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Cok benefits presentation
- 1. Personal Responsibility ina Health and Wellness Program Gary Eastes, Risk/Benefits Manager, City of Knoxville Christine Stickler, Benefits Coordinator, City of Knoxville
- 2. New Role ofa Health Plan • A vision of health “needs to be perceived as a priority business asset and has to be recognized as having a big and important impact on the ultimate success of the enterprise. It has to be viewed as critical to the strategy of the organization.” Dr. Catherine Baase Global Director of Health Dow Chemical Company
- 3. Health Program History •From 1970’s till 2004 the City operated a traditional onsite medical clinic, poorly managed • Many employees relied on the clinic as their only medical care • From 1990’s till 2006 the City was in State of Tennessee medical insurance pool • In the 5 years prior to 2006, premiums had increased 141%
- 4. Employee and Member Demographics •City claims per member historically have been above average of Tennessee employers which forced City out of self-funding in 1990s (28.3% above BCBST norm in 2007) • Prevalence of chronic disease significantly higher than norms (40% above HC21norms) . • Average employee age was 4 years older than the average Tennessee employer • Very heavily weighted with males over 40 in high risk occupations
- 5. Chronological Steps • 2004Closed the on-site clinic and contracted for uniformed annual exams and full time nurse to provide on-site screenings with 3 on-site offices • 2005 Began cash incentives for exercise and tobacco-free, in fall began Disease Mgmt Incentives for 5 diseases with logs • 2006 Left State plan, added $1000 deductible, 100% preventive coverage, lower-salary HRA contributions, included spouses in incentives
- 6. Chronological Steps • 2007Reopened The Health, Education and Wellness Center, fired DM vendor/made local provider DM vendor, added obesity and hyperlipids to DM, moved incentives to HRA, incentives for participation and A1C in contract, began combining data from insurance and biometrics • 2008 Added Oxy preauth, step and OTC programs, prenatal incentive
- 7. Chronological Steps • 2009Added hypertension to DM, reduced DM script copays, added 2nd disease coach • 2010 Expanded Oxy preauth to all schedule 2, increased $300 deductible to $500, made acute care at The Center available to retirees and dependents
- 8. The Leap • Simplicitywas a large contributing factor for change – Employee – easier to understand – Employer – easier to administer
- 9. The Leap Logically, “payingpeople cash incentives to lose weight, quit smoking, lower their blood pressure or engage in other healthy behaviors should work. But it doesn’t. Or at least, not in the long run.” Linda K. Riddell Health Economy, LLC
- 10. The Leap • For2011, we combined all of the carrots in creating the My Health Program • The difference in premium between My Health and Medical Only created the stick to engage more of the population to do more. • While carrots are much better received, research studies have shown that the risk of losing is a far greater motivator than the opportunity to win.
- 11. Medical Plan Offerings MyHealth Medical and prescription drug coverage Built-in rewards if you commit to health-conscious lifestyle Medical Only Medical and prescription drug coverage only Higher employee contributions (more out of your paycheck) No built-in rewards
- 12. Medical Plan withCityfunded Wellness Rewards
- 13. Why My Health? It’sworking! 73% of employees enrolled 13
- 14. Why My Health? “I’velost 40 pounds!” -Kathy Fox, Retiree
- 15. Why My Health? “MyHealth saves me money on my premiums every month. And I get money that I can use for doctor bills.” -Philip Reyes, Maintenance Technician
- 16. Why My Health? “Thediabetes classes probably saved my life.” -Cliff Thomas, Public Service Department
- 17. My Health rewards •Lower medical premiums • City-funded HRA dollars, up to $918/year • Free or reduced prescription copays – For certain chronic condition medications • Free testing supplies – For people with chronic conditions 17
- 18. My Health rewards •Lower medical premiums than Medical Only – $256 to $891/year less, depending on the deductible and network you choose 18
- 19. My Health rewards HRAdollars If you: You can earn: Enroll in My Health $32/month or $384/year (employee only) $64/month or $768/year (employee + one or more dependents) Additionally, if you: Earn less than $30,805/year $150/year Earn $30,805 - $41,458/year $75/year Or your covered dependent participates in prenatal program $200 upon delivery of baby 19
- 20. My Health rewards HRAdollars If you: You can earn: Enroll in My Health $32/month or $384/year (employee only) $64/month or $768/year (employee + one or more dependents) Additionally, if you: Earn less than $30,805/year $150/year Earn $30,805 - $41,458/year $75/year Or your covered dependent participates in prenatal program $200 upon delivery of baby 20
