The document summarizes findings from a statewide health care study in Pennsylvania regarding public school employee health plans. Key findings include:
- Over 85% of schools participate in health care consortia which have experienced below average cost trends.
- The average monthly medical contribution for employees is $128 for single coverage.
- 85% of plans have an actuarial value over 90%, much higher than permitted on exchanges.
- School employee plans have more generous benefits and lower costs than plans purchased by average taxpayers or offered to state employees.
- A statewide pharmacy program could capitalize on bulk purchasing power and offer 3-4 plan designs to generate savings.
Current job trends in the RN labor market, where the jobs are, and estimates of future demand.
Presenters: Joanne Spetz, Professor at the
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco;
Teri Hollingsworth, Vice President, Human Resources Services,
Hospital Association of Southern California;
Judee Berg, Executive Director of the California Institute for Nursing & Health Care
Odyssey Recruitment Medical Professionals Salary Survey Presentation 2016Odyssey Recruitment
An online survey of 373 medical professionals was conducted between April 18-29, 2016 to understand salaries, benefits, job satisfaction, and future career intentions. Key findings included:
- Less than 40% were satisfied with their total remuneration package.
- Almost half anticipated a 12% pay rise would motivate them to stay in their current role, while a 31% increase would motivate them to change roles.
- Over 80% were actively looking or considering changing jobs in the next 12 months, with almost three-quarters open to relocating internationally.
This presentation was given by our Chief Executive, Dr Jennifer Dixon, to the International Improvement Science and Research Symposium at the 2014 International Forum on Quality and Safety in Healthcare.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
The document discusses implementing an episode-based payment system to improve healthcare quality and reduce costs. It provides an overview of how episodes of care are designed and implemented, including setting quality standards and cost thresholds. It also describes the reporting tools and data systems used to provide feedback to healthcare providers on their performance. The goal is to incentivize higher quality and more efficient care through gain- and risk-sharing arrangements.
Physican compensation presentation for physicians 270513Patricia Burchall
The document provides an overview of a project to develop a new physician compensation framework for Bermuda Hospitals Board (BHB). It finds that BHB's current compensation levels do not consistently align with comparator markets and lack clear governance, productivity expectations, and definitions of full-time work. Additionally, performance-based bonuses sometimes result in total compensation exceeding market benchmarks. The document recommends reviewing bonus formulas and physician productivity expectations to improve alignment with the current environment.
Capturing the Value Proposition: Repositioning hospital service linesJames Case
Service line planning in a value-based care environment has taken on new dimensions. We outline an approach to planning and operations that will allow providers to differentiate in the market, drive volume, and improve the patient experience of care.
The impact of quality and CMS scores on costJames Case
Quality performance is important for provider organizations, but it can be difficult to understand the financial implications of improved quality performance. Despite controversy, the CMS star ratings for providers will have a substantial impact on hospital's financial position through the relationships it has through the entire organization.
The document discusses the financial incentives and requirements for healthcare providers to demonstrate meaningful use of certified electronic health records (EHRs) under the Medicare and Medicaid EHR incentive programs. It outlines the eligibility criteria for hospitals and eligible professionals to qualify for incentive payments, describes the reimbursement schedules with payment amounts up to $63,750 over 6 years for Medicaid and $44,000 over 5 years for Medicare, and explains the clinical quality reporting requirements and functionality measures that must be met to demonstrate meaningful use in each stage.
Current job trends in the RN labor market, where the jobs are, and estimates of future demand.
Presenters: Joanne Spetz, Professor at the
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco;
Teri Hollingsworth, Vice President, Human Resources Services,
Hospital Association of Southern California;
Judee Berg, Executive Director of the California Institute for Nursing & Health Care
Odyssey Recruitment Medical Professionals Salary Survey Presentation 2016Odyssey Recruitment
An online survey of 373 medical professionals was conducted between April 18-29, 2016 to understand salaries, benefits, job satisfaction, and future career intentions. Key findings included:
- Less than 40% were satisfied with their total remuneration package.
- Almost half anticipated a 12% pay rise would motivate them to stay in their current role, while a 31% increase would motivate them to change roles.
- Over 80% were actively looking or considering changing jobs in the next 12 months, with almost three-quarters open to relocating internationally.
This presentation was given by our Chief Executive, Dr Jennifer Dixon, to the International Improvement Science and Research Symposium at the 2014 International Forum on Quality and Safety in Healthcare.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
The document discusses implementing an episode-based payment system to improve healthcare quality and reduce costs. It provides an overview of how episodes of care are designed and implemented, including setting quality standards and cost thresholds. It also describes the reporting tools and data systems used to provide feedback to healthcare providers on their performance. The goal is to incentivize higher quality and more efficient care through gain- and risk-sharing arrangements.
Physican compensation presentation for physicians 270513Patricia Burchall
The document provides an overview of a project to develop a new physician compensation framework for Bermuda Hospitals Board (BHB). It finds that BHB's current compensation levels do not consistently align with comparator markets and lack clear governance, productivity expectations, and definitions of full-time work. Additionally, performance-based bonuses sometimes result in total compensation exceeding market benchmarks. The document recommends reviewing bonus formulas and physician productivity expectations to improve alignment with the current environment.
Capturing the Value Proposition: Repositioning hospital service linesJames Case
Service line planning in a value-based care environment has taken on new dimensions. We outline an approach to planning and operations that will allow providers to differentiate in the market, drive volume, and improve the patient experience of care.
The impact of quality and CMS scores on costJames Case
Quality performance is important for provider organizations, but it can be difficult to understand the financial implications of improved quality performance. Despite controversy, the CMS star ratings for providers will have a substantial impact on hospital's financial position through the relationships it has through the entire organization.
The document discusses the financial incentives and requirements for healthcare providers to demonstrate meaningful use of certified electronic health records (EHRs) under the Medicare and Medicaid EHR incentive programs. It outlines the eligibility criteria for hospitals and eligible professionals to qualify for incentive payments, describes the reimbursement schedules with payment amounts up to $63,750 over 6 years for Medicaid and $44,000 over 5 years for Medicare, and explains the clinical quality reporting requirements and functionality measures that must be met to demonstrate meaningful use in each stage.
