Evalu8 72009
28
Integrating Value-Based Benefit Design eValue8 User Meeting July 15, 2009
-
Upload
creichardt -
Category
Documents
-
view
468 -
download
2
description
Chicago Presentation on Value-based benefits
Transcript of Evalu8 72009
Integrating Value-Based Benefit Design
eValue8 User MeetingJuly 15, 2009
About Journal Communications
4,000 employees, 1,200 pre-Medicare and Medicare-eligible participants nationally.
Our strategic plan focuses on providing quality benefits while maintaining shareholder value.
Like other employers, we struggle with managing: Affordable coverage (employer and retiree) The impact of medical inflation on our budget; The health status of medical plan participants.
5 years ago…
4 benefit plans Copays for doctor appointments and pharmacy Low deductibles
Cost per employee per year – 30% above the Midwest average!
Attitude of entitlement. Very passive, little engagement
2004: Our Concerns Employer concerns:
How to afford exponential increases year over year. Participants did not understand how their benefits worked
or how much procedures cost. Many had chronic disease driving frequent hospitalizations,
ER visits and prescription drug use. High utilizers often non-compliant and driving up medical
costs. Member concerns:
Participants did not know how expensive their care was; no money saved.
Patients did not understand benefits and relied on physician to steer.
Patients with medication management needed more “touch” than plan would allow.
Question
What can we can do today, to improve the health status of our participants today AND tomorrow?
Strategy for all – Actives and retireesImprove the health status of the participants Provide access to qualified providers; Offer medical plans that require engagement of
participants; Reduce the barriers to preventive care; Give participants with chronic diseases tools and
support to manage their condition; Increase compliance for disease-specific
medications; Introduce wellness program that provides feedback
and Communicate, communicate, communicate…
Step 1: Promote the right provider Implemented a Narrow PPO Network in SE
Wisconsin Online Transparency Tools
Compare providers Quality and Safety – following safety practices
developed by the Leapfrog group. Promote and provide incentives for patients to
use cost-efficient providers within the network MRIs, CT Scans, Colonoscopies Commodity rebate of $100
Use plan design to steer participants
Step 2: Reduce Barriers to Care
Integrated EAP (5 visits) Updated Mental Health Benefits (Parity) Implemented Transparency Tools, Nurse Line,
Personal Nurse Preventive Care and Wellness:
Provide 100% coverage (deductible waived) for all preventive care
HSA Plans - Waive the medical deductible for “preventive” prescription drugs
Send wellness reminders to medical plan participants Offer free flu shots at all locations for employees,
participants and spouses
Step 3: Manage Chronic Disease and Increase Prescription Compliance Traditional Disease Management in 2004 Pharmacy compliance in 2008 (Based on Asheville Project)
Members with a personal health coach (from a network of local pharmacists);
Coordination with the patient’s physician or other healthcare providers to help effectively manage their Condition: Diabetes High Blood Pressure Cholesterol
Medication and supplies at no cost / reduced costPartners: Mirixa and Piedmont Pharmaceutical Network
Coordination and Support for the Patient
Patient Incentives – Diabetes & Cardiovascular Face-to-face coaching
Improved reliability via direct observation Interpersonal connection Strengthens the patient-physician relationship
HSA Medical plan deductible waived for preventive RX 100% coverage diabetes medication, test strips and
supplies Reduce copays by 50% for medication
Cholesterol Blood Pressure
Free Glucometers & Insulin Pumps
A word about incentives
Incentives are used in the beginning to get participants to engage
Participants don’t stay in the program because of the incentives…they stay because: More knowledge about their disease Improved Health Improved sense of well-being
Testimonial
I signed up for HealthMapRx for Diabetes because the medications were free. I had no idea how much this decision would impact my life.
I have lost 70 pounds…I am eating better, I am walking and my A1C shows my diabetes is in control! I feel better, I have more energy and now I can keep up with my grandchildren!
Brenda (my coach) is great! I’ve learned so much from her!
Thank you so much for offering this program.
Better Outcomes – Participant
With weight management, exercise and better diet and medication compliance:
Control blood sugar Control blood pressure Control of blood lipids (“good” and “bad”
cholesterols) Care of feet, eyes, kidneys Live a healthy, active lifestyle
Better Outcomes –Plan
Reduced costs to employer for health care: Lowers hospital admissions, length of stay as
well as ER visits Reduced risk of serious disease events
(prevent complications) Participants are more knowledgeable about
self-care Increased medication expense (compliance) Collaboration with patient’s physician
Step 4: Integrate Wellness
Partnered with Quality Health Solutions Health Risk Assessment that measures:
health status, readiness to change (Prochaska model) personal health history and health care utilization data
Coaching On-site health screenings (glucose,
triglycerides, blood pressure and BMI) On-line wellness tools (includes biometrics)
Putting it all together
Putting it all together
Keys to success???
Partner with a TPA that can/will support your initiatives. Find a trusted resource to assist with managing
eligibility of plans to maintain HIPAA compliance. Integrate the data from all of your resources:
Sick time/LOA/FMLA Disability Wellness Medical
Take the time to create links between processes. Make sure the communication is relevant.
Partner with your TPA
Spend time to determine what your TPA can do for you. Find out what they are doing for other customers. (Products, initiatives, plan design)
Share your plan initiatives with your TPA so they can support you.
Analyze your experience. Ask what will make the biggest impact.
Leverage economies of scale when it makes sense.
Don’t be afraid to ask for assistance. Don’t be intimidated by the answer “no.”
Outsourced Eligibility Administrator Protect confidentiality/PHI Manage eligibility of all H&W plans
Employee enrollment Online feeds to vendors Liaison between employer/vendor/health plan
Provide service center for questions/concerns Send communications to participants under
company brand “focus on opportunity” Manage employee appeal process
Integrate your data - make it work for you! Ask your vendors to share data with each other.
Find benchmarks that show improvement toward your goals.
Create a report card and share with your vendors, staff and E-team.
Use this data to help provide timely connections.
Medical Plan Wellness Biometrics
Disease Mgmt Prescriptions Disability
Personal Nurse Leave Management Preventive Care
HRA Rewards EAP
Getting to the right place at the right time Educate your vendors so that they
understand all of the resources you offer to employees.
Make sure they refer patients to the best resource.
Patients should feel helped, not threatened.
Help them learn so they can stay engaged.
Communication is key
Show executive buy-in Communicate often Provide multiple ways
to learn Print Teleconference/Webinar On-line resources Video E-mail
Make it relevant
Still more to do…
Expand beyond HealthMapRxTM for Diabetes
and CV Health: Depression Asthma
Develop more value-based purchasing opportunities
Continue to create incentives for patients to use efficient providers
Our Goal – Improving Health
Encourage patient to work with MD to tailor and monitor medication regimen, promote adherence.
Use HRA to help the patient assess, identify key issues. Guide them to the correct resource so they may develop working plan of care.
Provide coaching to motivate, inspire toward better behaviors: develop mutually agreeable goals, provide support in meeting them, rewards for achievement
Provide tools and advocates – guide, provide assistance with coordination, navigation, integration of overall care of key resources.
Resources - Connections
Center for Health Value Innovation Cyndy Nayer 314-422-4385, [email protected]
Mirixa (HealthMapRx) Cindy Schaller, 703.865.2035, [email protected]
www.HealthMapRx.com Piedmont Pharmaceutical Care Network
Larry S. Long RPh, 336-202-7146, [email protected]
Quality Health Solutions Brian J. Thomas, 888-747-0708 ext 102,
