Madison, WI Milwaukee, WI Cedar Rapids, IA How is Medical - - PDF document

Madison, WI Milwaukee, WI Cedar Rapids, IA

How is Medical Coverage Placed Today? How is Medical Coverage Placed Today?

• PPO Discounts
• PBM Deals
• Case Management Programs
• Reporting Packages
• Size of Company
• Stop Loss Programs (Captives)

My deal is better than yours

Average Annual Premiums for Single and Family – KFF 2011

Sky Sky-

• Rocketing Costs

Rocketing Costs

Distribution of Deductibles Distribution of Deductibles – – KFF 2011 KFF 2011

Sky Sky-

• Rocketing Costs

Rocketing Costs

Source: Mercer’s National Survey of Employer-Sponsored Health Plans, 2010

Deductibles Continue to Climb

Average PPO Deductible for Individual, In-network Coverage

The Result of Sky The Result of Sky-

• Rocketing Costs

Rocketing Costs

Premiums for both single and family medical coverage have more than doubled since 2001* Employer medical plans with deductibles of less than $500 have reduced by 24% since 2006* Employer medical plans with deductibles of more than $1000 have grown by 40% since 2006* The average deductible nationally as of 2010 is $1,200 for single**

Source - *KFF / ** Mercer’s national survey 2010

The Results???? The Results????

In 2011 health plan costs grew by another 9%*

• -Average premium for single coverage: $5,429
• -Average premium for family coverage: $15,073
• -Average deductible is expected to exceed $1,500

for single

*Reported by Kaiser Health News on 9/27/2011

Beating Trend Beating Trend

Their health through:

• Culture - Habits and Environment
• Wellness - Population Health

The economics through:

• Consumer Driven Plan Design
• Transparency of Provider Value

The future of solving our health care COST crisis is up to you. We must engage patients in:

The Key The Key… …Transparency Transparency

What is transparency?

• Transparency gives clarity by providing detailed

information on both the cost and quality of medical care to insured’s.

The Economics The Economics -

• Transparency

Transparency

In today’s delivery system: Members choose a hospital but without relevant information about their options. Patients don’t have price or quality information on the medical services they buy. We spend more time researching price and quality of our next TV purchase than we do choosing a healthcare provider for

• urselves or a loved one.

Providers are reimbursed per service, meaning more incentive to increase services and costs. More is NOT better. National studies have proven more medical services provided, the worse the outcomes measured by mortality, complication rates and overall patient satisfaction. The result - many services with poor outcomes at inflated prices. What employers have been doing isn’t working!!!! Today’s system (continued):

The Economics The Economics -

• Transparency

Transparency

What is the solution???? What is the solution???? FocusHealth FocusHealth

This information is available to the public but is virtually unusable.

Average Allowable Example: Hospital A Hospital B Hospital C Hospital D Cardiac Catheterization -- Major $13,632.47 $18,253.76 $34,349.59 $26,215.08

Did you know there is a difference in price?

National Percentile Rank (100% being the best) Example: Hospital A Hospital B Hospital C Hospital D Cardiac – Surgical 85.68% 54.20% 26.81% 63.00%

Did you know there is a difference in quality?

FocusHealth FocusHealth

FocusHealth’s proprietary scoring system creates relevant transparency consumers can understand. Methodology:

Combines charge and discount data for all hospitals, statewide –

• ver 300,000 data elements (including LOS).

The system uses that allowed data to calculate a cost score at every hospital for all available clinical categories. Quality data used is nationally recognized. Quality ranking system uses statistical analysis of hospital: Core Processes, Patient Safety Indicators, Mortality, Complication, and Readmission Rates and Patient Satisfaction.

FocusHealth FocusHealth

Cost and Quality scores are combined to create Total Hospital Values. The result is simple

35 28 99 55

Scores La Crosse

Hospital A Cost Hospital B Cost Hospital A Quality Hospital B Quality Hospital A Value Hospital B Value

67 42

FocusHealth FocusHealth

Cost and Quality scores are combined to create Total Hospital Values. The result is simple

24 40 31 90

Scores Eau Claire

Hospital A Cost Hospital B Cost Hospital C Cost Hospital A Quality Hospital B Quality Hospital C Quality Hospital A Value Hospital B Value Hospital C Value

27 65 47 98 73

Auxiant combines the cost and quality to derive a score for each hospital in WI. The result is: Hospitals with the highest ranking are considered Preferred Plus hospitals. Members are incentivized for using these Preferred Plus hospitals for inpatient and outpatient (hospital based) services.

Make it Simple Make it Simple

Make it Simple Make it Simple

Benefit Type PPO Network Non-PPO Deductible $1,000 (2x) $3,000 (2x) Coinsurance 80% 60% Out of Pocket Max $2,500/$5,000 $5,000/$10,000 Physician/Ancillary Charges $35 Copay Ded/Coins Inpatient Hosp Co-pay Non- Preferred Plus Hospital (per confinement) $1,000 $2,000

How to “Drive” Provider Utilization

Sample Plan Design - Example 1

Benefit Type Preferred Plus Preferred PPO Non-PPO Deductible $500 (2x) $1,000 (2x) $2,000 (2x) Coinsurance 90% 70% 50% Out of Pocket Max $1,000/$2,000 $3,000/$6,000 $6,000/$12,000 Physician/Ancillary Charges $35 Copay $35 Copay Ded/Coins

How to “Drive” Provider Utilization

Sample Plan Design - Example 2

Benefit Type PPO Non-PPO Deductible $2,500 (2x) $5,000 (2x) Coinsurance 100% 70% Out of Pocket Max $2,500/$5,000 $7,500/$15,000 Physician/Ancillary Charges 100% Ded/Coins HSA or HRA contribution if Preferred Plus Hospitals only are utilized $1,000 $0.00

How to “Drive” Provider Utilization

Sample Plan Design- Example 3 HSA/HRA

FocusHealth on Auxiant.com

Auxiant has detailed cost and quality scores available for each hospital on our website. Visit our website at www.auxiant.com Sign in on website Click on AuxiantHealth Click on the FocusHealth icon

Click on FocusHealth Icon

FocusHealth will achieve the lowest possible medical spend in both the short and long-term. Short Term Impact:

Improved patient outcomes Patient choice of the highest quality providers at the most competitive price.

Long Term Impact:

This is health care reform The establishment of a market with provider competition drives to the lowest possible price. Providers must focus on their value, cost and outcomes, in order to compete in the long-term.

FocusHealth FocusHealth

Summary

FocusHealth: Engagement - Quality Transparency – Costs NOT an HMO Changing Healthcare as we know it!

FocusHealth FocusHealth

Questions? Questions?