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 • Synthesize into an Action Plan 2
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? 3
What’s New in Benefits Design? 4
Value-Based Insurance Design – How Does it Work? “Supply side” (payment) initiatives are Value-based payment restructuring provider incentives to move arrangements from volume to value Value Based Insurance Design strategies Value-based Insurance Design use “demand - side” incentives to move consumers from volume to value Put together, these strategies enhance Better healthcare value quality and experiences of care, and can contain costs 5
TURNING AN ACO INTO AN INSURANCE PRODUCT “VBID” 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. 6
How Can We Control Rx Cost? 7
THE PERFECT STORM … 8
PHARMACY BENEFIT MANAGER (PBM) CARVE-OUT • Transparency • AWP Discount • Dispensing Fees • Rebates • Clinical Programs • Formulary Management • Manufacturer Coupons 9
How Can We Control Cost? 10
ALTERNATE FUNDING OVERVIEW Self Insurance with Reference Based Pricing (*Up to 20% Savings) • Progressive Self Insured • Controls Costs (*5%-10% Savings) • Targets Hospital services • No Hospital Network Level Funding • Eyes wide open • Ultimate Savings • Applies stop loss knowledge (*3%-4% Savings) Greater • Risk Moderate to High Risk • • Lifts the veil Educational Curve/Risk • Cash Flow • • Fully Insured Form of self-insurance Lower Premium • Lower Premium • Introduction to stop loss • Limited Risk • Status Quo • • Provides Data Claim payments are variable • • No Risk Claim payments are variable • • Fixed Premium Plan Flexibility • • Limited Information Plan flexibility • Possible Surplus • Fixed Premium • Plan flexibility Greater Reward 11
SELF-INSURED WITH CAPTIVE • Each participant (employer) holds A program owned by at least one non-insurance company first layer of risk for purposes of managing and controlling employee Employer benefit risk Advantages: • Control (ownership)… retain profits • Captive holds middle layer risk • Lower overhead • • Captive has P&L Long-term stability Captive • Stop loss protection against large claim risks at a lower cost • Data availability and transparency • Collaboration/Best Practices Disadvantages: • • Captive purchases reinsurance for Potential up-front capital requirements • catastrophic claims More risk retained by participants Stop Loss 12
VALUE-BASED PAYMENTS – “VBP” https://vimeo.com/123839661 13
HOW VALUE-BASED PAYMENTS COMPARE 14
HEALTHCARE PRICING TRENDS Typical Renewal Inflation - Fully-Insured of 12% vs. Self-Funded of 8% vs. VBP tracking Medicare at 1%. 15
HOW DOES IT WORK? 16
What Else Should Employers Consider? 17
DIVORCING YOUR SPOUSE’S COVERAGE Medical Premium Spousal Expense Contributions Surcharge Reimbursement Plan (MERP) 18
THE WORKPLACE IS CHANGING … Millennials = 50% of the workforce in 2020 19
BENEFIT PLANNING & QUESTIONS • 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? 20
WHAT DOES THIS MEAN? 21
BENEFITS AND HR TECHNOLOGY 22
A Simple Solution to Navigating Healthcare 23
HEALTH NAVIGATORS / CARE COORDINATORS 24
BENEFIT PLANNING & QUESTIONS Guiding the patient through the system Finding the right doctor/hospital Referrals & Pre-Authorizations Discussing the options Answering questions Transition of care 2 nd Opinion Explaining 25
How do we get there? 26
DEVISING YOUR PLAN Components Phase 1 Phase 2 Phase 3 Fully Insured Level-Funded Self Insured Plan Design & Funding CDHP offered as an option CDHP as full replacement with dual option CDHP as full replacement with dual option, explore value based plan design. Approx. 75% Employer Paid Increase Spouse/Dependent Differential Increase Spouse/Dependent Differential Employer Contribution: None Earned Deductible Funding based on wellness activities Earned Deductible Funding based on wellness activities Employer HSA Funding: Establish Wellness Committee TBD by Wellness Committee TBD by Wellness Committee Health Improvement Gather baseline data on interests and biometrics Carrier Budget Carrier Budget Implement Preventive Care Campaign Enhanced Third- Party Portal Carrier Utilization Package Carrier Utilization Package Carrier Utilization Package Analytics Bi-Annual Reporting Package Quarterly/ Monthly Reporting Package Enhanced Analytics Package Carrier Dedicated Client Service Executive Carrier Dedicated Client Service Executive Carrier Dedicated Client Service Executive Service and Support Customer Advocate Center Customer Advocate Center Customer Advocate Center ThinkHR ThinkHR ThinkHR Custom Employee Communications Video Benefits Video Benefits Compass Custom Employee Communications Custom Employee Communications MD Live Compass Compass MD Live MD Live Payroll Vendor Support HRIS with Self Service HRIS with Self Service Technology EDI Compliance Advantage Assessment Compliance Advantage Compliance Advantage Compliance Seminars / Webinars Seminars / Webinars Seminars / Webinars BLR BLR BLR 27
What questions do you have? 28
EMILY L. BAILEY ERIC POMROY Principal, Managing Consultant Business Development Executive OneDigital | Health and Benefits OneDigital Health and Benefits Office: 860-773-6999 Mobile: 860-906-6851 Office: (860) 470-0325 ebailey@onedigital.com 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 29
Recommend
More recommend
