TEXAS HOUSING ASSOCIATION

• Indemnity• Preferred Provider Organizations (PPO)• Health Maintenance Organization (HMO)• Consumer Driven Health Plans• HRA, HSA, RRA• Improved Provider Cost Transparency• Wellness programs • Healthy Initiative Programs

Historical Overview of Benefit Plans & Health System

12.411.2%Pennsylvania

10.111.3%Michigan

11.512.0%Ohio

19.313.9%New York

12.814.2%Illinois

8.715.7%US

300.414.5%New Jersey

9.117.5%Georgia

36.118.8%California

17.819.6%Florida

22.924.6%Texas

Population in Millions

Percent

Location

Source: Wall Street Journal Politics & Economics December 21, 2006

Uninsured Population in large States

Understanding Insurance

• What Affects Cost?

– Plan Design– Utilization– Group Demographics

Who is enrolled in what plan?

55.2%

37.90%

5.80%0.90%

7.0%3.2%

0.0%0.1%3.3%

7.3%

89.3% 89.8%

0%

25%

50%

75%

100%

PPO HMO/POS/EPO CDHP FFS

National Texas Central TX

Plan Design

• Plan Design/Utilization– Deductible– Co-pay– Coinsurance– Out-of-pocket Maximum– Prescription Drugs– Network Steerage

Utilization

• Utilization & Review – Large Case Management– Disease Management– Hospital Surgical Utilization Review– Clinical Treatment Protocols – Health Coaches– Web Based Self Help Educational Tools

Health Care/Cost Management Components 2005-2007

2005-2006 2006-2007 2007-2008

Absorb Cost Increases 33% Absorb Cost Increases 39% Offer Health Risk Appraisal 13%

Increase Premium Contributions

25% Increase Premium Contributions

22% Disease Management Through Health Plan

11%

Increase Deductibles 22% Increase Deductibles 20% Employee Information on Provider Quality

8%

Increase Copays & Coinsurance

20% Increase Copays & Coinsurance

19% Behavior Change Programs Through Health Plan

8%

Offer Programs to Reduce Obesity

7%

Absorb Cost Increases 7%

Increase Premium Contributions

6%

Increase Copays & Coinsurance

6%

Disease Management Through Vendor

5%

Offer Personal Health Records

4%

Large Claims

• Effect of Large Claims

– 2007• 20% Of Claimants Account For 80% Of All Claims

Cost

– Often <2% of Claimants Account For 25-30% Of All Claims

How Does A Consumer Driven Health Plan work with an HSA or HRA?

• Insurance Protection (PPO)Insurance Protection provides comprehensive coverage and security

• Higher DeductibleCoverage starts above higher “deductible” to encourage prudent spending

• Integrated Savings AccountIntegrated Savings Accounts are for member to “use or keep” how they see

fit

Insurance Protection

Insurance Protection

HRA Insurance Protection

Plan D

$300

Health Reimbursement Account RRA

$$$$

One Plan

$750 Deductible

$4,000 OOP

80/50

MAC A 10/35

Debit Card procedures will be established for HRA balances that may be accessed for time of service eligible healthcare services

Money can be used to offset the cost of dependent care coverage

Unlike Flex Dollars, HRA monies are owned by the employer and roll from year to year

Plan A

Plan D

$300 Deductible

$2,500 OOP

80/50

MAC A 10/35

$300$350

Health Reimbursement Account RRA

$$$$

Two Plans

$750 Deductible

$4,000 OOP

80/50

MAC A 10/35

Payroll Deductions would need to be established for buy up plans

Debit Card procedures will be established for HRA balances that may be accessed for time of service eligible healthcare services

Money can be used to offset the cost of dependent care coverage

Unlike Flex Dollars, HRA monies are owned by the employer and roll from year to year

