Make It Stick: Engaging Today’s Consumer in a Post-Reform...
Transcript of Make It Stick: Engaging Today’s Consumer in a Post-Reform...
Make It Stick: Engaging Today’s Consumer in a Post-Reform WorldJohn Mills - Senior Director, Commercial Products, UPMC Health PlanLisa Fry - Partner, Subsidium HealthcareChristine Muldoon - Senior Director of Market Strategy, WebMD
June 3, 2014
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Our Conversation Today
Introductions and Overview1
2An Outside Perspective: Market TrendsLisa Fry, Subsidium Healthcare
4 Discussion and Q & AJohn Mills
Senior Director, Commercial Products UPMC Health Plan
3 UPMC Health PlanJohn Mills, UPMC
Lisa FryPartner
Subsidium Healthcare
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TOTAL MONTHLY UNIQUE USERS
64 MILLION39 MILLIONMONTHLY MOBILE UNIQUE
USERS1
ACTIVE US PHYSICIANS
625,000
440,000REGISTERED US PHYSICIAN
MOBILE USERS
REGISTERED USERS
7.1 MILLION
4.7 MILLIONACTIVATED PERSONAL
HEALTH RECORDS
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The Six Key Elements You Need to Knowfor Creating Member Engagement
New eBook!
Stay Tuned For Your Copy!All webinar attendees will receive a copy of the eBook.
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Motivate workers to take charge
Encourage workers to become better advocates for their health
Encourage healthy behaviors with financial
incentives
Inspire
Building a healthy workforce is a team
effort
Adopt healthy
behaviors
Engagement is THE Requirement
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IT’S ALLENGAGEMENT
An Outside PerspectiveLisa Fry - PartnerSubsidium Healthcare
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The stakes are huge….
The Battle for the Hearts and Minds of Healthcare Consumers
Nearly $1 of every $5 spent on health care
$1
….and it attracts a lot of attention from competitors
The Battle for the Hearts and Minds of Healthcare Consumers
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Planning Your Consumer Engagement Strategy
Identify Objectives and Define Success
Determine Key Capabilities
Required
Conduct Gap Analysis
Outline Key Programs and
Initiatives
Measure and Iterate
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Identify Objectives and Define Success
Overall Member Loyalty
Overall Member Loyalty:• Attracting new members• Retaining existing members
longer to improve ROI
Health Promotion and Improvement:• How will you define engagement?• Improved health status• Lower costs
Health plans will define success with a variety of metrics; these are changing with the impact of ACA and exchanges
Health Promotion
and Improvement
Overall Member Loyalty
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Fundamental Characteristics of Successful Consumer Engagement Programs
PersonalizationConvenience
TimeTrust
Easy-to-Understand Information
Resources(Money, Time,
Data)
Success Factors For Engaging Consumers
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Key Capabilities Required: Examples
BRANDBRAND
CONSUMER EXPERIENCECONSUMER EXPERIENCE
DATA/ANALYTICS
Rules Engine
Segmentation Profiles
Internal Longitudinal Data
External Consumer Data
TOOLS AND PROCESSES
Rewards, Loyalty Programs
Mobile Tools
Consumer Guidance
Multi-Modal Access and Contacts
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40%
17%1%
20%
6%
17%
2 in 5 Are Unaware of Their Insurer’s Health Information Site
Health Info Site Usage
Over half of eligible health plan members say they use or woulduse their insurance company’s health information website
Only 1 in 4 say they don’t use or would not use
Source: 2014 Blue Research® End User Insights Panel
Insurance company has site, I’ve used before
Insurance company has site, I have not used
Insurance company has website, don’t know if I have
used
Insurance company does NOT have site, I
would not use
Insurance company does NOT have site, don’t know
if I would use
Insurance company does NOT have site, but I would use
John Mills Senior Director, Commercial ProductsUPMC Health Plan
Impact of the ACA on Individual and Small Group Markets
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Premium Subsidies
Cost-Sharing Subsidies
Medical Loss Ratio Rate Review
Premium Tax/Other
FeesRating Rules
Essential Health
Benefits
Individual Mandate
• Major upheaval in Individual and Small Group markets• Influx of newly insured individuals• Insurance is moving towards a consumer market
• 55.7% are Male• 85% are between ages of 19 and 65• White residents make up the large majority of uninsured’s• 64% are below 200% of FPL, however 18% are over 300%• 60% of uninsured’s are working, 25% work for companies with less than
4 employees– Service industry (56.3%)– Retail (16.4%)– Construction (12.2%)– Manufacturing (10.4%)
• Lower income and education than overall population• Reduced ability to interpret labels and health messages
Demographic Characteristics of the New Uninsured Consumer
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• In the past year:– 40% have not seen a doctor – 60% have not seen a doctor for routine care – Less than 10% have stayed overnight in the hospital – 40% have visited the dentist – 10% sought care at an ER because they could not find a doctor
• Overall– Less likely to take prescription medications on a regular basis– Lower likelihood of seeking preventive care– Greater use of emergency care– Worse overall health status and higher mortality rates
• Cost is a barrier to Care– 10% skip doses or took smaller amounts to make Rx last longer– 20% had to pay $500 or more out of pocket for services in the past year– 40% report having trouble paying medical bills
Health Status of the New Uninsured Consumer
