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Demo4
- 1. Using Design180™ to Reduce Healthcare Costs and Improve Productivity
- 2. Issues facing the self-insured sponsor… Rising health care costs Costs shifting to the employee Unmanaged disease impacts profitability
- 3. Value-Based Health Management Value Based Health Management Recognizes the value of a healthy employee Shares accountability to achieve optimal value Monitor, Measure and Manage Basic premise Investing in employees wellness is more profitable than paying for them to be out sick.
- 4. The Big Question Are the dollars being spent on health care being spent effectively?
- 5. Questions? Can I see, on an on-going basis, the costs and results of the health care spend? Are my employees following their prescribed treatments? What impact would ensuring compliance have? What impact would cost-shifting between employer-employee have? What impact does employee wellness have on productivity?
- 6. Question #1 Can I see, on an on-going basis, the costs and results of the health care spend?
- 8. Screen shot of dasboard with % compliance chart Also Presenter shows nicely bound copy of standard report that includes same data
- 11. Scenario: Now that I can see what being compliance can mean to costs. What if I could increase the compliance and adherence to the plan? What if I shifted plan and member costs to increase compliance based on the high cost conditions in my population? The Wellness Plan Investment Calculator
- 16. Conclusion: based on dashboard, compliant chart and investment calculator we can concluded that: Non-compliant people cost a lot more If we make more people compliant we can see $x savings We can make more people compliant by shifting costs. Segue – that covers one disease, but what can be done for the overall plan….
Editor's Notes
- THIS CHART AND THE NEXT ARE OPTIONAL. KNOW YOUR AUDIENCE. IF THE ISSUES HAVE BEEN ESTABLISHED ALREADY OR IF THE CUSTOMER SHORT PITCH WAS PRESENTED RECENTLY, THESE TWO CHARTS MAY NOT BE NEEDED.* Health care costs are escalatingFrom an organization(1) perspective, the cost of providing health care for organizations is increasing for various reasons but the primary, manageable reason is simple because people do not follow their prescribed treatments. Not following the doctors orders not only increase the cost for a particular disease but it often results in addition problems (look up co-morbidities)* Costs continually get passed on to the employeeTypically, organizations(1) pass these costs onto the employees, effectively reducing their pay, reducing moral and causing the employee to start making trade-offs concerning health care. (eg. My deductibles increase so now I need to choose…follow my prescribed treatment that now costs me more money, or buy my kids shoes)* Unmanaged disease hits profitability as much as inflation/competition. The solution is to change the way of thinking about health care: from “Health care is an expense” to “Health care is an investment in the wellness of the company” this method of thinking is referred to as Value-Based Health Management or Value-Based Plan Management or Value-Based Plan Design.(1) Depending on the audience you may want to change this to companies or businesses.
- * Recognizing the Value of a healthy employeeHealth plan benefits costs are the metric with the key goal of reducing employer costs, and historically shifting costs to the employee. As opposed to looking at historical data costs reactively, VBHM is proactively looking ahead to say, “what can I do to keep my employee healthy?” By keeping the employee healthy, I decrease costs for the company, and the employee, while productivity increases. Shares accountability to achieve optimal valueMotivating the employeeto better health through shared accountability Shared accountability is the employer monitoring the employees use of the health plan and providing the appropriate balance of carrots and sticks in the design of the health benefits plan, the employees accountability is that they use the plan properly and following recommended care guidelines. Monitoring, Measuring and ManagingTotal management perspective, monitoring and measuring trends, to achieve optimal value* Investing in employees wellness is cheaper than paying for them to be sick and out of work. …sometimes with catastrophic results, if someone is not following doctors orders or standard of care
- Or is the expense being incurred being spent wiselyOr is there something that can be done to spent the dollars better etc.And The Big Question spawns a series of other questions like….