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
Edifecs CJR: don't fumble with your bundle ssEdifecs Inc
Comprehensive Care for Joint Replacement (CJR) opens the door to opportunity for improved joint replacement patient care delivery. With full accountability for both cost and quality for the joint replacement episode, hospitals must share critical data in near real time to align and coordinate the full continuum of post-acute providers. The top complexities Jay Sultan addressed include:
The top complexities Jay Sultan addressed include:
Considerations for entering into contracts with your orthopedic surgeons and other collaborating episode providers
Episode bundle administration and monitoring; gain sharing administration
Real-time data acquisition from collaborating providers
Analytics and reporting, focused care delivery management, and preparation for CMS audits
Whatever burning issues and questions are on your mind
Merit-Based Incentive Payment System: Strategic Deployment Within Your Organi...PYA, P.C.
This presentation, “Merit-Based Incentive Payment System: Strategic Deployment Within Your Organization,” outlines the requirements for MIPS participation and scoring in 2018. It also provides strategic guidance for creating an opportunity for positive financial impact for practices.
Network Optimization: Why Physician Quality Should Drive Your Benefits StrategyGrand Rounds
Employers and payers are increasingly interested in narrow network or "high performance" networks to control healthcare costs. But there's a science to reshaping your physician network to cut costs while avoiding member blowback. Learn how to optimize networks for cost and quality, while reassuring your employees that they can still access the care they need.
Rising unscheduled care attendances are putting pressure on A&E departments across Scotland. Attendances have increased by 63,750 (4.8%) over the past two years, with the largest rises in NHS Highland, Greater Glasgow and Clyde, Fife, and Lanarkshire. Self-referrals have risen the most, increasing by 3.6%. Younger age groups like 0-4 have seen higher attendance increases. Several initiatives are underway to better manage demand, including improved redirection of non-emergency cases, social media campaigns on alternative care options, and consultant-led triage of referrals.
Using modelling to inform our diagnostics strategyUNITAID
The document discusses using mathematical modeling to inform diagnostic strategies for HIV/AIDS. It summarizes several studies modeling the impact and cost-effectiveness of introducing new diagnostic tools, such as a device-free test that could expand access to CD4 count monitoring. The modeling considers factors like how many additional people might receive CD4 monitoring, as well as total costs of treatment versus impact on the epidemic under different testing scenarios. The document advocates using modeling coordination to help address strategic questions about which tests and strategies could have the greatest impact.
Physician-Hospital Integration Strategies to Maximize the Bottom Line for Ort...Wellbe
Economic pressures on physicians and hospitals have increased attention on integration and collaboration between providers. The passage of the Patient Protection and Affordable Care Act (ACA) has propelled physician-hospital integration onto the national stage, forcing physicians and hospitals to change and accelerate their alignment structures with each other to meet the ACA’s mandates: quality excellence, population health management, efficiency, and cost savings. This presentation provides a detailed overview of strategies for the orthopedic service line that have been successfully implemented in order to achieve the Triple Aim while enhancing alignment with the service line’s physicians.
About the Speaker:
DanielleDanielle L. Sreenivasan, MHA is a senior manager with The Camden Group with more than ten years of healthcare experience. She specializes in strategic and service line business planning, facility planning, financial feasibility analyses, and medical staff planning and alignment on behalf of community hospitals, healthcare systems, academic medical centers, and physician medical groups. Ms. Sreenivasan has worked with clients analyzing current and potential markets and developing population-based healthcare strategies.
Prior to joining The Camden Group, Ms. Sreenivasan directed the Virginia Cardiac Network, LLC for Inova Fairfax Hospital located in Falls Church, Virginia. Her responsibilities included the development of strategic business plans and scorecards for clinical quality and budgeting processes, as well as oversight for the implementation of operational performance improvement plans. Ms. Sreenivasan’s experience also includes departmental and operational audits, and reimbursement analysis.
Ms. Sreenivasan received her master’s degree in health administration from Medical University of South Carolina with Honors, and her bachelor’s degree in accounting, business administration, and finance from the College of Charleston. She is a member of the American College of Healthcare Executives.
SHRM Survey Findings: Smoking in the Workplaceshrm
Over half of organizations allow smoking in the workplace. Most have formal smoking policies, and many limit the number of daily breaks. Common smoking policies provide wellness information on quitting or impose health premium surcharges for smokers. Since implementing these policies, many report decreased smoking. Vaping policies are also increasing, with most either banning or designating vaping areas. Violations typically result in verbal warnings.
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
This document discusses network alliances as an alternative to traditional mergers and acquisitions for hospitals. It describes network alliances as formal relationships between two or more entities to share resources and capabilities. The document outlines the key considerations for developing a network alliance strategy, including defining the scope of the relationship and ensuring the form follows the intended functions. It provides an example case study of the Health Network of Missouri, describing its purpose, corporate structure, governance structure, voting rights, and committee organization as a network alliance between five hospital systems.
SHRM’s 2014 Strategic Benefits Survey: Health Careshrm
SHRM’s 2014 Strategic Benefits Survey collected extensive information on the costs of health care and changes in total costs over time.
This research found that about four-fifths (79%) of respondents from organizations that provided health care coverage to their employees indicated their organization was “very concerned” about controlling health care costs. About one-half of organizations offered educational initiatives related to health and wellness (56%) and/or lower-cost generic prescription drugs (48%) to help control the costs of health care. In terms of employee contributions to the total costs of health care, one-half of respondents indicated their organization increased the employee share of the total costs of health care compared with the previous plan year.
The document summarizes the results of a survey on healthcare systems in several European countries and the US. Key findings include:
- Respondents rated their country's healthcare system quality, though Germany, Sweden, and the UK received higher ratings than Italy, Poland and the US.
- Perceptions of doctors' skills and training quality were generally positive, though sharing of information between providers needed improvement.
- Ensuring access for all citizens and managing costs for an aging population will be ongoing challenges for healthcare systems.
