David E. Edman LOOKING AHEAD: EMERGING TRENDS IN HEALTH BENEFITS Tuesday, May 20, 2008, 2:00 PM
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David E. Edman LOOKING AHEAD: EMERGING TRENDS IN HEALTH BENEFITS Tuesday, May 20, 2008, 2:00 PM 175 Strafford Avenue Suite One Wayne, PA 19087 610-975-4415 ♦ ♦ ♦ ♦ www.RMPLLC.biz 2008 Disease Management Colloquium
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David E. Edman LOOKING AHEAD: EMERGING TRENDS IN HEALTH BENEFITS Tuesday, May 20, 2008, 2:00 PM. 2008 Disease Management Colloquium. 175 Strafford Avenue ♦ Suite One ♦ Wayne, PA 19087 ♦ 610-975-4415 ♦ www.RMPLLC.biz. Manager of Health Benefits. RISK MANAGEMENT PARTNERS LLC - PowerPoint PPT Presentation
Transcript of David E. Edman LOOKING AHEAD: EMERGING TRENDS IN HEALTH BENEFITS Tuesday, May 20, 2008, 2:00 PM
David E. Edman
LOOKING AHEAD:
EMERGING TRENDS IN HEALTH
BENEFITS
Tuesday, May 20, 2008, 2:00 PM
175 Strafford Avenue ♦ Suite One ♦ Wayne, PA 19087 ♦ 610-975-4415 ♦ www.RMPLLC.biz
2008 Disease Management Colloquium
Manager of Health Benefits
RISK MANAGEMENT PARTNERS LLCHealthcare Solutions That Work
175 Strafford Avenue ♦ Suite One ♦ Wayne, PA 19087 ♦ 610-975-4415 ♦ www.RMPLLC.biz
RISK MANAGEMENT PARTNERS LLCHealthcare Solutions That Work
175 Strafford Avenue ♦ Suite One ♦ Wayne, PA 19087 ♦ 610-975-4415 ♦ [email protected]
WHY DOES HEALTHCARE COST SO MUCH?
Primarily because 25% to 30% of healthcare costs are wasted on:
• Unnecessary Care
• Inappropriate Care
• Poor Quality Care
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Annual Cost of Poor-Quality: $2500 Per Employee (est.)
MOST COSTLY QUALITY PROBLEMS
1. Drug misuse2. Overuse of antibiotics3. Overuse of inpatient care4. Preventable hospital-acquired infections5. Diabetes – direct and indirect costs6. Depression – total economic burden7. Inadequate care after heart attack8. Underuse of influenza and pneumococcal vaccinations9. Asthma – direct and indirect costs10.Congestive heart failure – direct costs
Source: Midwest Business Group on Health, in collaboration with Juran Institute, Inc. and The Severyn Group Inc., 2002.
RISK MANAGEMENT PARTNERS LLCHealthcare Solutions That Work
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“The Quality of Health Care Delivered to Adults in the United States”
Medical Condition % Adherence To Quality Indicators
Breast Cancer 75.7
Low Back Pain 68.5
Hypertension 64.7
Congestive Heart Failure 63.9
Depression 57.7
Asthma 53.5
Diabetes 45.4
Headache 45.2
Alcohol Dependence 10.5
Source: RAND Corporation Study, published by New England Journal of Medicine, June 26, 2003
THE MYTH OF ‘BEST IN THE WORLD’
BY SHARON BEGLEY, NEWSWEEK, March 22, 2008
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How does the US infant mortality rank among industrialized countries?28th of 30 countries (7 deaths per 1000 live births)
The five-year survival rate for cervical cancer?Worse than Italy, Ireland, Germany, and others.
The survival rate for breast cancer?You would do better in Switzerland, Norway, Britain, and others.
Asthma mortality?Twice the rate of Germany’s or Sweden’s.
Source: Organization for Economic Cooperation and Development (OECD), 2007
THE SHAPE OF THINGS TO COME
From Dec 11th 2003, The Economist print edition.
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Main Entry: 1in·sur·ance Pronunciation: in-'shur-&n(t)s also 'in-"Function: noun1 a : the business of insuring persons or property b : coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril c : the sum for which something is insured2 : a means of guaranteeing protection or safety <the contract is your insurance against price changes>
Insurance (definition)
HSA Concept
Traditional
Health
Coverage
Traditional Health
Coverage
Member Responsibility
Health Savings
Account
(HSA)
From: To:
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100% F
or In
-Netw
ork P
reventive C
are
Insured Claims Experience
80% of insureds have claims < $3,000
70% of insureds have claims < $2,000
55% of insureds have claims < $1,000
Milliman USA (2002)
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Prevention: Health Coaching & Wellness Programs
On-line Portal: Patient Education, Information Gathering & Sharing
24 Hour Nurse: On-Line & Telephone Coaching
Intermediate Care Programs
Disease Management Programs
Catastrophic Case Management
Healthy Acute Illness Chronic Illness Catastrophic
Prevention: Health Coaching & Wellness Programs
On-line Portal: Patient Education, Information Gathering & Sharing
24 Hour Nurse: On-Line & Telephone Coaching
Intermediate Care Programs
Disease Management Programs
Catastrophic Case Management
Transition of Care
Source:
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Population Management Segmented By Individual’s Level of Risk
HEALTH BENEFITS
FROM PATERNALISM TO SHARED RESPONSIBILITY
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Paternalism Shared Responsibility
Employer Pays The Premium Employer/Individual Buys A HDHP
EE Pays Little or Nothing At Point of Care
Patient Pays From HSA Up To High Deductible
Doctor Knows BestDoctor Recommends, Patient
Decides
BENEFITS OF SHARED RESPONSIBILITY
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• Greater Efficiencies From Appropriate Application of Insurance Principles
• Lower Costs and Great Value For Purchasers
• Employee Incentives: Healthy Lifestyles and Appropriate Utilization
• Greater Employer Control Over Future Healthcare Costs (Carrier Agnostic)
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CRITICAL ROLE FOR PURCHASER DRIVEN ADVOCACY
• Focus on Consumerism
• Promote Enhanced Transparency
• Centers of Excellence/Certificate of Need (CON)
• Emphasize Primary Patient Care
• Offer Association (Like) Health Plans
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SPARK THE REVOLUTION:
Health Reform is Gaining Traction in the Marketplace
“HSAs put individuals in charge of their own ‘cost containment’, rather than the government or HMOs. The latest news is that they have been proving their attractiveness in the marketplace more rapidly than supporters expected.”
--Wall Street Journal, December 27, 2005, A20
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Will This Be déjà vu All Over Again?
