EBMS developed a value-based health strategy to improve healthcare financing and member engagement, shifting from traditional cost containment practices that led to increased employee contributions and barriers to accessing care. The initiative includes the opening of an on-site medical clinic, wellness programs, and chronic condition management aimed at reducing costs while enhancing member health outcomes. Overall, EBMS's approach promotes personalized care, encourages compliance, and aims for long-term cost savings through improved health management.

1. EBMS, Inc.
Value Based
Benefit Strategy
2005-2009

2. Contents
Introduction 3
Challenges and Reactions 4
Yearly Plan Analysis 5
Program Initiatives
Chronic Condition/Disease Management 10
Wellness 11
miCare Clinic 12
Plan Summary 17
Results 18
EBMS Core Values
Excellence
Passion
Innovation
Commitment
Integrity
EBMS Value Based Health Plan Initiative
Maximize member benefits at the least cost, significantly impacting
both the personal and fiscal health of our organization.
EBMS Mission Statement
EBMS is an innovative benefit administration and management
company. We are dedicated to providing superior quality and
cost-effective, personalized services.

3. Introduction
EBMS developed an integrated, value-based health strategy as a
potential solution to the health care financing crisis. Value – the
clinical benefit achieved for the money spent – had been absent from
any former solutions EBMS developed to solve rising healthcare costs.
Instead, the dialogue focused on two trends in benefit design – cost
containment and quality improvement – which often created a conflict
of incentives for members.
Much like other employers, EBMS increasingly enrolled beneficiaries
in disease management programs designed to improve patient self-
management, often by intervening to enhance compliance with specific
medications. However, at the same time EBMS negated these efforts
with increased copayments and greater cost-sharing, creating financial
barriers that discouraged the use of recommended services needed to
keep members compliant.
When individuals are required to pay more for their healthcare, it is
well known that they buy less – of both essential and excessive therapies
alike. A value-based health strategy adjusts out-of-pocket costs on an
assessment of the clinical benefit to the specific patient population and
aligns financial incentives to encourage the use of high-value care.
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4. Challenges
EBMS’ Billings, MT corporate office employs 260 of 320 employees;
the remaining sixty employees are spread throughout satellite offices in
Portland, OR and Aurora, CO, with remote employees, home-based,
in Salt Lake City, UT. Like many of the organizations for whom
EBMS administers health benefit plans, maintaining a benefit plan that
encourages the personal health of employees and the financial health of
the organization has become a challenging balancing act.
Until 2006, EBMS used similar strategies many of employers in the
United States still use today. If costs increased, EBMS increased
deductibles, co-pays, and employee contributions to offset those
increases. Though this strategy allowed EBMS to stay in front of the
costs, EBMS continued to average a 9% increase each year between
1999-2005, with peaks as high as 24%. It became apparent that for
EBMS to shift the paradigm, a change in strategy was needed.
Reactions
Transforming EBMS’ benefit culture would require significant energy
and resources from EBMS leaders. Once established, however, EBMS
was confident this energy would permeate throughout the organization
and eventually shift the benefit philosophy from cost management to
consumer (employee) engagement. Any culture change takes time;
EBMS stayed realistic in expectations and began with subtle changes.
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5. 2005
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6. 2006
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7. 2007
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8. 2008
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9. 2009
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10. Chronic Condition and
Disease Management
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11. Wellness
* Though EBMS offers wellness education and activities to all
employees, the data is only reflective of plan members.
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12. EBMS values innovation. But innovation comes with a certain amount
of risk. EBMS regularly tests concepts on our own benefit plan before
rolling them out to clients. In 2005, EBMS began exploring the
concept of on-site, employer sponsored clinics. These clinics would be
operated for the sole use of the covered employees and dependents of the
employer. This model, though not a new concept for large companies,
had not been widely tested until the early 2000’s for smaller companies.
In April, 2006, after forming miCare, LLC, EBMS opened an on-site
clinic at its Billings, MT corporate office.
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13. Model