- Most respondents felt their country's healthcare industry contributes significantly to economic growth.
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
This document summarizes a presentation on the financial toll of prescription drug addiction from the perspective of third-party payers. It includes presentations from experts at the CDC, a private insurance company, and a university. The presentations outline national trends in opioid use and expenditures, strategies used by an insurance company to identify and manage high-risk opioid claims, and a description of North Carolina's Medicaid Lock-In Program aimed at curbing prescription drug misuse. The document provides disclosure statements for each presenter and learning objectives for the session.
The AVA Panel provides access to a verified sample of over 500 AVA members for market research through surveys, focus groups, and interviews. A survey of these members found the top challenges for the vascular access industry are improving clinician education resources, implementing data collection tools for benchmarking, and advancing practices through more research. The AVA Panel offers an affordable way for companies to conduct research and get insights from vascular access professionals to help guide industry efforts.
The survey found that:
- Two-thirds of organizations offered wellness programs, and 40% increased investment in these programs.
- Most organizations did not analyze return on investment or cost savings from wellness programs.
- Around half of organizations saw increased employee participation in wellness programs over time.
- Wellness programs were viewed as effective in reducing healthcare costs and improving employee health.
- About 60% of organizations offered wellness incentives like premium reductions, which significantly increased employee participation.
This document summarizes a webinar on prescription drug costs and purchasing strategies for employers. It includes:
1) An agenda for the webinar outlining presentations on current employer strategies, additional strategies employers can implement, and purchasing and policy options.
2) A discussion of employer survey results finding specialty drugs are a top cost concern and priorities include better vendor management and transparency.
3) Presentations from groups in Minnesota and Ohio on their initiatives. These include employer learning networks, analyzing vendor relationships and costs across pharmacy and medical benefits, and developing action plans including standardizing data and reimbursement.
4) The document advocates employers evaluate all strategies like traditional utilization management, pursue innovative approaches with vendors,
This document discusses patient engagement in healthcare. It provides definitions of patient engagement from various organizations and studies that have measured outcomes of patient engagement strategies. Key points made include that patient engagement is emerging as a major focus in healthcare reform and involves patients actively managing their own care. Plans and providers will need to define engagement strategies that are outcome-focused and involve ongoing management of chronic conditions in primary care settings. Measurement studies show patient engagement approaches can reduce healthcare utilization and costs when integrated with primary care.
Healthy Advantage Rewards is a new wellness product offered to employers through Security Health Plan. Visit www.securityhealth.org/healthyrewards for more information.
Health Rosetta Case Study - City of Kirkland, WashingtonDave Chase
City of Kirkland, WA is a suburb of Seattle that was, like municipalities, struggling with healthcare costs and feared the coming Cadillac Tax. Their "moonshot" goal was to improve health benefits while eliminating healthcare cost inflation
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
Edifecs CJR: don't fumble with your bundle ssEdifecs Inc
Comprehensive Care for Joint Replacement (CJR) opens the door to opportunity for improved joint replacement patient care delivery. With full accountability for both cost and quality for the joint replacement episode, hospitals must share critical data in near real time to align and coordinate the full continuum of post-acute providers. The top complexities Jay Sultan addressed include:
The top complexities Jay Sultan addressed include:
Considerations for entering into contracts with your orthopedic surgeons and other collaborating episode providers
Episode bundle administration and monitoring; gain sharing administration
Real-time data acquisition from collaborating providers
Analytics and reporting, focused care delivery management, and preparation for CMS audits
Whatever burning issues and questions are on your mind
Merit-Based Incentive Payment System: Strategic Deployment Within Your Organi...PYA, P.C.
This presentation, “Merit-Based Incentive Payment System: Strategic Deployment Within Your Organization,” outlines the requirements for MIPS participation and scoring in 2018. It also provides strategic guidance for creating an opportunity for positive financial impact for practices.
Network Optimization: Why Physician Quality Should Drive Your Benefits StrategyGrand Rounds
Employers and payers are increasingly interested in narrow network or "high performance" networks to control healthcare costs. But there's a science to reshaping your physician network to cut costs while avoiding member blowback. Learn how to optimize networks for cost and quality, while reassuring your employees that they can still access the care they need.
Rising unscheduled care attendances are putting pressure on A&E departments across Scotland. Attendances have increased by 63,750 (4.8%) over the past two years, with the largest rises in NHS Highland, Greater Glasgow and Clyde, Fife, and Lanarkshire. Self-referrals have risen the most, increasing by 3.6%. Younger age groups like 0-4 have seen higher attendance increases. Several initiatives are underway to better manage demand, including improved redirection of non-emergency cases, social media campaigns on alternative care options, and consultant-led triage of referrals.
Using modelling to inform our diagnostics strategyUNITAID
The document discusses using mathematical modeling to inform diagnostic strategies for HIV/AIDS. It summarizes several studies modeling the impact and cost-effectiveness of introducing new diagnostic tools, such as a device-free test that could expand access to CD4 count monitoring. The modeling considers factors like how many additional people might receive CD4 monitoring, as well as total costs of treatment versus impact on the epidemic under different testing scenarios. The document advocates using modeling coordination to help address strategic questions about which tests and strategies could have the greatest impact.
Physician-Hospital Integration Strategies to Maximize the Bottom Line for Ort...Wellbe
Economic pressures on physicians and hospitals have increased attention on integration and collaboration between providers. The passage of the Patient Protection and Affordable Care Act (ACA) has propelled physician-hospital integration onto the national stage, forcing physicians and hospitals to change and accelerate their alignment structures with each other to meet the ACA’s mandates: quality excellence, population health management, efficiency, and cost savings. This presentation provides a detailed overview of strategies for the orthopedic service line that have been successfully implemented in order to achieve the Triple Aim while enhancing alignment with the service line’s physicians.
About the Speaker:
DanielleDanielle L. Sreenivasan, MHA is a senior manager with The Camden Group with more than ten years of healthcare experience. She specializes in strategic and service line business planning, facility planning, financial feasibility analyses, and medical staff planning and alignment on behalf of community hospitals, healthcare systems, academic medical centers, and physician medical groups. Ms. Sreenivasan has worked with clients analyzing current and potential markets and developing population-based healthcare strategies.
