total population management masi winter conference february 21,2013
Post on 01-Apr-2015
214 Views
Preview:
TRANSCRIPT
TOTAL POPULATION MANAGEMENT
MASI WINTER CONFERENCEFEBRUARY 21,2013
• Bo Hartsfield– Vice President, Employee Benefits Consultant
Cobbs, Allen & Hall, Inc
• Dave Douglas– National Vice President of Sales Healthstat, Inc
• David Greene– Director of Marketing and Training Cobbs, Allen &
Hall, Inc.
Total Population Management
• The Issues– Rising Healthcare Costs
• We are unhealthier but we’re living longer• PPACA
– Groups wanting to be self funded– Managing Worker’s Compensation Costs
• Current Trends• Co-morbidity
• The Solutions– Consumerism
• Plan Design• Transparency• Onsite Clinic
– Worker’s Comp Management• Best Practices from a former underwriter
Total Population Management
THE PRESENT STATE OF HEALTH CARE
The Cost of Health Insurance
$5,791
$10,880
$15,069
$-
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Average Cost of Family Health Insurance in the U.S.
Health Care Cost – A Look at Wellness
The Obesity IssueTrends by State 1985-2010
35.7% of the U.S. Adult population qualify as obese
Approximately 17% of children & adolescents are obese (ages 2-19)
No state has an obesity rate less than 15% (the national goal)
“Children will be entering adulthood heavier than they’ve ever been at any time in human history.” – Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston
Percent of Obese (BMI ≥ 30) in U.S. Adults
U.S. Obesity Trends. CDC.com. Feb. 2012. Apr. 2012 <http://www.cdc.gov/obesity/data/trends.html>Parker-Pope, Tara. “Obesity Rates Stall, But No Decline.” The New York Times. 17 January 2012. 6 April 2012. <http://well.blogs.nytimes.com/2012/01/17/obesity-rates-stall-but-no-decline/>.
Arthritis, heart disease, cancer and diabetes are the leading causes of death and disability in the U.S.
70% of all deaths and 75% of the $2.6 trillion the nation
spends on health care servicesAsthma is the most common chronic disease in
children7 million children currently have asthma
Health-related work productivity losses are estimated to cost the U.S. $260 billion each year
In a study with over 1.3 million employed OptumHealth HRA participants:
56% reported having at least one health problem. 31% reported
being a high risk for health problemsAn average of 1.99 days per month of work missed
due to health9.04 days at work per month but with limited
performance
“
Pappas, S. “Obesity’s Hidden Job Costs: $73 billion”. msnbc.com 8 Oct. 10, 2 Feb 11. <http://www.msnbc.msn.com/>World Health Organization. “Asthma”. May 2011. Apr. 2012 <http://www.who.int/mediacentre/factsheets/fs307/en/index.html>Mitchell, Rebecca. “Measuring Health-Related Productivity Loss”. 14 April 2011. 11 April 2012. National Center for Biotechnology Information. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128441/>
Chronic Diseases
WHAT ARE YOUR OPTIONS?
High Deductible Health Plans Employees need to have some “Skin in the Game”
Co-pay driven health plans disguise the cost of healthcare from the consumer
Consumers must become aware of their medical spend
Develop a plan design that drives consumer behaviors High Deductible: Deductibles of $1,000 or higher for an
individual Pair plan designs with appropriate tax-advantaged accounts
74% of employers report they will increase the offering of account-based health plans between now and 2014
Source: Towers Watson
% of Covered Workers Enrolled with a General Annual Deductible of $1,000 or More for Single Coverage
High Deductible Health Plans
16%
21% *
35% *
40%
46%50% 49%
6%8% 9%
13% *17%
22% *26%
10%12% *
18% *
22% *
27% *31% 34%
0%
10%
20%
30%
40%
50%
2006 2007 2008 2009 2010 2011 2012
All Large Firms (200 or More Workers)
All Small Firms (3-199 Workers)
All Firms
* Estimate is statistically different from estimate for the previous year shown (p<.05).