Plan A

Plan C

Plan B

$0 Deductible

$3,000 OOP

90/10 Hospital

80/50

MAC A 10/35

$200$265$325

$$$$

Group Individual Choice Health Plan

$750 Deductible

$4,000 OOP

80/50

MAC A 10/35

$500 Deductible

$2,500 OOP

80/50

MAC A 10/35

Payroll Deductions would need to be established for buy up plans

Debit Card procedures will be established for HRA balances that may be accessed for time of service eligible healthcare services

Health Reimbursement Account Retiree Reimbursement Account

Section 125 Flex & HRA

Flexible Spending Accounts Direct Management of Flex–Medical and Dependent–Debit Card & Paper–Direct Deposit–Recurring Expense–Grace Period Coordination

Health Reimbursement Account

Direct Management of HRA –Medical Contributions–Eligible Medical Services–Dental Contributions –Eligible Dental Services–Vision Contributions –Eligible Vision Services–Medicare Part B Premiums–Medicare Supplement/Advantage Premiums

Health Savings Account

Health Savings AccountExante is Bank Trustee –Medical Contributions –Eligible Medical Services–Dental Contributions–Eligible Dental Services–Vision Contributions –Eligible Vision Services–Medicare Part B Premiums–Medicare Supplement/Advantage Premiums

Prescription Drugs

Prescription Metrics

Prescription 2007 % Retail Prescriptions 91.6%

% Mail Prescriptions 8.4%

Biotech Specialty 14.8%

Member Cost Share 30.5%

% Generic Filled 54.07%

% Brand Filled 45.26%

% Biotech Specialty Filled .34%

% of Specialty $ to Total Rx $ 12.51%

 

With health care costs on the rise, the use of generic medicines is an easy and effective way to save money.

Here’s why:

    Generics are reviewed by the U.S. Food and Drug Administration (FDA) for safety and efficacy and are manufactured under the strict standards that apply to brand-name drugs

   

Generic drugs create competition, which keeps prices down

Research shows that plan participants can save an average of 30% to 80% when they fill their prescriptions with a generic instead of a brand-name medicine

Why Generics?

• Quantity Dispensed• Administrative Fee• Dispensing Fee• Rebate• Formulary• Extended Release Medications costing more than

standard version (anti-depressants, anti-cholesterol, calcium channel blockers, hypertensive agents and sedative hypnotics)

Prescription Transparency

Copay Steerage

Generic $10

Name Brand $38

MAC A

If a brand name drug is dispensed and a generic equivalent drug exists, the Covered Person pays the difference between the brand name and generic price in addition to the appropriate copayment for the brand name.

Mail Order 2 or 2.5 of retail copay

Biotech $80

Wellness

Focus on Wellness is rapidly becoming part of the employer, group health plan and community landscape.

Major benefit of a healthier workforce is reduced

healthcare cost

Other benefits include enhanced workforce productivity, reduce absenteeism and fewer work-related injuries.

Investing in the Health and Well-being of employees

Early Diagnosis and Intervention

Medical Management Disease Management

Large Case Management

Treatment Compliance

Integration of Healthcare Components

Claim Cost Management

Health / Wellness Promotion

Consumer Education (Mail-Outs)

E-Tools

Personal Health Record

$150 Incentive

Healthy Population Acute Chronic Catastrophic

D2Hawkeye

Prescription Claims

Medical Claims

Lab Values

HRA

Medical Management Resource Tool

HEALTHY INITIATIVES INTERVENTION

Healthy Population

Chronic CatastrophicAcute

Wellness Material

Wellness Material

Wellness Materials

Wellness Materials

3 Health Coach Calls

5 Health Coach Calls

36 Health Coach Calls

52 Health Coach Calls

Provider Provider Provider

Reinsurance Reinsurance

BeWellat TML

Activity Duration Points MON. TUES. WED. THUR. FRI. SAT. SUN TOTAL Brisk Walk OR Jog 1 mile / daily 2