Prior to joining The Camden Group, Ms. Sreenivasan directed the Virginia Cardiac Network, LLC for Inova Fairfax Hospital located in Falls Church, Virginia. Her responsibilities included the development of strategic business plans and scorecards for clinical quality and budgeting processes, as well as oversight for the implementation of operational performance improvement plans. Ms. Sreenivasan’s experience also includes departmental and operational audits, and reimbursement analysis.
Ms. Sreenivasan received her master’s degree in health administration from Medical University of South Carolina with Honors, and her bachelor’s degree in accounting, business administration, and finance from the College of Charleston. She is a member of the American College of Healthcare Executives.
SHRM Survey Findings: Smoking in the Workplaceshrm
Over half of organizations allow smoking in the workplace. Most have formal smoking policies, and many limit the number of daily breaks. Common smoking policies provide wellness information on quitting or impose health premium surcharges for smokers. Since implementing these policies, many report decreased smoking. Vaping policies are also increasing, with most either banning or designating vaping areas. Violations typically result in verbal warnings.
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
This document discusses network alliances as an alternative to traditional mergers and acquisitions for hospitals. It describes network alliances as formal relationships between two or more entities to share resources and capabilities. The document outlines the key considerations for developing a network alliance strategy, including defining the scope of the relationship and ensuring the form follows the intended functions. It provides an example case study of the Health Network of Missouri, describing its purpose, corporate structure, governance structure, voting rights, and committee organization as a network alliance between five hospital systems.
SHRM’s 2014 Strategic Benefits Survey: Health Careshrm
SHRM’s 2014 Strategic Benefits Survey collected extensive information on the costs of health care and changes in total costs over time.
This research found that about four-fifths (79%) of respondents from organizations that provided health care coverage to their employees indicated their organization was “very concerned” about controlling health care costs. About one-half of organizations offered educational initiatives related to health and wellness (56%) and/or lower-cost generic prescription drugs (48%) to help control the costs of health care. In terms of employee contributions to the total costs of health care, one-half of respondents indicated their organization increased the employee share of the total costs of health care compared with the previous plan year.
The document summarizes the results of a survey on healthcare systems in several European countries and the US. Key findings include:
- Respondents rated their country's healthcare system quality, though Germany, Sweden, and the UK received higher ratings than Italy, Poland and the US.
- Perceptions of doctors' skills and training quality were generally positive, though sharing of information between providers needed improvement.
- Ensuring access for all citizens and managing costs for an aging population will be ongoing challenges for healthcare systems.
- Most respondents felt their country's healthcare industry contributes significantly to economic growth.
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
This document summarizes a presentation on the financial toll of prescription drug addiction from the perspective of third-party payers. It includes presentations from experts at the CDC, a private insurance company, and a university. The presentations outline national trends in opioid use and expenditures, strategies used by an insurance company to identify and manage high-risk opioid claims, and a description of North Carolina's Medicaid Lock-In Program aimed at curbing prescription drug misuse. The document provides disclosure statements for each presenter and learning objectives for the session.
The AVA Panel provides access to a verified sample of over 500 AVA members for market research through surveys, focus groups, and interviews. A survey of these members found the top challenges for the vascular access industry are improving clinician education resources, implementing data collection tools for benchmarking, and advancing practices through more research. The AVA Panel offers an affordable way for companies to conduct research and get insights from vascular access professionals to help guide industry efforts.
The survey found that:
- Two-thirds of organizations offered wellness programs, and 40% increased investment in these programs.
- Most organizations did not analyze return on investment or cost savings from wellness programs.
- Around half of organizations saw increased employee participation in wellness programs over time.
- Wellness programs were viewed as effective in reducing healthcare costs and improving employee health.
- About 60% of organizations offered wellness incentives like premium reductions, which significantly increased employee participation.
This document summarizes a webinar on prescription drug costs and purchasing strategies for employers. It includes:
1) An agenda for the webinar outlining presentations on current employer strategies, additional strategies employers can implement, and purchasing and policy options.
2) A discussion of employer survey results finding specialty drugs are a top cost concern and priorities include better vendor management and transparency.
3) Presentations from groups in Minnesota and Ohio on their initiatives. These include employer learning networks, analyzing vendor relationships and costs across pharmacy and medical benefits, and developing action plans including standardizing data and reimbursement.
4) The document advocates employers evaluate all strategies like traditional utilization management, pursue innovative approaches with vendors,
This document discusses patient engagement in healthcare. It provides definitions of patient engagement from various organizations and studies that have measured outcomes of patient engagement strategies. Key points made include that patient engagement is emerging as a major focus in healthcare reform and involves patients actively managing their own care. Plans and providers will need to define engagement strategies that are outcome-focused and involve ongoing management of chronic conditions in primary care settings. Measurement studies show patient engagement approaches can reduce healthcare utilization and costs when integrated with primary care.
Healthy Advantage Rewards is a new wellness product offered to employers through Security Health Plan. Visit www.securityhealth.org/healthyrewards for more information.
Health Rosetta Case Study - City of Kirkland, WashingtonDave Chase
City of Kirkland, WA is a suburb of Seattle that was, like municipalities, struggling with healthcare costs and feared the coming Cadillac Tax. Their "moonshot" goal was to improve health benefits while eliminating healthcare cost inflation
This document summarizes a presentation about creating sustainable funding for postgraduate medical education at the Northern Ontario School of Medicine (NOSM). It describes the high costs of distributed medical education across multiple sites in Northern Ontario. Current funding models from the Ministry of Health and Long-Term Care do not cover costs for specialty and family medicine residency programs. NOSM is advocating for a new funding formula that recognizes fixed program costs plus variable costs per resident. Strategies to achieve sustainable funding include engaging communities, pursuing educational innovation grants, collaborating with hospitals and optimizing budgets. Most NOSM postgraduate graduates practice in Northern Ontario.