- 21. My Health rewards HRAdollars If you: You can earn: Enroll in My Health $32/month or $384/year (employee only) $64/month or $768/year (employee + one or more dependents) Additionally, if you: Earn less than $30,805/year $150/year Earn $30,805 - $41,458/year $75/year Or your covered dependent participates in prenatal program $200 upon delivery of baby 21
- 22. HRA dollars • Usefor medical, prescription, dental, vision expenses incurred by you and eligible dependents: – Deductibles – Copays – Coinsurance – Other out-of-pocket health care expenses • Not all expenses eligible 22
- 23. HRA dollars • LeftoverHRA dollars roll over – Available as long as covered by Citysponsored medical plan (including COBRA and retiree coverage) • Health Care FSA participants: – FSA funds used first, then HRA 23
- 24. My Health rewards Prescriptiondrug copay discounts Chronic condition medications for My Health enrollees only Non-chronic-condition medications for My Health enrollees and ALL medications for Medical Only enrollees Network retail pharmacy (up to 30-day supply) Home delivery/ 90 days at retail (up to 90-day supply) Network retail pharmacy (up to 30-day supply) Home delivery/ 90 days at retail (up to 90-day supply) Generic $0 $0 $5 $10 Preferred brand $5 $10 $20 $40 Non-preferred brand $20 $40 $40 $80 You pay… 24
- 25. My Health rewards •Free testing supplies: – Peak flow meter (asthma and COPD) – Blood pressure cuff (hypertension) – Diabetes monitor, lancets, test strips (diabetes) 25
- 26. My Health requirements • • • • • • Completeannual health screening Be physically active Complete quarterly health education Manage chronic conditions Annual well-child visit documentation Prenatal program (optional) 26
- 27. My Health requirements •Receive annual health screening – At The Center – Within previous 12 months 27
- 28. My Health requirements •Be physically active at least: – 60 minutes/week (at least 3 sessions/week, 10 minutes each) • Submit physical activity affidavit by 10th of month – Through BCBST’s BlueAccess website, OR – Via paper affidavits to The Center • Honor System – but it’s working 28
- 29. Why My Health? “Iclean everything from Cumberland to the Old City. I walk so much I went through three pairs of shoes last year .” -Arturo Cano, Public Service Department
- 30. My Health requirements •Quarterly health education – Lunch and learns – Internet classes – CDs, DVDs, printed literature available from The Center 30
- 31. My Health requirements •Manage chronic conditions through The Center’s health coach program: – Asthma, chronic obesity (BMI greater than 35), congestive heart failure, COPD, coronary artery disease, diabetes, hyperlipidemia (high cholesterol), high blood pressure 31
- 32. My Health requirements •Tobacco users must: – Participate in health coach program – Complete Tobacco Certification section of enrollment form (if enrolling in My Health for first time) 32
- 33. My Health requirements •Annual well-care visit for children – All covered children under age 26 – Documentation required (visit within past 12 months) 33
- 34. My Health requirements •Prenatal program (optional): – Enroll by 10th week of pregnancy – Receive HRA contribution upon delivery of baby 34
- 35. Why My Health? “It’snot just a quick fix —it’s a whole lifestyle change.” -Jason Scott, Police Department
- 36. Medical Only • Medicaland prescription drug coverage only • Higher employee contributions than My Health – More out of your paycheck • No built-in rewards (HRA dollars, etc.) 36
- 37. Prescription Drugs • Over-the-counter(OTC) program – If OTC alternative available, coverage is reduced from a normal copay to 50% of the drug’s cost. • Schedule 2 narcotics program – If a schedule 2 narcotic prescription exceeds a 60-day supply, you must obtain prior authorization. – To fill a prescription beyond 60 days, your doctor must be in the BCBST network and prescription must be considered medically necessary. 37
- 38.
- 39. The City ofKnoxville’s Health Education & Wellness Center
- 40. The Center “The Center discoveredI had diabetes, which I might not have known otherwise.” -Betty Davis, Public Service Department
- 41. The Center “The Centeris more than a doctor relationship. It’s more like an advisor, where you can ask all kinds of questions.” -Linda Clevenger, Public Service Department
- 42. The Center • Freewellness/health coaching services – Offers health education classes – Assists with researching treatment, medication and other self-care information • Treatment for short-term illnesses for copay – Pay with cash, check, debit/credit card or FSA/HRA 42
- 43. The Center • Acutecare for children – Children age 13 and older can be seen at The Center an – Ages 6-12 can be seen at a Summit Express Clinic (SEC) 43
- 44. The Center • Operatedby Summit Medical Group • Staff follow HIPAA privacy rules; health information is confidential 44
- 45.
- 46.