- Are my employees following their prescribed treatments?...is this even relevant
- Presenter should have standard report printout and show that
- This is a sample of the dashboard that is built into Design180. The far left column shows the varies of different graphs, and charts that can be pulled into the view on the right.This view on the right shows (starting in the upper left and going clockwise) The Plan Summary: How many employees I have and how many family members A pie chart showing In vs Out of Network usage A pie chart showing the amount spent by member: A bar chart showing a list of chronic diseases in my population and, based on standards established for each disease, how many of my employees are compliant, that is, following the standard of care. The line chart shows the Monthly Claims trend.Keep in mind, our goal is not to reduce costs, it is to improve the wellness of our employees. If we focus on the wellness of the employees, the costs will drop AND productivity will increase. Let’s explore then, the bar chart showing the compliance of our population.`
- Design180’s member filter allows you to measure,more specifically, compliance and non-compliance of your targeted population, above and below the percentage thresholdsyou define
- Calculate the investment cost for increased compliance and adherence (plan and member cost) for your plan’s selected high cost conditions that you want to affect change in behaviors
- Wellness Investment Calculator – Increases or decreases utilization for specific services related to standards of care and preventative screenings based on user input. Cost allocation to these services may also be modified from their original status
- Visual sliders allow for quick manipulation and a pleasant user experience. Example: What if a new plan design pays 100% for all of the services the American Diabetic Association management guideline calls for – and what if 100% goal compliance was met for the past 2008 measurement period? The Change in Cost & Utilization will visually indicate the compliance to this service as well as the cost distribution between member and plan.
- These values may be changed, allowing the utility to factor in the cost of the added utilization and added plan cost of the services to the overall plan modelAccumulation of additional new targetpopulations andwellness investments are reflect in total in the summary results up top…
- A summary report can also be generated to effectively communicate the proposed modeling of Positive Utilization (good dollars being spent).
- Model Health Reimbursement Accounts, Health Saving Accounts, and other plan designs to provide added member incentives to take greater responsibility for their wellness and lifestyle choices
- 4. Model Health Reimbursement Accounts, Health Saving Accounts, and other plan designs to provide added member incentives to take greaterresponsibility for their wellness and lifestyle choices
- Detailed Plan Modeling – the Design180™ ‘plan modeler’, allows more intricate and focused plan design development supporting Value-Based health management principles.Plan benefits can be added, modified, or deleted to the plan model separate from the core plan design elementsThe ‘stipulations’ available for individual benefits are: Co-pay (fixed or percent), tiered co-pay (fixed or percent), separate deductible, separate co-insurance percentage, occurrence limit, maximum allowable amount, paid at 100%, and ‘not covered’ Additional plan modeling output has been developed to show the impact of these individual stipulations on the plan/member cost distribution as well as members affected
- Monitors and Alerts – A major enhancement to Design180™, Monitors and Alerts allows you to setup automated monitors that will alert you when pre-defined thresholds are reached, tracking the results as often as the data is refreshed without user effort.
- Within each monitor type there are various measurements and comparison periods to allow you to set specific monitors for your organization and create distribution lists for updates. Are we on track, based on the changes we’ve made?
- How it is done today…not iterative…
- Like the “Quality Management Process” our health plans need 4 basic steps to assure VBBD. They are “Plan, do, Check, and Act.” Typically our health planning has done okay with the first two steps of “Plan, and Act.” But, unfortunately we have stopped there. We have historically not had the capability to measure outcomes and make fact based decisions moving forward so our plans have been stagnated with sometimes good intentions, but bad results. NavigatorMD gives us the capability to “Check” (measure) in tremendous detail the results of our decisions and to “Act” upon what we learn and improve processes and benefit design to meet ever changing demands. Thus we have a complete loop of decision making that runs from Planning, to Doing, to Checking and Acting. And the process becomes continuous to meet ongoing needs and demands of our systems. Short Quote: “VBBD is not a “thing,” but rather a process. In my 30 plus years in health benefit design and management I have been disappointed that we do not apply the same decision making processes to benefit design that we do to every other aspect of our businesses. 12 years ago in the beginning of The Asheville Project® our capacity to measure outcomes was largely manual. We were able to make better choices going forward, albeit slowly at first. Now, with NavigatorMD health plans have THE tool to measure the efficacy of our design strategies instantly, and compare the results we are getting against our original needs / intentions, and make appropriate adjustments… Virtually in real time.” Source: John Miall, Retired Risk Manager for the City of Asheville, NC, and co-founder of The Asheville Project®