problemsOnsite clinic
  7. Very common Shift benefit cost to employeesChart on how many are affectedDecisions to makeComplete replacement of existing option or new optionIncentives to elect high deductible optionLower employee contributionsEmployer contribution for HSA or HRAStatistical data is starting to show behavior modificationsDesign attracts all types of employees
  8. Ok to use higher or lower benefits to steer utilization towards low cost providersExamples: MRIs and X-rays, dialysis, oncology servicesKeep generic Rx copayments low while increasing brand copayments
  9. Visit limits are ok and dollar limits are notMore flexibility for benefits not part of “essential benefits” definitionExamples Limit of 15 chiropractic visits$10,000 limit for sleep disorders (if not part of essential benefits)Definition of appropriate emergency room usage and higher copayments for ER visits.
  10. Spousal carve-outs for working spousesConsiderationsIs the other coverage comparable Is the other coverage affordableHow do you enforce it?Dependent auditsEasy financial decision when the expected savings is more than the cost of auditOne employer defaulted to a “not covered decision” if the employee did not respond to the request for data.
  11. Identify potential problemsFlag problems before they become larger onesFlag noncompliance in medication usage for chronically sick.Methods includesHealth screeningsAllow spouses to participate as wellCompliance with age-appropriate guidelinesData mining Rx usage Q for Gomez – what do you once you identify the sick person?
  12. Conceptually good idea if goals can be meetLower cost of services compared to using existing network of providers (hard dollars)Improvement in clinical measures because of easy access (soft dollars)Reduced out of office time (soft dollars)Other considerationsMore face time with doctorsAbility to add wellness coachingAbility to monitor health of chronically sick membersNot cost efficient for smaller employers
  13. Because rates are averaged over two years, it will take a couple of years for costs to declinePlans will likely see high requirements drop quickly to zero within a few years of rates increasing
  14. Areas of Expertise Include: Cash Balance Plan Defined Benefit & Pension Defined Contribution & 401(k) Employee Stock Ownership Plan (ESOP) Flexible Spending, HRA & HSA Healthcare Actuarial ConsultingLearn more at www.nyhart.com
  15. Areas of Expertise Include: Cash Balance Plan Defined Benefit & Pension Defined Contribution & 401(k) Employee Stock Ownership Plan (ESOP) Flexible Spending, HRA & HSA Healthcare Actuarial ConsultingLearn more at www.nyhart.com