Employees and their dependents drive the care they receive. Rarely
do these decisions relate to the cost of the care provided, only the
expected outcomes from the care/treatments received. The miCare
clinic model brings the following:
• Clinic space at location of employer’s choice.
• Clinic funded by employer, managed by miCare.
• Services offered:
– Routine medical care
– Laboratory testing-all results are electronically loaded
into the Electronic Medical Record and available within
24 hours
– Physical examinations
– Preventive screenings
– Health education, consultation, and wellness (nutrition
counseling, cholesterol screening, prenatal programs)
– Basic adolescent and child care, including back-to-
school and sports physicals
– Chronic disease management
– Case management
– Dermatology
– Prescriptions
– Annual Health Risk Assessment
• Twenty minute appointments with no waiting, scheduled online
or telephonically by the patient at a time convenient for them.
• Labs and office visits are offered at no cost to the employee
because the employer can access these services at the wholesale
(direct) costs. There is no provider or facility in the middle to
mark up costs.
• Clinic is staffed with a Family Practitioner, a mid-level Nurse
Practitioner or Physician’s Assistant, and a Medical Assistant or
LPN. Malpractice insurance is carried by the practitioners, and
miCare provides general liability coverage.
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14. Costs
Costs are broken down into two categories:
1. Fixed Administrative Costs - miCare charges a flat administrative fee
per employee per month. This fee covers:
a. Electronic Medical Record
b. Communications
c. 24 hour Nurse Call Line
d. Coordination of Services/Development of New Services
e. Recruitment and Staff Management
f. Supply Management
g. Reporting
2. Variable Expenses-Remainder of costs are passed through monthly
to the employer. There is no mark up of the charges.
a. Staff contracted hourly rates will include prorated costs for
malpractice insurance
b. Supplies
c. Medications
d. Lab tests outside of the Annual Health Risk Assessment
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15. Savings Engine
Lab tests are contracted through LabCorp, a national laboratory
services provider. miCare directly contracts with LabCorp at a rate
that is comparable with what they provide to practitioners within
the same community. miCare completed an evaluation of lab
tests within the Yellowstone County community and discovered
that there is a significant savings opportunity when lab services are
obtained through miCare.
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16. Savings Engine (cont.)
miCare is a licensed pharmacy for all medication types except Controlled
Substances. Prescription medications are provided pre-packaged. Upon
prescription by a Practitioner, the miCare Pharmacist dispenses the labeled
medication. During evaluation, it has been determined that a plan can save
up to 65% off of standard Pharmacy Benefit Manager savings.
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17. EBMS Value-Based Summary
In summary, EBMS created a holistic approach toward its benefit
plan with a strategy that focused first on the patient/member, and
second on the financial health of the organization. The approach
accomplishes the following:
1. Supports the health and well being of the member by wrapping
a benefit design that supports prevention and wellness, with the
ability to support the patient in the event of an unplanned or
unexpected illness or injury. This is done through the wellness
benefit available at first dollar, the Health Reimbursement
Account that can be carried over from year to year, reasonable
out-of-pocket expenses, and generous in-network co-insurance.
2. Engages the member by incentivizing completion of an annual
Health Risk Assessment and additional funding by EBMS into
the Health Reimbursement Account.
3. Empowers the member through Disease Management and
Wellness initiatives geared toward their personal needs, with
specific coaching and guidance to encourage compliance.
4. Encourages members to receive appropriate care by offering an
onsite practitioner, which allows for timely, convenient patient
care and support at no cost. In addition, the practitioner
works closely with the benefit plan to close the loop between
benefit plan management and the services the patient is actually
receiving.
5. Educates members on needs which are specific to their personal
health status. EBMS found that obesity and nicotine use were
issues among our population. Through smoking cessation and
wellness initiatives, EBMS has seen a positive impact, and a
reduction in illnesses tied to both of those behavior issues.
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18. EBMS Health Plan Savings
2006-2009
Projected Average
Plan Trend * :
2006-2009 PEPM Expense - Projected* vs. Actual 9%
2006-2009
$600
Actual Average
Plan Trend:
$500 1.99%
$400
$300
2006 2007 2008 2009
YTD**
2005 Baseline Costs: $422.92 PEPM
*Based on a 9% annualized expected trend
**2009 YTD reflects 1/1/09 - 6/30/09
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