Phoning It In
Eric Johnson
What’s Going to Happen?
1) Single Payer!
2) The ACA will remain the law of the land
(with fixes)
3) The President will let the ACA “explode”
4) The ACA will be repealed and replaced
5) Nothing
We’ll Know Soon Enough
• The details of the replacement plan aren’t that important.
• What is important is the current trends in the industry and the impact the
changes will have on those trends.
REVERSE
STAY THE
SAME
ACCELERATE
• With this information, you can start planning to help your clients as the
changes are implemented.
Trends – the 4 Ps
Premiums
Plan Design
The 4 Ps
Prescriptions
Provider
Networks
Premiums
Why?
• Essential Benefits
• Guaranteed Issue
• Healthcare Inflation
Premiums
Why?
• Essential Benefits
• Guaranteed Issue
• Healthcare Inflation
Premiums
Long-term, the emphasis on consumerism
and transparency could actually bend the
trend line downward. It will take time, though.
Why?
• Essential Benefits
• Guaranteed Issue
• Healthcare Inflation
Plan Design
What we’ve
seen:
Higher Out
of Pockets
This isn’t going to
change!
No up-front
copayments
Instead of a reduction in outof-pockets, we’ll see a focus
on ways to cope with the
rising out-of-pockets.
More focus
on HSAs
Prescriptions
The Trend:
The Proposal:
Smaller
formularies
Preferred
pharmacies
Higher
costs
No up-front
copayments
Speed
drugs to
market
Provider Networks
Getting
smaller
Provider
shortage
Longer
wait times
ACA Replacement Ideas
More power to the
states in regulating
provider networks
Selling insurance
across state lines
More power to the states
Source: Patient Protection and Affordable Care Act; Market Stabilization Proposed Rules
Insurance Across State Lines
Difficult to accomplish with
provider networks
May require reference based
pricing
Possible Result: more balance
billing
Premiums
Plan Design
• Repeal could set back the premium
clock a couple years
• Trend line won’t change without
lower health care costs
• President Trump promises much
better coverage at a much lower
price
• Replacement plans focus on
expanding HSAs
The 4 Ps
Prescriptions
Provider Networks
• ACA replacement focuses on
increasing competition by
approving new drugs more quickly
• Won’t be an instant fix
• Networks have been shrinking
• No sign that this will change with
ACA replacement
PRESCRIPTION INFLATION
15
$
$
$
$
$
$
16
$
$
$
$
Copays
$
$
17
Holes = Cost Strategies
Increasing deductibles
and out of pockets,
increasing or dropping
copays, moving drugs to
higher Rx tiers, and
shrinking provider
networks are all
strategies put in place to
keep premiums under
control. Premiums are
still going up, just not as
quickly…
18
Employees Don’t Understand
19
Brokers are lifeboat salespeople
1. But we can’t sell whole
lifeboats – they’re not in our
clients’ budgets.
2. We have to sell lifeboats with
holes.
3. For the past six years, we’ve
been strategically placing
those holes in the boat.
4. In 2016, we need to fill those
holes.
5. We need to do that in 2017
too…
20
Health Savings Accounts
Continued to grow during President Obama’s
terms in office
Are a big part of President Trump’s proposal
Are part of every Republican replacement plan
for the Affordable Care Act
Are what I’m talking about at 2pm…
21
Worksite insurance products can
fill some of the gaps in coverage
Accident
plans
Critical
illness
plans
Hospital
indemnity
plans
Medical
bridge
plans
22
Unfortunately…
While these other insurance
products can help soften the
effect of increasing deductibles
and out-of-pocket limits, they
do little to offset the access
issues created by smaller
networks, missing copayments,
and less generous drug
formularies.
23
Discount / Savings Networks
• Can provide alternatives to the insurance
discounts offered through the health
plan.
• Pair well with an HSA for dental and
vision services.
Telehealth / Telemedicine
• Can help restore access to health care
providers at a time when costs and wait
times are increasing.
• Disclosure: Telehealth is not insurance
coverage and does not meet the
minimum creditable coverage
requirements under the Affordable Care
Act. Some state restrictions may apply.
Different Levels of Medical Need
Urgent/Emergent, Physicals,
IN-PERSON DR. Significant Specialty, Surgery
TELEHEALTH
DOCTORS ONLINE
Primary Care, Acute,
Short Term, Rx, Triage
Advice, Triage, No Rx,
Primary & Specialists
What is Telehealth?
Call anytime, consult with a
U.S. doc & get a prescription
written, if needed.
Some charge a consult fee.
Some don’t.
Up to 70% of
medical issues can be
solved over phone/video.
This is NOT Insurance.
Some state restrictions apply.
Telehealth Experience
1.
Complete medical history
2.
Request a consult
3.
Talk with a physician
4.
Resolve the issue
5.