The document discusses the transition to value-based care models and accountable care organizations (ACOs). It outlines five core competencies needed for early success in an ACO program like the Medicare Shared Savings Program (MSSP): 1) physician-centered governance, 2) collection and reporting of quality metrics, 3) data analysis and spend identification, 4) developing a post-acute quality provider network, and 5) population management strategies. It provides examples from Methodist Health System's experience in an MSSP ACO.
"Implementing the Affordable Care Act in Georgia" presented by Dr. Bill Custer on September 23, 2013 at 2014 is Now: Addressing Healthcare Access, Cost & Quality in Georgia.
Economic Stimulus Presentation August 2010Thinsolutions
The document provides an overview of the economic stimulus package passed in 2009 and incentives for healthcare providers to adopt electronic medical records (EMRs). It details the Medicare and Medicaid incentive programs that began in 2011, including payment amounts, eligibility requirements, and criteria for demonstrating meaningful use of EMRs. Providers can receive up to $44,000 from Medicare or $63,750 from Medicaid for adopting a certified EMR system and meeting usage goals focused on improving care delivery.
Acting as a roadmap through the changes in healthcare and healthcare law that occur almost daily, this presentation uses a case study to illustrate real-world issues and concerns associated with the compensation redesign process, including types of compensation models, service-specific compensation components, legal and contractual issue identification and mitigation, fair market value challenges
The document discusses the goals and services of the Georgia Regional Extension Center (GREC) which aims to help healthcare providers select and meaningfully use electronic health records to improve patient care. It provides an overview of meaningful use criteria and incentives for both Medicare and Medicaid eligible providers and hospitals to adopt electronic health records. It also addresses some of the challenges and opportunities around developing Georgia's healthcare information technology workforce.
saskdocs Presentation to RM of Eldon april 2013 James Winkel
This document summarizes information presented at a ratepayers meeting about physician recruitment and retention in Saskatchewan. It provides statistics showing growth in the number of physicians in the province in recent years. It outlines recruitment needs projected to 2020 and current recruitment strategies, including targeting Canadian students studying abroad, residents, and international medical graduates. Surveys of medical learners, recently departed physicians, and newly settled physicians are summarized to understand factors impacting recruitment and retention. Stakeholder consultations on incentives identified priorities like work-life balance, family considerations, and developing relationships. The conclusion emphasizes the need for multifaceted solutions from all partners to address physician shortages.
This document discusses DTE Energy's strategic planning for health management and implementation of a scorecard to measure programs. It outlines DTE Energy's employee population and details the development of a dashboard to track health metrics like conditions, costs, screening rates and participation. It also describes creating a scorecard to monitor goals in areas like assessments, education, biometrics, utilization and employee engagement to evaluate the impact of wellness programs.
Combatting the Effects of Inflation: Keeping Benefits Competitive While Cutti...Aggregage
https://www.compandbenefitstoday.com/frs/23650923/combatting-the-effects-of-inflation--keeping-benefits-competitive-while-cutting-cost/email
After years of facing the global pandemic, we are now struggling with a new problem: inflation.
No one could have predicted the impact of inflation on employee benefits and how it affects both employees and employers. Employers are now trying to maintain or lower the cost of benefits while competing for talent in a competitive and tight labor market, but the rising costs of consumer goods and healthcare make it extremely difficult to consider increasing their benefit offerings.
Join total rewards leader Jaye Johnson for a breakdown of inflation's impact on employee benefits. You'll also learn actionable strategies to decrease cost while maintaining competitive benefits for your employees.
Learning objectives:
• Understand the rising costs of healthcare as a result of inflation and the state of specialty pharmacy drugs
• How not addressing employees' current needs can impact your organization
• How DEI programs impact employee benefits
• Steps employers can take now to offer valuable, cost-effective benefits while keeping costs low
Health Insurance Terminology and Technology Tools-06-15Barbara O'Neill
This document provides information about health insurance terminology and technology tools. It defines key terms related to private health plans like HMOs, PPOs, and POS plans. It also defines terms like deductible, copay, coinsurance, out-of-pocket maximum, and premium. The document provides examples of how these costs are calculated based on medical bills and plan details. Additionally, it summarizes government programs like Medicare and Medicaid and other types of supplemental health insurance plans.
HealthCheck360 provides a 5-step wellness program to help employers reduce rising healthcare costs. The program uses biometric screenings and a proprietary scoring system to identify and stratify health risks among employees. Participants receive targeted interventions based on their risk level, such as health coaching or condition management. HealthCheck360 analyzes data to track results over time, showing reductions in health risks, healthcare claims costs, and medical cost trends compared to benchmarks. The program aims to keep healthy employees healthy while improving health and managing costs for those with risks or conditions.
Class XVIII Health Care Day - Charles Buckboldsolutions
Charles Buck presented on healthcare policy and reform to the Greater Naples Leadership group. He discussed the major issues facing the U.S. healthcare system, including the need for universal coverage and bending the cost curve. The Affordable Care Act aims to address universal coverage through the expansion of Medicaid and subsidies for private insurance. Buck argued that improving quality is key to reducing excess costs, and that accountable care organizations can help by organizing healthcare delivery around patient needs. Community leaders can support higher quality providers and push for performance transparency.
Setting a Path for Improved Health Outcomes RBFRBFHealth
Learning is a critical part of the HRITF RBF portfolio, with all programs benefiting from an embedded impact evaluation and in some cases, complemented by qualitative research components such as process evaluation studies. The presentation discusses the following topics:
1. Using RBF at the community-level to address demand side barriers
This presentation elaborates on the early evidence and the rationale for using RBF at the community level. It will share lessons learned from the implementation of community RBF at country level.
2. Using RBF to Strengthen Quality of Care: Early Lessons
This presentation discusses the broader policy implications of using RBF to strengthen the quality of care. It will explore how Measuring and Paying for the Quality of Care has been operationalized and will highlight the experience of Nigeria. Lastly, it will focus on measuring and Analyzing the Quality of Care from the Impact Evaluation perspective.