- 47. Recognitions 2006: City ofKnoxville’s employee health plan featured in the journal of the College for Advanced Management of Health Benefits 2006: City of Knoxville named finalist for Employer Excellence in Value-Based Purchasing Award by the National Business Coalition on Health 2010: selected as finalist for Benefit Manager of the Year and named to the Benefits Management Honor Roll by Business Insurance. 2011: Champion Award for Excellence in Workers Compensation Risk Management, presented by National Underwriter to the City of Knoxville. 2011: Achievement Award for Excellence in Human Resources, presented by the Tennessee Municipal League to the City of Knoxville for its health program. 2011: Featured in the October issue of Public Risk. 2011: Silver Pen Award presented by the Middle Tennessee chapter of the International Association of Business Communicators (IABC) to the City of Knoxville for its benefits communication program. 47
- 48. New Role ofa Health Plan • A vision of health “needs to be perceived as a priority business asset and has to be recognized as having a big and important impact on the ultimate success of the enterprise. It has to be viewed as critical to the strategy of the organization.” Dr. Catherine Baase Global Director of Health Dow Chemical Company
- 49. National Employer Trends •“Value-minded employers are engaging directly with quality-focused providers to explore and test new business arrangements and collaborative approaches to health management programs, services and benefits.” Research Study conducted by Benfield and the American Medical Group Association
- 50. National Employer Trends •Employers with 500 or more employees vary employee premiums for smokers by an average of 12%. Employers with 20,000 or more employees vary premiums for smokers by 24%. Two-thirds of firms with 200 or more employees offered smoking cessation programs in 2011. Mercer
- 51. National Employer Trends •By 2012 four of five medium and large companies plan to offer financial rewards to individuals who participate in their health management programs. Use of penalties rose from 8% to 19% from 2009 to 2011, and 38% of medium and large employers expect to have penalties in place in 2012. Towers Watson Survey
- 52. National Employer Trends •Consumer-driven health plans are now 12% of the medical plan market. Employee Benefit Research Institution
- 53. National Employer Trends •“Although the top human resources executive is still the primary champion of employee benefits consumerism, we saw an uptick in respondents reporting that the CEO, president or another member of the senior leadership team is their primary advocate.” Lenny Sanicola commenting on a survey by WorldatWork
- 54.
Editor's Notes
- #14 My Health has been in place since January of this year. 73% of employees are enrolled in it. And the plan is having a very real impact on the lives of participants.
- #18 Here’s what My Health enrollees receive: - Lower medical premiums - HRA dollars from the City – up to $918 a year - Free or reduced prescription copays for certain medications - And, for people who live with certain chronic conditions, free testing supplies. Let’s look at each one more closely.
- #19 When you choose My Health, you pay $256 to $891 a year LESS than employees who enroll in the Medical Only option. Your actual savings depend on the network and deductible you choose.
- #20 As a My Health participant, you also earn HRA dollars -- $32 a month for employee-only coverage, or $64 a month if you cover dependents.
- #21 If you earn less than $41,459 a year, you receive additional HRA dollars from the City.
- #22 And if you or a covered dependent participates in The Center’s prenatal program, you can earn 200 in HRA dollars.
- #23 You can use your HRA dollars to pay for qualified medical, prescription, dental and vision expenses incurred by you and your eligible dependents. This includes out-of-pocket expenses that count toward your annual deductible, copays, coinsurance and other eligible expenses. Not all expenses are eligible though. You can visit wageworks.com for complete list of eligible expenses. This web address is listed in your 2012 Enrollment Guide.
- #24 If you don’t spend all your HRA dollars during the year, they roll over to the next and are available to you as long as you remain covered by a City-sponsored medical plan. This includes COBRA and retiree coverage. If you expect to have out-of-pocket expenses greater than the HRA dollars you’ll receive from the City, you can contribute your own pre-tax money to the Health Care FSA. Since any leftover FSA dollars are forfeited at year-end, expenses are paid from your FSA account first. When your FSA funds are gone, expenses will then be paid from your HRA.
- #25 For example, if a Medical Only enrollee purchased a 90-day supply of a generic drug through Home Delivery, he would pay $10. My Health participants would pay nothing. [Pause a few seconds] This chart is also listed in your 2012 Enrollment Guide.
- #26 Finally, My Health participants who live with certain chronic conditions can receive free testing supplies: Peak flow meters for those with asthma and/or COPD A blood pressure monitor for those with hypertension And diabetics receive a free glucose monitor, lancets and test strips. [pause] My Health rewards can really add up to significant savings, but there ARE some requirements you have to meet.
- #27 To qualify for My Health rewards, you must: - Complete the online COK Health History - Receive an annual health screening - Be physically active and complete a monthly physical activity affidavit - Complete quarterly health education - Manage any chronic conditions you have, including tobacco use And - Seek an annual well-care visit for your covered children. The prenatal program is optional. Let’s take a closer look at each one...
- #28 My Health participants, including covered spouses, must also receive an annual health screening at The Center. You must have received your screening within the previous 12 months for your My Health election to be effective on January 1, 2012.
