Bending the Healthcare Cost Curve
April 7, 2016
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Goals For Our Time Together
Interactive discussion on strategies employers are using to successfully address
ever increasing healthcare costs. These strategies include initiatives such as:
 Telehealth
 Medical Price Transparency
 Outcomes Based Wellness
 Defined Contribution Healthcare
We’ll wrap up with customer discussions explaining how they’ve used these
strategies
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Consumerism
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Employees = Consumers and Their Expectations are High
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Telehealth
• What is it? - The remote diagnosis and treatment of patients by
means of telephone or video technology when a primary care
physician is not available.
• Up to 70 percent of Medical issues can be handled by phone.
• Top conditions addressed by telehealth: Sinus problems, Pink Eye,
Bronchitis, Upper Respiratory Infection, Nasal Congestion, Allergies,
Flu, Cough, Ear Infection
Let’s Take a Look
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Telehealth
What can’t Telehealth handle?
• Prescribing controlled substances, psychiatric or lifestyle drugs.
• Management of chronic conditions such as diabetes, heart disease,
hypertension, except for short term needs.
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Telehealth
Effectiveness of Telehealth confirmed by Rand Study of 300,000
participants:
• Telehealth consultations for same conditions resulted in far fewer
follow-up visits:
• Telehealth follow-up visit need – 6%
• Office Visit follow-up need – 13%
• Emergency Room follow up visit need – 20%
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Telehealth
• Projected savings for Telehealth - $237 per consult.
• Projected productivity savings per consult - $88
• Preferred billing arrangement – no consult fee for employee. Encourages
utilization.
• Cost range for Telehealth - $6-$12 a month depending on whether ER or EE
paid.
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Telehealth
Indicators for one National Telehealth Vendor:
•
•
•
•
•
11 million families served
95% member satisfaction
92% patient issues resolved
Median response time less than 10 minutes
0 malpractice claims since 2002 founding
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Promoting Healthcare Consumerism:
Price Transparency
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Local Newspaper Quotes
• “Price of health care a well-kept secret”
• “Don’t plan on bargain hunting for a hospital visit in Connecticut. You won’t find
prices for a hip replacement, surgical gown or even a handful of Tylenol listed on
hospital websites or in brochures.”
• “That is a problem for patient advocates and groups supporting price care
transparency.”
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In-Network Contracted Rate Variance
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What Will Address Wide In-Network Price Variation?
Transparency
• What are the models?
• Insurance carrier provided. Hampered by non-disclosure agreements. A
partial solution.
• Third party vendor on-line cost info. Can be highly effective in revealing true
cost. Some concern about whether consumers understand enough detail to
make effective comparisons,
• Third party employee concierge model. Health professional provides cost
comparisons.
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Employee Concierge Model
• Claimant is made aware of a dedicated resource to contact via phone,
internet.
• Vendor’s Health professional prepares cost comparison of other options vs.
recommended provider, after requesting permission from claimant’s doctor.
• Other services provided by Health Professional: Finding doctors who accept
new patients, scheduling appointments, reviewing explanations of benefits
and bills, researching generic Rx alternatives.
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Cost Comparison Example
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What Are the Employer Expected Results?
Actual results on over 1,600 employers:
•
•
•
•
25% of employees access the consumer advocate help line
Resulting in $620 PEPY in gross cost savings
No implementation fee
Every client to date has experienced a positive return on investment in
Year 1
PEPM contract model allows employer to terminate at any time if claim
cost savings are not experienced
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Who Benefits Most from Price Transparency Service?
• Employees participating in higher deductible plans. Average
results are based on $750 single deductible. Over $1,000
deductible levels participation and savings tend to increase.
• Savings tend to accrue approximately 2/3 to employers and 1/3
to employees.
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Centralize Employee Access with a Benefits Technology Platform
Employees
enjoy
easy
access to
all their
resources
in one
place
Quick Links
EMPLOYEE RESOURCES
Phone my Doctor
Shop for
Procedures
My Wellness Buddy
INSURANCE RESOURCES
Medical
Dental
Vision
FSA / HSA
AFLAC
Direct
employees
to
participate
To Do List
Update your Wellness Plan
View this month’s wellness video
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Consider how people with diabetes could use technology to manage their health — all
without visiting an office-:
COMMUNICATE
EMPLOYEE PORTAL & MOBILE APPs
Use a mobile phone or other
device to upload food logs,
medications, dosing and blood
sugar levels for review by a
nurse who responds
electronically
Watch a how-to video on
carbohydrate counting and
download an application (app)
for it to your mobile phone.
