I nsura nc e Ove rvie w Dr. Cra ig A. Sc hilling , CE O, SBM - - PowerPoint PPT Presentation
Gle nbr ook HSD 225 Nor thbr ook/ Gle nvie w Nationally Re c ognize d for Cost Containme nt and He alth Pr omotion I nsura nc e Ove rvie w Dr. Cra ig A. Sc hilling , CE O, SBM PROS, L L C I nsura nc e A Histo ric a l Pe
O, SBM PROS, L L C
Gle nbr
Nor thbr
“Nationally Re c ognize d for Cost Containme nt and He alth Pr
Ge ne ra l Ove rvie w
Ra tio na le fo r Se lf-I
nsura nc e
SSCRMP Wo rke r’ s Co mpe nsa tio n He a lth/ De nta l/ L
ife
He a lth I
nsura nc e
Philo so phy Co st Co nta inme nt Re tire me nt He a lth Pro mo tio n Re la tio nship with E
mplo ye e Gro ups
F
One o f the mo st suc c e ssful pub lic sc ho o l
insura nc e po o ls
I
nitia lly a pro pe rty a nd lia b ility po o l
Wo rke r’ s Co mpe nsa tio n & He a lth I
nsura nc e a dde d in 2007
L
ife insura nc e a dde d in 2009
Distric ts ha ve sa me b usine ss o b je c tive s Stre a mline distric t o ve rsig ht o f a ll insura nc e line s Re duc e d c o st b y e limina tio n o f b ro ke r c o mmissio n a nd insura nc e
c o mpa ny pro fit a nd o ve rhe a d in se lf-insura nc e la ye r
I
mpro ve me nt o f purc ha sing po we r a nd a b ility to ne g o tia te with ve ndo rs
Pro vide pro te c tio n a g a inst future le g isla tive c ha ng e s Co mpe titive e dg e in ne g o tia tio n a nc illa ry line s o f c o ve ra g e suc h
a s life insura nc e
Prio r to 2007 the Distric t pa rtic ipa te d in the SE
L F Wo rke r’ s Co mpe nsa tio n Po o l
I
n SE L F , Gle nb ro o k wa s o ne o f the la rg e r distric ts whic h re sulte d in hig he r a dministra tive c o sts (sma ll distric ts b e ne fite d)
Gle nb ro o k mo ve d to SSCRMP to :
Ga in a c o mpe titive a dva nta g e – the sma lle st o f the distric ts, a nd Jo in distric ts tha t ha d simila r c o nc e rns a nd c ha lle ng e s (hig h
sc ho o ls) whe re it c o uld b e ne fit fro m a c o nso lida te d pre ve ntio n pro g ra m.
Sha re c utting e dg e WC c o st c utting to o ls (Nurse T
ria g e / L
lo a d a djusting mo de l
I
n 1992, the distric t ha d a T PA, 3rd pa rty ne two rk a nd pla n de sig n tha t ne ithe r se rve d the distric t no r its e mplo ye e s we ll.
No o ut-o f-po c ke t ma ximum No fo rg ive ne ss o n diffe re nc e s o n “usua l a nd c usto ma ry a nd
a c tua l c ha rg e s”
An RF
P wa s issue d sho rtly the re a fte r. Ga lla g he r-Ba sse t b e c a me the b ro ke r a nd Blue Cro ss-Blue Shie ld b e c a me the ve ndo r
An RF
P wa s issue d a g a in in 2006. CBC b e c a me the b ro ke r.
I
n 2007 Gle nb ro o k jo ine d o the r distric ts within SSCRMP in c re a ting a n he a lth insura nc e po o l. As the sma lle st distric t in the po o l, Gle nb ro o k b e ne fite d fro m:
Re duc e d a c c e ss, a dministra tive a nd re insura nc e fe e s. Se lf-insuring HMOI
c la ims
“No Risk Sha ring ” Re ne g o tia ting the pre sc riptio n drug pla n
Blue Cro ss-Blue Shie ld issue s “Co o pe ra tive E
lig ib ility a nd Pric ing Po lic y” to disc o ura g e simila r c o o pe ra tive s like SSCRMP fo rming he a lth insura nc e po o ls.
Po o le d g ro up fo r life / disa b ility De nta l Pla n
O N T H E C U T T I N G E D G E
Goals:
Work c oope ra tive ly with e mploye e g roups to ma na g e he a lth c a re c osts. E duc a te a nd c ommunic a te he a lth c a re informa tion. Work towa rds lowe r he a lth risk a nd c ost throug h he a lth promotion. Se e k out innova tive prog ra ms a nd se rvic e s. E va lua te prog ra ms a nd se rvic e s ba se d on da ta drive n re sults.
What is it?
T he HIAC me t pre - ne g otia tions for a bout thre e months. It’s c omposition inc lude d a ll e mploye e g roups – union, non- union, a nd a dministra tive . It’s mission: Re vie w a ll he a lthc a re informa tion inc luding pa rtic ipa tion, pla ns, a nd c osts. Re vie w a lte rna tive s suc h a s ne w pla ns, be ne fit c ha ng e s, we llne ss, e tc . T he HIAC me e ts a s a Me dic al Insur
anc e Co st Co ntainme nt Co mmitte e , post ne g otia tions.
What doe s it do?
Re vie w pre sc ription drug pla n Re vie w proc e dure s for se tting pre miums Re vie w be ne fit c osts a nd utiliza tion Ide ntify pote ntia l a re a s for sa ving s a nd e nha nc e me nts Re vie w de duc tible s a nd c o-pa ys
c o -pa ys
c o -pa ys Re sults –
T he distr ic t ne gotiate d the same be ne fit pac kage with all e mploye e gr
E ac h e mploye e gr
e e d to inc r e ase the ir he alth insur anc e c ontr ibutions ove r the ne xt five ye ar s! E ac h e mploye e gr
e e d to c ontr ibute towar ds single me dic al insur anc e for the fir st time – past pr ac tic e had e xiste d 50 ye ar s. PPO de duc tible s, out- of- poc ke t, and pr e sc r iption dr ug plan c ontr ibutions we r e r aise d. HMO c o- pays and pr e sc r iption dr ug plan c ontr ibutions we r e r aise d. Ne gotiations e stablishe d a he alth pr
am imple me ntation c ommitte e . Re tir e e me dic al c ontr ibutions r e str uc tur e d for pr
Fitness Classes Newsletters Web Site & 24/7 Tools Incentive Programs Trainings, Books & Health Decision Tools 24/7 EAP
Health Care Solution
Flu Shots Health Coaching Wellness Screenings Benefit Plans
Utiliza tio n re po rts De duc tib le a nd o ut-o f-po c ke ts a na lysis Pre sc riptio n drug c la im re vie w
Ge ne ric drug utiliza tio n L
ine ite m re vie w
He a lth Pro mo tio n da ta
Boa rd Support Ma na g e me nt Stra te g y E mploye e Support a nd Pa rtic ipa tion He a lth Promotion Pa rtne rships Da ta Drive n Re sults
Post SYL Implementation Average Increase – 3.5% Savings – Over $5,000,000
I llustra tio n o f He a lth Ca re Co sts