Opportunities & Challenges: A Home Health and Hospice Executive SurveyMcKesson Corporation
In the ever changing health care environment, home health and hospice organizations face enormous challenges. Discover their top challenges, such as Medicare reimbursement cuts, and other statistics on health care reform in the 2014 McKesson executive survey.
This document summarizes health care cost trends and initiatives for the City of Cincinnati from 1999-2009. It shows rising health care costs until initiatives like an 80/20 plan in 2005 and the Healthy Lifestyles wellness program launched in 2007 helped control increases. The Healthy Lifestyles program provides incentives for preventative health activities to encourage employees to adopt healthier lifestyles and lower costs long-term. Statistics on program participation and incentives earned are provided for 2007-2009, showing increasing participation over time.
De Pere Area Chamber Affordable Care Act Presentation, Daren Allen, Common Gr...Cheryl Detrick
Presentation on the Affordable Care Act given by Daren Allen, Vice President of Sales & Business Development for the Common Ground Healthcare Cooperative to De Pere Area Chamber of Commerce on 9/11/13.
Employee Engagement: Your Tool for Tackling Heath Care CostsDigital Measures
Everyone is concerned about increasing health care costs. This interactive session will review the various triggers that drive health care and insurance costs and cover the major communication and engagement strategies that companies use to reduce their trend. Case studies to be discussed include wellness, employee engagement and communication, benefit plan design and consumerism. Successful benefit incentive programs that support communication programs and have a quantifiable return on investment will also be discussed.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
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Statewide Health Care Study:
Review of Findings
So What’s Next?
Date: March 11, 2016
Presented to: PASBO
2. Background
Senate Resolution 250 directed a study of
the feasibility and cost effectiveness of
merging public school district health
plans.
2
The study included medical, dental, vision, and
prescription drug benefits and addresses eleven
areas:
3. SR 250 Had 11 Study Areas
3
1. Analysis of the specific health benefits, policies and contracts provided by
at least 50 percent of the school entities throughout the Commonwealth
2. Cost of current benefits for the next five years
3. Cost of current school employee contribution or average per employee.
4. Impact on PSERS and SERS
5. Comparison of coverage with average taxpayer in the relevant region.
6. Regionalization versus one health care plan.
7. Cost savings realized with consortia
8. Administrative, staffing, and technology costs associated with forming
mergers.
9. Comparison of school employees with Commonwealth employees
10. Cost of least used benefits by school employees
11. Cost impact of Health Care Reform (PPACA)
4. Today I’ll focus on the findings from these 6
4
1. Analysis of the specific health benefits, policies and contracts provided
by at least 50 percent of the school entities throughout the
Commonwealth
2. Cost of current school employee contribution or average per employee
3. Comparison of coverage with average taxpayer in the relevant region
4. Comparison of school employees with Commonwealth employees
5. Regionalization versus savings from one state-wide health care plan
6. Cost impact of Health Care Reform (PPACA)
Following set of slides provide the findings on 1. and 2.
5. Analysis of School Health Benefit Plans
Information was gathered from a variety of sources, including school districts,
health care consortia, health insurance companies and interviews with key
stakeholders.
5
Data Provided
• The survey was
administered to all 500
school districts
• Respondents provided
copies of their CBAs,
SPDs and health plan
rates
• 27 of the 37 Consortia
provided claims data for
last 5 years
PA-taxpayer health
insurance information
from:
• Aetna
• Capital Blue Cross
• Geisinger Health System
• Highmark Blue Cross
Blue Shield
• Independence Blue
Cross
Stakeholder interviews
•PEBTF
•PASBO
•PSEA
•PAIU
•PSERS
•SERS
•Philadelphia Federation of
Teachers H&W Fund
•Department of Education
•State Board of Education
•Governor’s Office of
Administration
•Pennsylvania Association of
Health Underwriters
7. Key Findings
Most school districts obtain coverage through a consortium
Over 85% of schools participate in one of 37 Consortia
Consortia have experienced below average healthcare cost trends
Some are implementing novel cost-saving programs
7
8. Key Findings
8
25%
18%
4%5%
48%
EE only
EE + Spouse
EE + Child
EE + Children
EE + Family
88%
50%
43%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Medical Dental Vision
Employee Contributions Required
$128
$106
$57
$0 $20 $40 $60 $80 $100 $120 $140
EE + Family
EE + Spouse
EE only
Average Monthly Medical Contribution
9. Key Findings
9
38%
57%
60%
85%
86%
86%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Grandfathered Plan
Dental coverage is self-insured
Vision coverage is self-insured
Medical coverage is self-insured
School districts participating in a consortium
Prescription Drugs included w/ Medical Plan
10. Medical Plan Designs
10
Percentiles 10% 25% Median 75% 90%
Summary across all plans, including plans with no deductibles
Individual coverage cost-sharing
In-Network Deductible $- $- $100 $350 $1,300
Out of Network Deductible $200 $250 $400 $700 $1,500
In Network Out-of-Pocket maximum $515 $1,888 $6,350 $6,350 unlimited
In Network Coinsurance 100% 100% 100% 100% 100%
Out of Network Coinsurance 100% 80% 80% 80% 70%
Summary across only plans with deductibles
In-Network Deductible $100 $231 $350 $713 $1,300
Out of Network Deductible $200 $250 $450 $700 $1,500
In Network Out-of-Pocket maximum $515 $1,888 $6,350 $6,350
unlimite
d
11. Medical Plan Designs
11
Percentiles 10% 25% Median 75% 90%
Summary across all plans, including plans with no copays
Office Visits
Primary Care Physician $- $- $10 $20 $20
Specialist $- $10 $20 $25 $30
Emergency Room $- $- $35 $75 $100
Routine Lab $- $- $- $- $10
Radiology $- $- $- $- $10
Summary across only those plans with copays
Office Visits
Primary Care Physician $10 $10 $15 $20 $25
Specialist $10 $15 $20 $25 $30
Emergency Room $25 $35 $50 $100 $100
Routine Lab $10 $10 $15 $20 $21
Radiology $10 $10 $15 $20 $26
Hospital and Outpatient Copays
Hospital In Network Per Admission $22 $38 $100 $250 $365
Hospital In Network Per Day Copay $75 $75 $75 $88 $150
Outpatient In Network Copay $13 $20 $30 $75 $100
12. Prescription Drug Plan Designs
12
Percentiles 10% 25% Median 75% 90%
Summary across only those plans using copays
Retail
Generic Copay $5 $5 $8 $10 $10
Brand Formulary Copay $10 $15 $20 $30 $35
Brand Non-Formulary Copay $15 $25 $35 $50 $60
Specialty Copay $15 $25 $35 $50 $70
Mail Order
MO Generic Copay $7 $10 $12 $20 $20
MO Brand Formulary Copay $20 $25 $40 $50 $70
MO Brand Non-Formulary Copay $20 $35 $60 $90 $110
13. Prescription Drug Plan Designs
13
Percentiles 10% 25% Median 75% 90%
Summary across only those plans using coinsurance
Retail Generic 18% 20% 20% 20% 20%
Retail Brand Formulary 20% 20% 20% 20% 25%
Retail Brand Non-Formulary 20% 20% 20% 20% 40%
MO Generic 18% 20% 20% 20% 20%
MO Brand Formulary 20% 20% 20% 20% 22%
MO Brand Non-Formulary 20% 20% 20% 20% 40%
14. Health Plan Actuarial Values
14
Definition – the estimated percentage of a typical policyholder’s healthcare
bills that the plan is expected to pay. The smaller the member’s out-of-
pocket costs the larger the plan’s actuarial value.