Research the pros and cons of
alternate treatments, such as
insulin pumps
Send an email or text message
to a nurse or diabetes educator
when you have questions.
Get email, text or phone
reminders when you need a flu
shot, foot exam or other
preventive care.
EDUCATE
Order testing supplies and medications online
Use the same app to estimate,
based on your diet and exercise
level, how much insulin you
need.
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Outcomes Based Wellness
Is there an ROI?
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Health Care Costs……Current State
Without change, per employee health costs
will nearly triple over the next 10 years
$ 4,918
2001
218% Increase
$ 10,473
$ 10,743
2010
266% Increase
95% Increase
$ 28,530
2019
Largest portion of cost increases are associated
potentially modifiable lifestyle-related chronic illnesses
Source: WELCOA / Wellness Council of America
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Health Benefit Strategies
1. Large
Claimants
Drive Costs
2. Large Claimants
Change Each
Year
10% workforce = 80% costs
59% are new each year
3. 70% of spend
is preventable
Only 3% spent on prevention
Lack of Prevention due to Poor Awareness & No Accountability
Condition
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Prevalence
Undiagnosed
High Cholesterol
22%
47%
High Blood Pressure
23%
35%
Diabetes
8%
35%
Depression
8%
66%
Metabolic Syndrome
23%
?
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The Outcomes Based Difference
• We have PROVEN Results that have been validated by a 3rd party company (20% lower medical
spend than non-Interactive Health program users)
• This program is based on a strategic approach that utilizes incentives to drive employee
accountability
• Comprehensive, Integrated Solution that is based on a clinical foundation, connecting care and
year round tools and resources to ensure success
• Supported with Industry Leading Service & Quality (Highest Accreditation with NCQA, over 21
years experience and the only company that is endorsed by the American Hospital Association)
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Corporate Opportunities
•
Proven ROI: Reduce Claims Trend; CDC suggests $2 - $6 saved to each $1 invested
•
Improve Productivity and Work Quality
•
Best Practices – 80% engaged, 80% reaching clinical health goals by year 2
•
Program can be implemented so that it is funding neutral
Employee Opportunities
•
Only 8% of the population completes an annual wellness exam – improves access by making it
available at work
•
CDC suggests 75% of health spend is due to chronic diseases that are preventable and caused by
unhealthy lifestyles.
•
Wide variety of tools & resources provided year round, including 1:1 coaching with Master degreed
health care professionals.
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Claims Study: Medical Spend
Outcomes Based clients had lower average
annual medical cost trend:
Non Outcomes Based Health Group
Outcomes Based Health Group
Source: Zoe Consulting, Inc., two-time C. Everett Koop award winning
consulting firm; published 8/23/2012
•
5.9% vs. 12%
•
7.7% reduction in medical spend from
2010-2011
•
20% lower medical spend compared to
employers not using the Interactive
Health program
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Measure – Comprehensive Health Evaluations
•
Same tests/process physicians uses to detect early-stage chronic disease
• Blood Pressure
• 36 Panel comprehensive fasting preventive testing
• + Smart Testing triggers additional tests (PSA, Thyroid)
Why comprehensive testing?
63% not seen their physician in
three years
58% unmanaged conditions
42% newly discovered
3% potentially life threatening
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Motivate - Personal Health Score and Goal
Creates accountability and action:
•
•
•
•
•
•
Each employee assigned a score & unique,
achievable goal
Measures performance based on clinical
outcomes
Rewards incremental performance
Incentives drive Participation,
Outcomes Based reward drives activity and
behavior change
83% of members achieve goals
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Corporate Reporting Measures Success
Ongoing Analytical Reporting (examples)
• Biometrics Summary
• Cardiac Risk Score
• Population Health Dashboard
• Incentive Management
• Program Usage Statistics – including challenges, workshops, etc.