Continuity of care
This is NOT Insurance.
Some state restrictions apply.
Telehealth Value
If they didn’t use telehealth, where
would these people have gone?
What would these visits have cost?
hhhhhhhhhh 8%
hhhhhhhhhh ER Visit $1,477/visit
hhhhhhhhhh 42%
hhhhhhhhhh Urgent Care $163/visit
hhhhhhhhhh
hhhhhhhhhh 39%
hhhhhhhhhh Office Visit $131/visit
hhhhhhhhhh
hhhhhhhhhh 11%
Unknown future cost of neglected issues
hhhhhhhhhh Do Nothing $?
Average medical savings per call: $237
SHORTCost of 4 hours lost productivity: $ 88
TERM
…………………………………..……………………..………………….…………………
Immediate savings/consult: $325
SAVINGS:
VERACITY study found cost of higher
SHORT &
ER use, readmit rates & neglected issues:
LONG-TERM ……………………………………………..……………………..………………….…………………
Actual savings/consult: $717
SAVINGS:
……………..……
……………..……
……….……….…
………..…………
*Per Teladoc member reporting. Individual results may vary.
This is NOT Insurance.
Some state restrictions apply.
Telehealth compliant
with all state regulations
This is NOT Insurance.
Revised July 2015
Texas Medical Board drops appeal against Teladoc lawsuit
By Dave Barkholz and Erica Teichert | October 22, 2016
The Texas Medical Board last week withdrew its appeal against Teladoc's lawsuit that alleges
the state's telemedicine rules violate federal antitrust laws, sending the dispute back to a
federal trial court.
The board's proposed rule requires physicians to meet with patients in person before they
can treat them remotely, or another provider must be physically present during the first
telemedicine appointment to establish a doctor-patient relationship. Lewisville, Texas-based
Teladoc maintains that the board violated the law because federal antitrust laws require the
board to be supervised by the state in order to create the rules, which the company
maintains will affect access to care. According to the board, the restrictions are to ensure
quality of care, not to stifle competition.
But the U.S. Justice Department and the Federal Trade Commission recently took Teladoc's
side in the dispute, telling the 5th U.S. Circuit Court of Appeals that the state's rules were
anticompetitive and lacked appropriate review. The agencies encouraged the appeals court to
reject the medical board's appeal and maintained the underlying rule should be eliminated.
21st Century Cures Act
Currently being reconsidered in TX
• A bill is working its way through the Texas
legislature that would confirm that
telehealth is in fact legal in the state of
Texas.
• Will also allow for video consults.
• Good chance of passing.
What is Doctors Online?
Get fast answers
at no cost
from specialists
via email or app:
physicians,
psychologists,
dentists, dietitians,
fitness trainers.
This is NOT Insurance.
Some state restrictions apply.
Doctors Online
I have kidney cancer. My doctor suggests
surgery. What questions should I consider first?
I was bit by a dog while jogging. Owner says his
shots are up to date. Should I be concerned?
This is a picture of an odd-shaped growth on my arm.
Is it bad? Any ideas?
My recent blood test is attached. My white cells are low.
What does this mean, & what do I do?
My knee hurts when jogging. Can I rehab it myself?
I lost my mom (& best friend) last year. I have no energy
& gained 25lbs. I’m so depressed. Can you help?
This is NOT Insurance.
Some state restrictions apply.
Doctors Online Value
th
4
Every
session saves
a doctor visit:
$156
The average user has
4 sessions / year.
This is NOT Insurance.
Some state restrictions apply.
CASE
studies
Soften the Move to Higher OOP$
Encon Systems
Saved Visits, Saved $
“We Teladoc’d Teladoc to death!
The experience is BETTER than we expected!”
Self Funded Case: Save Claims & Time
Masergy Communications
240 employees: cost: $26,000
144 telehealth consults.
savings:
$46,000-$110,000
Shrinking Network / Growing Wait Time
North State Grocery
300 employees
retail hours
Redirect Unnecessary Claims
Ed Martin Auto Group
272 employees: cost: $28,000
100 telehealth consults.
savings:
$33,000-$76,000
ROI Compounds Annually
The Delta Companies: 2.5 years
324 employees: cost: $73,000
631 telehealth consults.
savings:
$205,000-$452,000
Testimonials Compound Annually
“Every week someone stops by with great feedback:
‘Telehealth is easy to use,’ ‘it’s convenient,’ ‘it saved
me from having to make an ER visit on a late night.’
Advocacy also saves me a lot of time – I no longer
have employees bring me a stack of EOBs to look
over and tell them what to pay!
We get to give our employees their time & sanity
back, and we save many times more than what this
costs us!”
- Calli Corley, VP HR
Telehealth cost savings:
Done right, it’s no myth!
But it does take some work.
You can’t phone it in.