Under PPACA, employer plans must have a minimum actuarial value of 60%
to avoid an employer penalty.
On the healthcare exchanges, to facilitate comparison shopping, healthcare
plans must have an actuarial value that fits one of four metal tiers:
Platinum = 90%
Gold = 80%
Silver = 70%
Bronze = 60%
Individual plan AV’s can be no more than +2% or -2% from these values to
be eligible for the Exchanges.
15. Actuarial Values of School Health Plans
15
Actuarial Value Percent of School
Health Plans
Platinum plus Over 92% 71%
Platinum 88% to 92% 14%
Gold plus >82% and <88% 14%
Gold 78% to 82% 1%
Silver plus >72% and <78% 1%
Silver 68% to 72% 0%
Bronze & bronze plus >60% and <68% 0%
85% of SD’s have health plans with an actuarial value of 90% or more, with
over 70% more generous than is permitted for a plan to be marketed on the
Exchanges.
17. Healthcare costs varied substantially among consortia.
The largest consortium (ACSHIC) had the lowest cost.
17
AnnualCost
Number of Covered Lives
18. Next we’ll compare how the school health
plans compare to the average tax payer
18
3. Comparison of coverage with average taxpayer in the relevant region
19. Average Taxpayer Coverage
19
Health Plan Coverage Level Actuarial Value Group Policies
Individual
Policies
Total
Platinum plus Above 92% 223,409 - 223,409
Platinum 88% to 92% 605,974 31,772 637,746
Gold plus 82.1% to 87.9% 486,272 43 486,315
Gold 78% to 82% 464,245 81,296 545,541
Silver plus 72.1% to 77.9% 296,712 8,632 305,344
Silver 68% to 72% 174,118 265,607 439,725
Bronze & bronze plus 60% to 67.9% 104,570 58,484 163,054
Total 2,355,300 445,834 2,801,134
Average Actuarial Value 82.9% 72.7% 81.3%
20. Actuarial Values of Health Plans Purchased or
Provided by Pennsylvania Taxpayers
20
22. Comparison of Actuarial Values of Health Plans of Pa
Tax Payers by Region
22
85.4% 85.2%
83.4%
80.7%
60%
65%
70%
75%
80%
85%
90%
Western Northeastern Central Southeastern
Group Policies
73.7%
75.9%
73.7%
71.1%
60%
65%
70%
75%
80%
85%
90%
Western Northeastern Central Southeastern
Individual Policies
Group policies are more generous in the Western and Northeastern parts of
the Commonwealth. For both Group and Individual policies, less generous
plans are purchased or provided in the Southeastern area. This may be a
consequence of the higher cost of healthcare in Philadelphia and
surrounding suburbs.
23. Comparison of School Employee Benefits
to State Employee Benefits
23
4. Comparison of school employees with Commonwealth employees
24. School & State Employees
Plan Design Comparison
24
In-Network Out-of-Network / Non-
Network Providers
Plan Feature/Benefit School Median
Plan
State PPO
Plan
School Median
Plan State PPO Plan
Deductible
—Individual $ 300 None $ 750 $400
—Family $500 None $1,500 $400 per person
Member Coinsurance 20% 0% 20% 30%
Out-of-pocket limit
—Individual $1,300 $6,600 $3,000 $1,900
—Family $1,500 $13,200 $6,000 $3,000 excluding
deductible
Hospital inpatient (member pays) 100% 100% 20% 30%
Outpatient care (member pays) 20% $15 20% 40%
Emergency room $85 $50 $50
Urgent care facility 20%
Office visit
—Primary care (member pays) 20% $15 $25 30%
—Specialist (member pays) 20% $25 $40 30%
25. School & State Employees
Plan Design Comparison
25
In-Network
Plan Feature/Benefit School Median Plan State PPO Plan
Retail copays
Generic drugs $7 $10
Formulary $12 $18 +
Non-Formulary $20 $36
Mail Order Copays
Generic drugs $5 $15
Formulary $20 $27 +
Non-Formulary $30 $54
+ Plus pay the difference between the cost of the generic and the brand drug.
Median School Health Plan State PPO Plan
Actuarial Value 95% 96%
26. Comparison of School Employee Benefits to State
Employee Benefits – Dental Benefits
26
School Dental Benefits State
Percent Paid by Plan 100% 80% to 90% 60% to 75% 50%
Schools
Average
PEBTF
Preventive Services 96% 3% 1% 0% 98% 100%
Basic Restorative Services 83% 14% 3% 0% 95% 90%
Major Restorative Services 21% 29% 6% 44% 66% 60%
Maximum benefit $1,215 $1,000
Average deductible $27 $50
Most, but not all, schools provide dental coverage. Almost all (96 percent) of school districts cover
preventive services at 100 percent. Most (83 percent) school districts cover basic restorative services at
100 percent. Only 21 percent of school districts cover major restorative services at 100 percent, with
the most common level at 50 percent.
