Business Forum Presentation March 7, 2018
In The Beginning . . . . Headline (Secondary Page) Add Text Here (Subhead) • Fort Wayne Medical Society • Avoid the ‘Gatekeeper’ model Secondary Text • Dr. Jack Gumbert , PHP’s first chairman Secondary Text • UHC’s predecessor ran the plan Secondary Text • Summer 1983 Secondary Text
Headline (Secondary Page) Why Not-for-Profit w/ Physician Governance Add Text Here (Subhead) • 1,008+ member physicians • Board is elected by member physicians Secondary Text • Consumer directors elected by physician board members • Financial risk is taken by member physicians, in return for: Secondary Text • Governance • Medical policies and procedures Secondary Text • Consumer directors control member physicians’ remuneration Secondary Text • $26.6 million of physician fees have been retained since PHP’s inception through 2016
PHP’s Vision Statement Headline (Secondary Page) Add Text Here (Subhead) PHP delivers innovative strategies and services Secondary Text for the health of our communities by: Secondary Text • Personally engaging to provide service excellence for those who put their trust in us Secondary Text • Embracing our responsibility to improve economic growth and help employers sustain a healthy, efficient workforce Secondary Text • Sharing information to create both well-informed consumers and providers to foster effective decision making
Not Your Parents’ PHP Headline (Secondary Page) Add Text Here (Subhead) 2015 2018 Members Served 34,000 64,000 Secondary Text Employees 100 160 New Disciplines (Past 3 Years) N/A 6 Secondary Text • Data Analytics Secondary Text • Provider Contracting & Network Development • Business Intelligence Secondary Text • Risk Adjustment • Medical Informatics & Intervention • Population Health
Headline (Secondary Page) What Will PHPNI Look Like? Add Text Here (Subhead) TPA Servic ices Re Re- Ancill illar ary Insurance ance Product oduct Secondary Text & Captiv tive e Servic ices Servic ices Secondary Text Medic dical al PEO Mgmt. t. Servic ices Servic ices PHP HPNI NI Secondary Text Provi vide der Data ta Secondary Text Netw etwor ork Analy alysis is Servic ices Servic ices Health alth Welln llnes ess Insu surance ance Servic ices es Servic ices
Headline (Secondary Page) PHP’s Market Share (Full Risk) Add Text Here (Subhead) • Allen County = 29% • Northeast Indiana (non-Allen) = 16% Secondary Text • North Central Indiana = 4% Secondary Text • Other Northern Indiana = 1% Secondary Text Secondary Text
Mission of the Foundation Headline (Secondary Page) Add Text Here (Subhead) The PHP Foundation is dedicated to building Secondary Text healthier communities by addressing the health and Secondary Text wellness needs of low-income, high risk individuals Secondary Text in the neighborhoods we serve. Secondary Text
PHP Foundation Grantees Headline (Secondary Page) Add Text Here (Subhead) Big Three: Secondary Text Matthew 25 Health & Dental Clinic ($1,260,000) • Neighborhood Health Clinics ($1,175,000) • Secondary Text Super Shot ($800,000) • Secondary Text Nearly rly 75% of tota otal l disbur sbursem ements ents since ce ince ception tion Secondary Text
Headline (Secondary Page) PHP Foundation Grantees Add Text Here (Subhead) Additi tional onal recip ipients ients: • Cancer Services of Northeast • HearCare Connection Indiana Secondary Text • Heart City Health Center • Cancer Services of Grant County • Panos Free Clinic Secondary Text • Huntington County Free Health • Pat Dyer Patients Assistance Clinic Fund • Jay County Medical Secondary Text • Pathway Family Center • Community Transportation • Positive Resource Connection Network Secondary Text • St. Martin’s Health Care • Focus on Health • Turnstone • Francine’s Friends • YMCA of Greater Fort Wayne • GiGi’s Playhouse
Insurance Primer
An Insurance Primer Headline (Secondary Page) Add Text Here (Subhead) Who is Insured by Whom Secondary Text 10% 10% Secondary Text 15% Secondary Text 50% Secondary Text 15% Medicare Medicaid & Gov't Employers Individual Coverage Uninsured
