Benefits as a Strategic Plan June 13, 2018 | Emily Bailey, Eric - - PowerPoint PPT Presentation

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Benefits as a Strategic Plan June 13, 2018 | Emily Bailey, Eric - - PowerPoint PPT Presentation

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HRLA of Eastern CT Benefits as a Strategic Plan June 13, 2018 | Emily Bailey, Eric Pomroy 1 Agenda Plan Design Prescription Drug Programs Cost Control Measures Other Considerations Navigating the Healthcare System

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Benefits as a Strategic Plan

HRLA of Eastern CT

June 13, 2018 | Emily Bailey, Eric Pomroy

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Agenda

  • Plan Design
  • Prescription Drug Programs
  • Cost Control Measures
  • Other Considerations
  • Navigating the Healthcare System
  • Synthesize into an Action Plan

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WHO IS IN THE ROOM?

  • Employee Count
  • Under 50
  • 50 to 250
  • 250-1000
  • 1,000+
  • Fully Insured VS. Self-Funded
  • Early Adopters – More like a municipality or more like a tech

company?

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What’s New in Benefits Design?

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Value-Based Insurance Design – How Does it Work?

“Supply side” (payment) initiatives are restructuring provider incentives to move from volume to value Value Based Insurance Design strategies use “demand-side” incentives to move consumers from volume to value Put together, these strategies enhance quality and experiences of care, and can contain costs

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Value-based payment arrangements Value-based Insurance Design Better healthcare value

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What is an ACO? A change in provider reimbursements, delivery of care, and patient satisfaction are the cornerstones of Accountable Care Organizations. What is New? Many carriers are now offering specific plan designs and benefit packages around the ACO model which offers 3 Tiered Networks.

TURNING AN ACO INTO AN INSURANCE PRODUCT “VBID”

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How Can We Control Rx Cost?

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THE PERFECT STORM…

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PHARMACY BENEFIT MANAGER (PBM) CARVE-OUT

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  • Transparency
  • AWP Discount
  • Dispensing Fees
  • Rebates
  • Clinical Programs
  • Formulary Management
  • Manufacturer Coupons
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How Can We Control Cost?

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ALTERNATE FUNDING OVERVIEW

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  • Status Quo
  • No Risk
  • Limited Information
  • Fixed Premium

Fully Insured

  • Lifts the veil
  • Form of self-insurance
  • Introduction to stop loss
  • Limited Risk
  • Provides Data
  • Fixed Premium
  • Possible Surplus
  • Plan flexibility

Level Funding

(*3%-4% Savings)

  • Eyes wide open
  • Applies stop loss knowledge
  • Claim payments are variable
  • Plan flexibility
  • Moderate to High Risk
  • Cash Flow
  • Lower Premium

Self Insured

(*5%-10% Savings)

  • Progressive
  • Controls Costs
  • Targets Hospital services
  • Claim payments are variable
  • Plan Flexibility
  • No Hospital Network
  • Ultimate Savings
  • Educational Curve/Risk
  • Lower Premium

Self Insurance with Reference Based Pricing

(*Up to 20% Savings)

Greater Risk Greater Reward

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SELF-INSURED WITH CAPTIVE

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A program owned by at least one non-insurance company for purposes of managing and controlling employee benefit risk Advantages:

  • Control (ownership)… retain profits
  • Lower overhead
  • Long-term stability
  • Stop loss protection against large claim risks at a lower cost
  • Data availability and transparency
  • Collaboration/Best Practices

Disadvantages:

  • Potential up-front capital requirements
  • More risk retained by participants

Employer

  • Each participant (employer) holds

first layer of risk

Captive

  • Captive holds middle layer risk
  • Captive has P&L

Stop Loss

  • Captive purchases reinsurance for

catastrophic claims

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VALUE-BASED PAYMENTS – “VBP”

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https://vimeo.com/123839661

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HOW VALUE-BASED PAYMENTS COMPARE

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HEALTHCARE PRICING TRENDS

Typical Renewal Inflation - Fully-Insured of 12% vs. Self-Funded of 8% vs. VBP tracking Medicare at 1%.

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HOW DOES IT WORK?

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What Else Should Employers Consider?

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DIVORCING YOUR SPOUSE’S COVERAGE

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Premium Contributions Spousal Surcharge Medical Expense Reimbursement Plan (MERP)

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THE WORKPLACE IS CHANGING…

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Millennials =

50% of the

workforce in

2020

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BENEFIT PLANNING & QUESTIONS

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  • What benefits are we missing to retain & attract employees?
  • How will our benefit communication change?
  • Open enrollment meetings
  • Open enrollment handouts
  • Enroll via portal
  • How will yearly enrollment change?
  • How can we leverage technology for our communication &

enrollment strategy?

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WHAT DOES THIS MEAN?

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BENEFITS AND HR TECHNOLOGY

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A Simple Solution to Navigating Healthcare

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HEALTH NAVIGATORS / CARE COORDINATORS

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BENEFIT PLANNING & QUESTIONS

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Guiding the patient through the system Finding the right doctor/hospital Referrals & Pre-Authorizations Discussing the options Answering questions Transition of care 2nd Opinion Explaining

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How do we get there?

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DEVISING YOUR PLAN

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Components Phase 1 Phase 2 Phase 3 Plan Design & Funding

Fully Insured CDHP offered as an option Level-Funded CDHP as full replacement with dual option Self Insured CDHP as full replacement with dual option, explore value based plan design.

Employer Contribution:

  • Approx. 75% Employer Paid

Increase Spouse/Dependent Differential Increase Spouse/Dependent Differential

Employer HSA Funding:

None Earned Deductible Funding based on wellness activities Earned Deductible Funding based on wellness activities

Health Improvement

Establish Wellness Committee Gather baseline data on interests and biometrics Implement Preventive Care Campaign TBD by Wellness Committee Carrier Budget TBD by Wellness Committee Carrier Budget Enhanced Third- Party Portal

Analytics

Carrier Utilization Package Carrier Utilization Package Bi-Annual Reporting Package Carrier Utilization Package Quarterly/ Monthly Reporting Package Enhanced Analytics Package

Service and Support

Carrier Dedicated Client Service Executive Customer Advocate Center ThinkHR Custom Employee Communications Compass MD Live Carrier Dedicated Client Service Executive Customer Advocate Center ThinkHR Video Benefits Custom Employee Communications Compass MD Live Carrier Dedicated Client Service Executive Customer Advocate Center ThinkHR Video Benefits Custom Employee Communications Compass MD Live

Technology

Payroll Vendor Support HRIS with Self Service HRIS with Self Service EDI

Compliance

Compliance Advantage Assessment Seminars / Webinars BLR Compliance Advantage Seminars / Webinars BLR Compliance Advantage Seminars / Webinars BLR

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What questions do you have?

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ERIC POMROY Business Development Executive OneDigital | Health and Benefits

Office: (860) 470-0325 Mobile: (860) 575-0685 Toll Free: (800) 964-7575 x6410 Fax: (855) 242-1977 5 Batterson Park Road, Suite 1, Farmington, CT 06032 epomroy@onedigital.com | onedigital.com

EMILY L. BAILEY

Principal, Managing Consultant OneDigital Health and Benefits Office: 860-773-6999 Mobile: 860-906-6851 ebailey@onedigital.com