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• Performed extensive persona work and identified key purchasers– In and Out of Medicaid– Blue Collar– Small Business– Affluent
Persona Work
19
Personas
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FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals
Annual Income for Ind. $15,856-$28,724 $28,725-$45,959 $45,960+
• Subsidy Eligible• Shop on Price Primarily• Network is Secondary• Highly Likely to Change
PCP for 10% Discount in Premium
Personas
21
FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals
Annual Income for Ind.$15,856-$28,724 $28,725-$45,959 $45,960+
• Shop on Marketplace• Tax Credit Eligible• Price Driven• Network is Important• Brand and Access• Wants Insurance that
Covers his Bills without a lot of Hassle
Personas
22
FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals
Annual Income for Ind.$15,856-$28,724 $28,725-$45,959 $45,960+
• Shop Direct or Via Producer
• Price is Important• Network is Important• Brand and Access• Higher Income, Can
Afford Brand Choice• Less Likely to Switch Year
to Year
Personas
23
FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals
Annual Income for Ind.$15,856-$28,724 $28,725-$45,959 $45,960+
• Shop Direct or Via Producer• Benefits are Most Important• Will Pay More Up Front to
Not Have to Worry About Costs During the Year
• Higher Income, Can Afford Brand Choice
• Less Likely to Switch Year to Year
• Take a Healthy Step (TAHS) program is a standalone health and wellness offering that can be adopted with any medical plan Earn points or dollars Complete set of activities to accomplish goal Incentives can be disbursed in a number of ways, at discretion of employer;
Deductible credits, premium reduction, gift cards, etc..
• HealthyU is a CDHP product with an integrated health and wellness component Earn Incentives during the plan year to use during the plan year Standard Incentive Package Earn dollars, not points Earn up to $500/$1000 each plan year Incentives are used to pay plan covered medical expenses
Consumer Engagement
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• Financial incentives can be successful in program participation and behavior change
• 2011 Harvard University study found that financial incentives helped improve participation in– Smoking cessation programs– Weight loss activities
• Affordable Care Act permits health plans to charge more for smokers than non-smokers– Rates can be lowered by enrolling in and completing a smoking cessation
program
• Major corporations have used financing incentives as a way to change behavior for years
Financial Incentives
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Step 1: Traditional HMO/PPO Low Deductible Plan
Traditional EPO or PPO
product
DentalVisionCobra
Workers Compensation
Member
• Little to no member engagement
• Health care is ‘free’ and my behaviors do not impact cost
• Complex administration• Disparate messaging on
Health and Productivity
Plan DesignDeductible $0PCP Copay $15Spec. Copay $30Pharmacy $4-$15-$50
Step 2: Cost Sharing + Integrated Wellness (Option 2)
DentalVision
CobraWorkers
Compensation
Member
• Member is engaged• Health care has a cost• My behaviors impact this cost• Wellness programs lead to
better health
• Complex administration• Disparate messaging for Health and
Productivity
Plan Design-HealthyUDeductible $750
Health Incentive $500PCP Copay 10%Spec. Copay 10%Pharmacy $4-$30%-50%
Step 3: Integrated Population Health Management
Integrated Product with Member Engagement
• Engaged Member• Incentivized Health and Wellness
• With Carrots and Sticks
• “It’s my health and my money and I am going to take better care of both”
• Unified messaging and communications• Ease of administration
Plan DesignDeductible $1,500Health Incentives $500PCP Copay 10%Spec. Copay 10%Pharmacy $4-30%-50%
Tools for Engagement
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Health Risk Assessment
30
Personalized Health Activities
31
Quality and Cost Information
32
• Compare Procedure Costs
• Compare Pharmacy Costs
• Find UPMC Health Plan Member-only Discounts
Compare Hospitals
33
View Information Regarding:
• Number of Patients• Mortality• Complications• Length of Stay• Safety• Patient Experience
• Identification of members with chronic conditions– Diabetes and Pre-Diabetes– Hypertension– Obesity– Smokers
• Improved program compliance– Success weight loss– Completion of smoking cessation program– A1Cs levels– Blood pressure
• Lower overall medical expenses
Success Metrics
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• Many individuals enrolling through Exchanges have chronic conditions but are unfamiliar with the healthcare system– Lack a regular doctor– Receive irregular treatment for chronic conditions
• Engagement tactics that have worked in an employer setting may not work with the Exchange population
• Experimentation will be necessary to determine to identify successful programs and interventions
Conclusions
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Making it Stick….The End Goal
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Making it Stick….The End Goal
• Members use your site as an integral part of their daily life, the way they use Facebook.
• They would panic at the thought of you going out of business because you have become indispensable to their health.
• You have engaged them on the level that drives results: Loyalty, retention, and healthy behaviors.
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• Map out your plan
• Get members involved
• Make your site awesome –intuitive navigation
• Communicate that awesomeness
Helping You Grow Your Engagement Potential
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