• Dietician and Trainer Usage
Aggregate Results Report
•Population health status and trend data
•Benchmark norms vs. national and peer organizations
•Impacts on productivity and avoidable costs
•Continual improvement recommendations
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Proven, Sustainable Results
Member
•
81% of members achieve their goals
•
26% of smokers quit smoking
•
64% of members with elevated glucose reduced their glucose levels
•
82% of members with elevated blood pressure improved their blood pressure
•
95% of members lose weight
Employer
•
20% lower medical costs
•
Outcomes based members experience over 11 fewer WC days
•
Outcomes based members return from STD over 16 days sooner
Outcomes Based Model
•
99.5% satisfaction with Interactive Health Medical Team
•
97.3% client retention rate
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Help Employees Connect the Dots
Employees
understand the
benefit of
participating in
their smoking
cessation wellness
program
Greater company
contribution
- OR Lower payroll
deductions
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Help employees connect the dots
Employees
understand the
impact of their
Health Risk
Assessment
Greater company
contribution
- OR Lower payroll
deductions
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Benefit Administrators Gain Access to Critical Data
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Manage Your Investment / Maximize Your R.O.I
Identify and manage risk
factors associated with
employee biometric
results
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Manage Your investment / Maximize your R.O.I
Identify and manage the
impact of employee
compliance or non
conformity
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Defined Contribution Healthcare / Private Exchange
What have we learned so far?
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We’re Experiencing a Period of Unprecedented Change
Trends impacting the Benefits Function
Implications for Benefits Leaders
Rapid expansion of regulatory
and cost pressure as a result of
the ACA
Focus on Employee/Plan “Fit” to
manage the cost curve
Four generations of talent
converging in the workforce
Tools to simplify the complex
while removing manual
workflows
The war for top talent is heating
back up in the marketplace
Plan design evolves beyond
traditional benefits to
strengthen value proposition
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A Private Exchange Definition
A technology platform that provides the following:
Choice of product and plans to meet a diverse workforce’s need
Transparency – clearly communicates the financial commitment of the employer
Decision support – with more choices there is a greater need for employee education
Administrative efficiency – end to end eligibility maintenance, consolidated billing and
payment, consistent communication of benefits across divisions and locations
• A platform for future engagement into the tools available to address the cost drivers of
a benefit program
• Flexibility – to accommodate multiple products and multiple contribution strategies
•
•
•
•
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Benefits To Employers
• Costs have continued to escalate at an unsustainable rate. Budget certainty
is critical for future ability to offer coverage.
• Administrative gains and cost savings are tangible.
• ACA compliance assistance
• Employers are tired of being the “Bad Guy”
– It does away with the take it or leave it historical approach.
– It engages employees to select plan appropriate for their individual situation –
Greater Employee Satisfaction
Lets Take a Look
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Benefits to Employees
• Having control of benefit choices and being able to follow our own
purchasing preferences makes us happier.
• Transparency – In an Exchange, employees appreciate benefit dollars as
compensation.
• Access – employees have access to benefits information and tools that allow
them to be better consumers
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R&K Exchange Early Results
• Many clients have been able to keep employer contributions to a 3% range.
• All clients have benefitted from consolidated billing and single benefits
database.
• Clients are typically offering 6 to 8 Medical options and seeing 10% to 15%
participation in each plan.
• Employees report being more engaged in enrollment process and better
appreciate the employer’s benefits contributions.
• Virtually all clients expressed a very positive experience moving from paper
to an integrated web-based system.
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Assist Employees in Making the Right Decision
79%
49%
Of employees select
the wrong benefits
plan1
Of employees are not
fully satisfied with
their plan2
22%
Have switched jobs
for a better benefits
plan3
1 Johnson
EJ, Hassin R, Baker T, Bajger AT, Treuer G (2013) Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture.
Employee Benefit Research Institute, “2014 Health and Voluntary Workplace Benefits Survey”
3 Employee Benefit Research Institute, “Findings from the 2015 Health and Voluntary Workplace Benefits Survey”
2
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Employees Become Educated Consumers
Employees can
establish their
buying
preferences and
identify their
benefit plan needs
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Employees Become Educated Consumers
Employees
identify the best
plan based on
buying
preferences and
benefit plan needs
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Employees Become Educated Consumers
Employees can compare and contrast their plan options based on cost, plan
design, and coverage levels
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Employees Become Educated Consumers
Employees
evaluate plan
options against
their own
usage or their
peers
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Employees Become Educated Consumers
Employees can
plan for
upcoming
needs or adjust
predicted plan
usage to
determine the
impact on their
overall out or
pocket costs
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Bringing it All Together
COMMUNICATE
CHANGE BEHAVIOR
MANAGE
ANALYZE
EDUCATE
ENROLL
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Let’s Hear From our Customers
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