- #29 My Health participants must be physically active… At least 60 minutes a week, which includes at least 3 sessions a week for 10 minutes each. In other words, one continuous hour a week would NOT satisfy the requirements. You must submit a physical activity affidavit EVERY month by the 10th of the month. You can do this either through BCBST’s BlueAccess website, OR you can download and print a paper affidavit off the Risk Management page of the City’s intranet, and submit it to The Center. I’ll talk more about The Center a little later.
- #30 Being physically active wasn’t that hard. In most cases it involves exercise employees were already getting. That was the case for Arturo
- #31 You must also participate in quarterly health education. This requirement can be fulfilled by attending scheduled “lunch and learns” or internet classes, or by reviewing CDs, DVDs and printed literature available from The Center.
- #32 My Health participants with certain chronic conditions must work with a Center health coach to actively manage their condition. This includes people with asthma, chronic obesity, congestive heart failure, COPD, coronary artery disease, diabetes, high cholesterol, or high blood pressure.
- #33 Tobacco users must participate in a health coach program offered through The Center. And, if you’re enrolling in My Health for the first time, you must complete the Tobacco Certification section of the 2012 enrollment form. Tobacco cessation drugs are covered under the City’s medical plan.
- #34 Finally, you must provide documentation that each of your covered children under age 26 had an annual well-care visit through their own physician within the previous 12 months. It they’re age 13 or older, they may have their annual visit at The Center.
- #35 The prenatal program, offered through The Center, is optional. If you or a covered dependent becomes pregnant in 2012, you may enroll in the City’s prenatal program by the 10th week of pregnancy and receive an HRA contribution upon delivery of the baby.
- #37 If you choose not to participate in My Health but still want City-sponsored medical and prescription drug coverage, you can enroll in the Medical Only option. Medical and prescription drug benefits are the same for both My Health and Medical Only participants. But employee contributions for Medical Only coverage are higher than My Health, and there are no built-in rewards such as HRA dollars.
- #38 Which leads us to the last – and probably most important -- choice in selecting your medical coverage: My Health or Medical Only. The My Health plan is medical and prescription drug coverage with built-in rewards for committing to a health-conscious lifestyle. The Medical Only plan is medical and prescription drug coverage without the built-in wellness rewards. Employees who choose to participate in My Health and maintain all of the requirements pay less per paycheck – sometimes significantly less -- than employees in the Medical Only option.
- #39 Which leads us to the last – and probably most important -- choice in selecting your medical coverage: My Health or Medical Only. The My Health plan is medical and prescription drug coverage with built-in rewards for committing to a health-conscious lifestyle. The Medical Only plan is medical and prescription drug coverage without the built-in wellness rewards. Employees who choose to participate in My Health and maintain all of the requirements pay less per paycheck – sometimes significantly less -- than employees in the Medical Only option.
- #43 You don’t have to be enrolled in My Health to use Center services. All City employees can use The Center, but My Health enrollees receive services for a lower copay. Every quarter, The Center offers free health education classes on subjects like nutrition, exercise, diabetes management and more. Although these classes are open to anyone, My Health participants can attend them to meet their quarterly education requirement. The Center also provides free health coaching for employees with specific health concerns. The staff there work closely with you to help you achieve your goals and empower you to take better care of yourself. The Center also provides treatment for short-term illnesses for a small copay. You and your covered dependents ages 13 and older can take advantage of these services – and pay with cash, check, a debit or credit card, or your WageWorks card.
- #44 You don’t have to be enrolled in My Health to use Center services. All City employees can use The Center, but My Health enrollees receive services for a lower copay. Every quarter, The Center offers free health education classes on subjects like nutrition, exercise, diabetes management and more. Although these classes are open to anyone, My Health participants can attend them to meet their quarterly education requirement. The Center also provides free health coaching for employees with specific health concerns. The staff there work closely with you to help you achieve your goals and empower you to take better care of yourself. The Center also provides treatment for short-term illnesses for a small copay. You and your covered dependents ages 13 and older can take advantage of these services – and pay with cash, check, a debit or credit card, or your WageWorks card.
- #45 The Center is run by Summit Medical Group, and all staff are bound by the same confidentiality requirements as any other healthcare provider. HIPAA privacy rules require that your health information be treated confidentially, and The Center abides by those rules. That means that the City never sees your personal information. Your 2012 Enrollment Guide provides more information about The Center, including the address and phone number.
- #46 The Center is run by Summit Medical Group, and all staff are bound by the same confidentiality requirements as any other healthcare provider. HIPAA privacy rules require that your health information be treated confidentially, and The Center abides by those rules. That means that the City never sees your personal information. Your 2012 Enrollment Guide provides more information about The Center, including the address and phone number.
- #47 The Center is run by Summit Medical Group, and all staff are bound by the same confidentiality requirements as any other healthcare provider. HIPAA privacy rules require that your health information be treated confidentially, and The Center abides by those rules. That means that the City never sees your personal information. Your 2012 Enrollment Guide provides more information about The Center, including the address and phone number.