Trustees Finance & Audit Committee, April 2012
29
Trustees Finance & Audit Committee, April 2012 2013 Healthcare Program
description
2013 Healthcare Program. Trustees Finance & Audit Committee, April 2012. Current Status – April 2012. 17,300 FT Employees; 16,150 enrolled in medical 37,000 plus covered lives 4 medical plans: PPO networks, with member cost sharing Salary-based premiums, with credit for non-use of tobacco - PowerPoint PPT Presentation
Transcript of Trustees Finance & Audit Committee, April 2012
Trustees Finance & Audit Committee, April 2012
2013 Healthcare Program
Current Status – April 2012
17,300 FT Employees; 16,150 enrolled in medical37,000 plus covered lives4 medical plans: PPO networks, with member cost sharingSalary-based premiums, with credit for non-use of tobacco
HDHP & HSA with 8,100 employee enrollments PPACA compliantNo post-65 Retiree Healthcare liability FY 2011/12 IU Budget for Healthcare = $186.6 m
FY 2012/13 IU Budget = $197.8 m or $11,433 per eligible employee
Assumptions for CY 2013(as of April 2012)
Same or lower number of covered employeesSame medical plan options as 2012
increase enrollment in the HDHP & HSA plan
Moderate increase in total premiumssmall or no increase in HDHP plan premiums
PPACA: new “Summary of Benefits and Coverage”annual limit of $2,500 for health FSA contribution, starting 2013Form W-2 reporting for 2012 health coverage
Cost Increases: 1) provider fees and 2) medical utilization
Medical Utilization – The Top 10
“Disease and Injury” Classifications(by $s paid for 2011)
% Difference w/2010
Supplemental Classifications (e.g. pregnancy, dialysis) - .6%Musculoskeletal system & connective tissue + 29.4%Neoplasms + 22.9%Circulatory system + 4.7%Symptoms, signs and ill-defined conditions (e.g. ER) + .4%Digestive system - 10.3%Genitourinary system + 5.9%Nervous system & sense organs + 30.0%Injury & poisoning - 9.5%Complications of pregnancy and childbirth + 11.6%
Prescription Drug Utilization – The Top 10
Therapeutic Class (by $s paid for 2011) % of Total # Rxs
Miscellaneous (e.g. transplant, MS) 2.5%Anti-depressants 9.8%Lipotropics 7.8%Diabetic therapy 4.1%Anti-arthritics 2.7%Bronchial dilators 3.2%Anti-ulcer 3.7%Antivirals 0.9%Anti-neoplastics (cancer) 0.5%Other hypotensives (blood pressure) 7.4%
Relationship Between Members and Plan CostsIU’s Employee Medical Plans
Members Plan Costs
21%
12%
37%
29%
7%
20%
43%
15%
1%
1%
8% of members = 58% of costs
28% of members = 87% of costs
71% of members = <14% of costs
14% of members with no costs
Relationship Between Members and Plan Costs for 2011IU’s Employee Medical Plans
Members
29%
7%
20%
43%
15%
1%
14% 5,180 mbrs
15,910 mbrs
7,400 mbrs
2,590 mbrs 370 mbrs
5,550 mbrs
$ 0.0 --- $ 0 / yr
$ 1.9 m --- $ 342 /yr
$ 22.8 m --- $ 1,433 / yr
$ 55.1 m --- $ 7,446 / yr
$ 70.3 m --- $27,143 / yr $ 39.9 m --- $107,838 / yr
$ Per Member
Major Medical Program InitiativesInitiatives that
Are applicable across all medical plan optionsComplement or supplement provider and member activities
Integrated Clinical Care Services -- details to follow
Personal Health Record (PHR) Personal web-based access to medical records, such as: contact info, medications, immunizations, illnesses, medical history, allergies, biometric tracking, legal documents, etc.Data integration with Medco, Anthem, and IU Health/HealthSmartSupport for Clinical Care Services program (clinical portal)
TransparencyMember web-based access to: location of PPO providers; “price” for services by provider; “cost” for episodes of care by provider group/healthcare system; and quality measures & patient satisfaction
Major Medical Program Initiatives
Integrated Clinical Care Services Improve access to primary care providers, for routine and urgent careDedicated care management team, for patients with chronic and/or complex medical conditions Connectivity of medical records
Integrated Clinical Care Services
Virtual patient centered medical homeEssential components:1. Primary care provider group(s)2. Dedicated team of nurse care-managers3. Electronic medical records system (EMR)4. IU-based resources
Promotion to plan membersExpansion opportunities
Integrated Clinical Care Services
1. Primary Care Provider Groups Physicians, nurse practitioners, physician assistantsWalk in care, same day appointmentsAfter hours access: telephone, e-visitsElectronic Medical Records (EMR) system Quality Health First program measuresParticipate in care management activities
Integrated Clinical Care Services
1. Primary Care Provider Groups Proposed initial rollout in Bloomington
East of the IU Bloomington campusSare Rd. – Premier HealthcareClarizz Blvd. – IU Health Southern IN Physicians
West of the IU Bloomington campusLandmark Ave. – Premier HealthcareRogers St. – IU Health Southern IN Physicians
Integrated Clinical Care ServicesPrimary Care Provider Groups -- Proposed
Integrated Clinical Care Services
2. Nurse Care-Managers (including pt pharmacist)
Care transitions: hospital home, p-care specialty careMedication management for chronic conditionsRegistries for diabetes, high blood pressure, high cholesterol, asthma, heart failure, COPDOutreach to patients with a chronic conditionSupport self-management by patientsTriage agent
Integrated Clinical Care Services
3. Electronic Medical Records (EMR) SystemConnectivity across all providersMeet NCQA medical home standardsIncludes e-prescriptionsAdditional features:
Order & retrieval of lab and imaging testsPatient portal for medical records, scheduling appointments, prescription refills, referrals
Connected with IU Health and IU Health Physicians
Integrated Clinical Care Services
4. IU-based ResourcesMembership data: employees, retirees, graduate assistants and their families, who are covered by IU medical plansCoordinate with existing care-management programs
Anthem, Aetna, MedcoInterface with existing programs: 24-hour nurse line, tobacco cessation, nutrition & weight management, Employee AssistanceWritten and website communications
Integrated Clinical Care Services
Promotion to Employee/Retirees/Graduate AssistantsGreater access to primary careNurse care-manager for consultationEnhanced medical plan coverageEnhanced dental plan coverageElectronic connectivity
Electronic Medical Record (EMR)Personal Health Record (PHR)
Integrated Clinical Care Services
Expansion Considerations Pediatrics in Bloomington Adults in
EllettsvilleBedfordSpencerNashville
Adults and pediatrics at other Indiana regions, especially where meaningful numbers of plan members reside
Clinical Care ServicesProvider Locations
IU Health Southern Indiana Pediatrics Clarizz Blvd.
IU Health Southern Indiana Pediatrics Landmark Ave.
IU Health Southern Indiana Pediatrics Arlington Rd.
IU Health Southern Indiana PhysiciansClarizz Blvd
IU Health Southern Indiana PhysiciansRogers Rd.
IU Health Urgent Care EastWoodcrest Dr.
IU Health Urgent Care WestThird St.
Premier Healthcare Medical CenterLandmark Ave.
Premier Healthcare Family PracticeLandmark Ave.
Premier Healthcare Family PracticeSare Rd.