An Insurance Primer Headline (Secondary Page) Add Text Here (Subhead) Secondary Text Secondary Text Secondary Text Secondary Text
An Insurance Primer Headline (Secondary Page) Add Text Here (Subhead) Health Care is Very Expensive for Very Few Secondary Text Claim Value % of Claims Avg. Cost Per Claim Secondary Text No Claims 24.6% to 25.9% $0 Secondary Text < $1,000 64.9% to 67.5% $217 > $100,000 .4% to .5% $190,000 Secondary Text
An Insurance Primer Headline (Secondary Page) Add Text Here (Subhead) Health Care is Very Expensive for Very Few Secondary Text Population Overall (1) PHP (2) Utilization Secondary Text Top 1% 20% 36.5% Secondary Text Top 5% 50% 68.5% Top 20% N/A 92.0% Secondary Text Bottom 50% 2% 1% (1) Overall Population, AHIP Conference, February 2016 (2) Actual group PHP data for 2014 and 2015, as of August 2016 Note: 85% of the population does not reach their deductible each year (HDHP or not)
An Insurance Primer Headline (Secondary Page) Add Text Here (Subhead) Where Does The Money Go? PHP Medical Cost % (1) Cost Component Secondary Text Outpatient Facility 28% Inpatient Facility 23% Secondary Text Total Facilities 51% Secondary Text Rx * 20% Physician Services 14% Secondary Text Subtotal 85% Insurance Companies 15% TOTAL 100% * Retail (14%) and Medical (6%) (1) Actual group costs for 2014 and 2015 paid through August 2016
Headline (Secondary Page) An Insurance Primer Add Text Here (Subhead) What Impacts Medical Trend • Unit cost inflation Secondary Text • Increase in new types of units (R&D) • Aging population • Economic conditions Secondary Text • Supply increase • Leverage (1) Secondary Text = Medical Trend • 8% to 12% is NOT atypical Secondary Text (1) Leverage Example: Year 1 Year 2 % Change Procedure Cost $3,000 $3,150 5% Deductible $2,500 $2,500 0% Insurer’s Cost $500 $650 30%
An Insurance Primer Headline (Secondary Page) Add Text Here (Subhead) Non-Engagement Statistics • About one-third of a commercial population has not seen a physician in Secondary Text the past 24 months • Health System Study: Excluding Rx and out-of-area claims, 40% of Secondary Text activity occurs outside an integrated delivery network • Secondary Text Between 35% - 40% filled no prescriptions in the last year Secondary Text
Affordable Care Act The Good, The Bad, & The Ugly
The Good, The Bad, & The Ugly of ACA Headline (Secondary Page) Add Text Here (Subhead) Individual Insurance and the Exchanges • On vs. off exchange Secondary Text • One big difference – the subscribers • Advance Premium Tax Credit (80+%) • Secondary Text Cost Share Reductions (50+%) • 3 to 1 vs. 5 to 1 differential • A subsidy to be paid by the young and healthy Secondary Text • The mandate that wasn’t Secondary Text • Special enrollment periods
The Good, The Bad, & The Ugly of ACA Headline (Secondary Page) Add Text Here (Subhead) ACA Individual Market (High-Cost Cases) Secondary Text Pre-ACA ACA Multiple Range $10 – 50,000 1.5% 6.5% 4.3 Secondary Text $50 – 100,000 .2% 1.0% 5.0 Secondary Text $100,000 - $300,000 .1% .2% 2.0 > $300,000 0% .1% N/A Secondary Text 1.97% 8.59% 4.4 TOTAL
The Good, The Bad, & The Ugly of ACA Headline (Secondary Page) Add Text Here (Subhead) Small-Group Plans • If you like your health plan, you can keep your health plan Secondary Text (grandmothered & grandfathered plans) • 60+% of PHP small-group plans • 70+% of Anthem small-group plans Secondary Text • Medical cost differential under ACA (2016) • ACA small group: $482 PMPM Secondary Text • Transitional small group: $356 PMPM Typical annual cost differential for a 25-employee company = $68,000 Secondary Text • Is a large- or small-group mandate necessary?
The Rise of Network and Payment Alternatives Headline (Secondary Page) Add Text Here (Subhead) • Population Health • Narrow Networks Secondary Text • Risk-Sharing Contracts Secondary Text • Pay-Vider Solutions • Provider Owner Health Plans Secondary Text Secondary Text
Headline (Secondary Page) Add Text Here (Subhead) Qu Quest estio ions ns ? Secondary Text Secondary Text Secondary Text Secondary Text
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