Note: These estimates include workers enrolled in HDHP/SO and other plan types. Because we do not collect information on the attributes of conventional plans, to be conservative, we assumed that workers in conventional plans do not have a deductible of $1,000 or more. Because of the low enrollment in conventional plans, the impact of this assumption is minimal. Average general annual health plan deductibles for PPOs, POS plans, and HDHP/SOs are for in-network services.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2012.
Among Firms Offering Health Benefits, Percentage That Offer an HDHP/Tax Advantaged Account
High Deductible Health Plans
Note: Tests found no statistical difference from the previous year shown (p<.05).
Note: The 2012 estimate includes 0.6% of all firms offering health benefits that offer both an HDHP/HRA and an HSA-qualified HDHP. The comparable percentages for previous years are: 2005 [0.3%], 2006 [0.4%], 2007 [0.2%],2008 [0.3%], 2009 [<0.1%], 2010 [0.3%], and 2011[1.8%].
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2005-2012.
Transparency in Pricing?
The truth is….contracted rates vary
by as much as even within network.
300%
©2011 ACAP Health Consulting Confidential-Not for Distribution
Clinical Programs
Claims Management Quarterly Reviews
High Cost Claims Compliance with Care Behaviors that need to
be addressed Identify actionable items Tie back to wellness and
prevention
Emphasizes Primary Care
Rx Management Incentivizes Employees
Medical care at an affordable rate
Prevention and Disease Management Outreach
Data Analytics On-Site Clinics
A Shift to Consumer Engagement
Personalized Plans
Tax Advantaged
Accounts
Transparency
ToolsClinical
Programs
Wellness Solutions
Real World Incentives
• Improve the Health of Employee population• Reduce/Control Future Healthcare Spend• Enhance Benefits Package Offered to Employees:
– Recruit and Retain the Best Employees
• Optimize Access to Primary Care• Increase Productivity• Reduce Absenteeism
Objectives of the On-site Solution
• 80% of your health care costs come from 20% of your employees.
The 80/20 Rule
Acute/Episodic
Medication prescribingReferralsLab testingDiagnostic orderingMedication dispensing
Occupational Health
Chronic Condition Management
Cough, colds and fluURI, UTISprains, strainsLaceration Repair
Primary Care & Coordination
Preventative Health
Full physicalsVaccinations, Flu shotsBlood pressure checkBiometric screeningWellness education
Drug TestingWorkers’ CompAccident Triage“Fitness for duty” evaluations
Diagnose and TreatEducate/CounselProactive Outreach
Scope of Services
• Decrease healthcare cost
• Healthier employees• Increase productivity/
Decrease absenteeism• Increase employee
retention• Customized and
Scalable • Minimize risk exposure• Better utilization of
carrier/vendor programs
• It’s FREE• Reduce PTO usage- “on
the clock”• Convenient/ Easy
access to care• Onsite Rx dispensing• Time with provider• Personal care plan• Education• Confidential- HIPAA
compliant
A true WIN- WIN:
Employer Employee
On-site Employer Clinics
THE NEED FOR WC COST CONTAINMENT
• Combined ratio projected to be over 110% for the next several years
• Some markets are pulling back their WC writings• The rising cost of medical is a major issue
impacting WC• Aging workforce and co-morbidity factors will
negatively impact WC claim costs• Medical technologies are producing more costly
medical treatment options
WC Results Expected to Be Challenging
102.0
97.0
100.0
101.0
112.6
108.6
105.1
102.7
98.5
103.6
104.6 11
0.4
116.6
117.1
116.012
1.7
107.0
115.3
118.2
90
95
100
105
110
115
120
125
130
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12F
Workers Comp underwriting resultsare the worst they have been in a decade.
Sources: A.M. Best; Insurance Information Institute. From 12/2012 Insurance Information Institute presentation.
Workers Compensation Combined Ratio
Indemnity53%
Medical47%
Source: NCCI (based on states where NCCI provides ratemaking services ). From 8/2011 Insurance Information Institute Presentation.