27. Comparison of School Employee Benefits to State
Employee Benefits – Vision Benefits
PEBTF Participating Provider Non-Participating Provider
Yearly vision examination 100% covered Allowance of up to $28
Glaucoma test 100% covered Allowance of up to $3
Lenses
Standard glass/plastic
are covered in full
Single vision: $15
Bifocals: $24.50
Ex-Bifocals: $26.50
Trifocals: $31.00
Aphakic: $60.00
Frames – up to $20
Covered in full up to a
maximum of $20 $20.00
Frames – above $20 80% covered $20.00
27
28. Comparison of School Employee Benefits to State
Employee Benefits – Vision Benefits
28
Vision Coverages School District Plans PEBTF
25th Percentile Median 75th Percentile
Vision exam-amount plan pays (where not 100%) $30 $39 $58.75 $28
Standard single lenses amount plan pays 24 30 60 15
Bifocal lenses-amount plan pays 36 40 73 24.50
Trifocal lenses-amount plan pays 46 60 94 31
Frames-amount plan pays 24 55 62 20
Medically necessary contact lenses-amount plan pays 70 160 250
Elective contact lenses-amount plan pays 73.50 80 125
29. Comparison of school employees with Commonwealth
employees – average annual employee premiums
29
PEBTF cost based on salary of $55,450
30. Almost finished – lets review the potential
cost-savings from mergers
30
5. Regionalization versus savings from one state-wide health care plan
31. State-wide Pharmacy Benefit Program
Pharmacy benefits carved out from each medical plan.
Three or four benefit levels – to minimize copay differences moving from
current design to the state-wide program.
Each school district (or Consortium) could choose the benefit level(s) they
want for the first year of operation. School districts could move to one of the
alternative designs at open enrollment.
Single PBM to administer the program. PBM selected through a
competitive bidding process.
Could also include member choice from among 3 networks – with savings
passed on to participants.
31
32. Pharmacy Benefits – Current Benefit Levels
Schools Pharmacy Copays PEBTF KFF
10th MEDIAN 90th
Retail Generic Copay $5 $8 $10 $10 $11
Retail Brand Formulary Copay $10 $20 $35 $18 $31
Retail Brand Non-Formulary Copay $15 $35 $60 $36 $54
Retail Specialty $15 $35 $70 $36 $93
32
Smaller variation in pharmacy plan design across schools than in medical
Median plan design comparable to the PEBTF plan
90th percentile plan design comparable to private sector (KFF)
Only 14% of SDs have carved out prescription drugs
Opportunity to capitalize on bulk purchasing power if pharmacy is carved out of
all healthcare plans and competitively bid with 3-4 plan designs
33. State-wide Pharmacy Benefit Program
Straw man plan designs
Superior High Standard Basic
Generic $5 $10 $10 $10
Preferred brand $10 $20 $35 20% ($25 min. and $75 max.)
Non-preferred brand $15 $35 $60 50% ($50 min. and $100 max.)
Specialty $25 $40 $75 50% ($50 min. and $100 max.)
Mail Order 90 day supply at equivalent of 2 copays rather than 3
33
Network Choices
Broad PBM’s full network of pharmacies
Performance PBM’s performance network
Performance plus PBM’s performance network plus maintenance drugs must be
purchased through mail-order.
34. Short-term Savings Opportunities
Projected Total Cost and Potential Savings
Amounts in $millions
Fiscal Year 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20
Current Arrangements $2,693 $2,797 $2,937 $3,093 $3,260 $3,439
Carved Out Prescription Drug $74 $78 $82 $87
Additional Savings under State-
wide arrangement (medical plan
savings, stop-loss savings, etc.)
$33 $69 $109 $129
Total Savings under State-wide
Arrangement $107 $147 $191 $216
34
Carving out prescription drug benefits and competitively bidding a state-wide plan for all
school employees should save at least $74 million in FY2016-17, before taking into account
plan design harmonization.
A state-wide health plan covering all school employees with a range of health plan choices
should save an additional $33 million in the first year and over $130 million when all SDs
participate after the expiration of their CBAs.
35. Lastly, we identified an opportunity to
mitigate costs from PPACA
35
6. Cost impact of Health Care Reform (PPACA)
36. Longer-term Savings Opportunities
36
Healthcare Reform added an Excise Tax on high-cost health plans. The tax is
40% of the excess of the cost above a threshold of $10,200 for self-only
coverage and $27,500 for “other than self-only coverage”. Implementation date
of 2018 has been postponed to 2020, with the likelihood of more plans hitting
the threshold in the first year of operation.
If SDs participated in a multiemployer plan, the threshold is $27,500 (indexed)
for all employees, which has the effect of reducing the amount of the tax. The
savings are significant as illustrated in the table below (projected cost in 2027)
of $2,500 per employee – about 6% of the premium cost.
Threshold Cost Excess Tax Employees Total tax
Self $12,309 $16,823 $4,514 $1,806 30 $54,168
Other $33,187 $45,355 $12,168 $4,867 70 $340,704
Total single employer $394,872
Multiemployer $33,187 $36,796 $3,609 $1,444 100 $144,360
Savings if SDs participate in a multiemployer plan $250,512
37. Next Steps
Establish a statewide pharmacy program but who leads:
PEBTF? PSERS-HOP? PSEA?
Regional health plan:
Merging of “small” consortia
Merging of “high cost” consortia to avoid/defer Cadillac Tax
Implementing best practices:
Cost effective plan design options
Narrow networks
Contribution policies
Statewide health plan
Would likely need to be legislated, rather than voluntary to be
successful
37
38. Questions?
I would be happy to answer any questions you may have now, or after the
conference
Adam Reese FSA, FCA, MAAA
Adam.Reese@prmconsulting.com
(301) 951.5107
38