Aerobics / Bike Riding 30 min. / daily 2

Weight Training 30 min. / daily 2

Recreational Sports 60 min. / daily 2

House Cleaning/Yard Work (3 hours) Weekly 2 max XXX XXX XXX XXX XXX XXX XXX

Stretching 20 min. / daily 1

Drink Water 48 oz./daily 1

Low Fat Intake OR Low Calorie Intake < 45 g. / daily 2,200 Calories

1

Fruits/Veggies 4 servings

Daily 2

Limit 2 Caffeine drinks Daily 1

Sleep 7 hrs / nightly 1

Person al Quality Time Reading/Mediation

30min/daily 1

Perfect Attendance Quarterly 5 max XXX XXX XXX XXX XXX XXX XXX

Limit 1.5 hrs TV/Non -work Computer Daily 1

Limit 1 alcohol drink per day/7 weekly Weekly 3 max XXX XXX XXX XXX XXX XXX XXX

Nicotine Abstinence Weekly 3 max XXX XXX XXX XXX XXX XXX XXX

Brown Bag Session Attendance per session Quarterly

3 per session

Routine Biometric Screening

Power Points

_ Health Risk Appraisal Annually 25 _ Routine Physical Annually 25 _ Colo -Rectal Exam (50 yrs & older) Annually 25 _ Mammogram Annually 25 _ PSA test Annually 25 _ PAP test Annually 25 _ Cholesterol Screen Annually 25 _ Osteoporosis Screen Annually 25 _ Blood Glucose Screen Annually 25 _ EKG Annually 25 _ Digital Rectal Exam Annually 25 _ Bone Density Screening Annually 25

Total: [Wellness Points] WEEKLY TOTAL:

[Wellness Points + Power Points] ANNUAL TOTAL :

BeWellatTMLMaintenance Program

1.  Create a Wellness Committee & Establish a worksite Mission Statement recognizing employee health and wellness as being important to the long-term success and well being of the organization.

2.  Pre- and post-surveying of employees, suggestion/comments box on wellness, ideas/contests. Wellness on the worksite is best when it is fun!

 

3. Establish a physical activity program at the worksite (map and measure walking paths in and around the area surrounding the worksite).

4. Encourage healthy foods at worksite meetings and in vending machines.

 

5. Research and post local wellness initiatives that are occurring in the community.

6. Create a wellness calendar that highlights organized activities for the month. Events must be planned in advance and should tie into community programs, physical activity sponsored by programs, and national programs.

Wellness in the Workplace

Start Slow;Stay Steady-

You WIN!F I

N I

S H

Employee Education

New Hire Enrollment

Education is Key….

Health Fairs: Onsite lab services, Contests

Open Enrollment Education Meetings: Conduct presentations and provide education to employee population

Brown Bag Lunch: Employee Assistance Program or other resource

1. Stress2. Finances3. Depression4. Nutrition5. Exercise6. Nutrition

Wellness Committee

Employee Communication: Assist with payroll stuffers, posters, etc.

PEBA

Leverage for Political Entities

AGRIP

Retirees

• Baby Boomers are retiring and living longer• Generation X’s retiring earlier and starting

second career• Benefit Options [ For under 65 and over 65]

• Employer Definition of Retiree- Accordance with Existing Retirement Program (TMRS)- Under 65 & Over 65, Time of Service, Definitions- Develop Sample Employer Policy and Procedures/or

Ordinances• GASB-Support-Actuarial Service-Strategies

Retiree concerns are one of the biggest challenges faced by Employers

Retiree Solutions

• Comprehensive Medical Plan Option• Medical Plan Option

– Plan Subsidy / Employer Funding• Voluntary• Contributory• Mandatory

• Under 65 and over 65Retiree Benefits– Dental– Vision– Life

• Retiree Reimbursement Accounts

Retiree Benefits

TML IEBP Mission Statement

To provide excellent service and administrative services to eligible municipalities in Texas by

utilizing innovative, affordable alternatives while maintaining financial integrity.

Not-for-Profit

Member Equity

Operational

Efficiency

Exclusive to Public Sector

Questions?

“May I be excused? My brain is full.”

Thank You!