Indemnity48%
Medical52%
Indemnity42%
Medical58%1989
1999
2009p
Medical Costs Share of Total Costs for WC is Increasing Steadily
Co-morbidity
Definition: existing simultaneously with andusually independently of another medical Condition
©2011 ACAP Health Consulting Confidential-Not for Distribution
• Hypertension• Drug Abuse• Diabetes• Chronic Pulmonary• Obesity• Pregnancy
Common Co-morbidities
• In 1994, in no state was the percent of adultswho were obese as high as 20%.
• By 2010, all 50 states had adult obesity rates of20% or more. In 12 states, 30% of the adultswere obese.
Workforce Changes
Source: CDC
2000 2001 2002 2003 2004 2005 2006 2007 2008 20090.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
2.4%
6.6%
% WC Cased Diagnosed
Co-morbidity Diagnosis- Almost Tripled from
2000 to 2009
Source: NCCI 10/2012 Study on Co-Morbidities in WC
2327
2312 2404
2406
2393 2530
2498 2559 2627
25702632
2627
2562 2674 2859
2896
2723 284228723127
2951 3079
3047 3218
3201 3330
3344
3351
33643396
3334 34263480
3505
35063547 3764
3775
3626 3833 4074
4138
41054213
1027
1022
10261069
1037 1129
1094
1090
1115
1139
1142
1181
1215
1160
1182
1177
1135
1162
1138
1141
1177
1182
1183
1213
11931244
1250 13141375
126213141356
1385
1397
1385
1367
1370 1452
1442
1407
1389 1530
1524
1430 1495 15801633
15051550
1498 1598
1564
1584 16821726
1719 17791835
1842
624
636
641686
668718773
758
789
780
775
801
779
792
762815
790
774
802
765 863926
811 919
928
947
969
1039
9741055
10181076
1057
1085
1085
1072 1171
1152
1133
11511210
1224
1258
1256
11431190
1206
1198
1166 1279
1243
1185 1267
1280
1302
1311
1301
12841381
2473
2043
2067
20432083
2019
2051
2014 2106 22182251
22422283
223422652304
1250
986
500
1000
1500
2000
2500
3000
3500
4000
4500
1998.1
1998.3
1999.1
1999.3
2000.1
2000.3
2001.1
2001.3
2002.1
2002.3
2003.1
2003.3
2004.1
2004.3
2005.1
2005.3
2006.1
2006.3
2007.1
2007.3
2008.1
2008.3
2009.1
2009.3
2010.1
2010.3
2011.1
2011.3
2012.1
2012.3
Age 65-69 Age 70-74 Age 75 & over
Source: US Bureau of Labor Statistics, US Department of Labor; Insurance Information Institute.
There are now over 7.4 million senior workers. This is double the number in
1998. Over the next decade it will probably double again.
(Thousands)
Number of Workers Age 65-69, 70-74, and 75+,
Quarterly, 1998-2012
56
910
12
15
56
9
1112
13
56
8
10
13
15
56
9
12
14 14
0
2
4
6
8
10
12
14
16
20-24 25-34 35-44 45-54 55-64 65+
2008200920102011
Source: US Bureau of Labor Statistics, Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2011 (Table 10), released November 8, 2012. Insurance Information Institute.
Median Days Away From Work
Median lost time of workers age 65+ is 2-3X that of workers age 25-34. These numbers are pretty stable—they haven’t changed much since 2008.
Older Workers Lose More Days from Work Due to Injury or Illness
• The fundamentals of PIM still work:– Prompt reporting of claims– Good communication with injured workers– Return to work/stay at work/transitional duty programs
• Nurse case management involvement• Medical bill review• Pharmacy program• Post offer physicals• Be creative in your PIM program
WC Practices For Cost Containment
• Company Sr. management committed to safety - zero tolerance for unsafe actions
• Good hiring and HR practices• Thorough training programs• Documented safety programs• Clean/organized worksites• Consistent treatment of employees – no favorites• Low frequency of claims
What Makes A Good WC Risk?
QUESTIONS???
top related