Solutions for Effective Health and Benefit Plans Healthcare Cost - - PowerPoint PPT Presentation
Solutions for Effective Health and Benefit Plans Healthcare Cost Transparency Tools March 2015 Todays Presenters Kristine Klepper Senior Vice President/Practice Leader Conner Strong & Buckelew Dan McCormick Senior Vice
March 2015
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$18,074 $19,393 $20,728 $22,030
2010 2011 2012 2013 2014
$0 $5,000 $10,000 $15,000 $20,000 $25,000
Annual Medical Cost for Family of Four
Source: 2015 Milliman Medical Cost Index
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Identified waste $1.2 trillion
Behavioral $303 billion to $493 billion Clinical $312 billion Operational $126 billion to $315 billion
Claims processing $21 billion to $210 billion Defensive medicine $210 billion Obesity/overweight $200 billion Smoking $567 million to $191 billion Non-adherence $100 billion Alcohol abuse $2 billion Preventable hospital readmissions $25 billion Poorly managed diabetes $22 billion Medical errors $17 billion Unnecessary ER visits $14 billion Treatment variations $10 billion Hospital acquired infections $3 billion Over-prescribed antibiotics $1 billion Ineffective use of IT $81 billion to $88 billion Staffing turnover $21 billion Paper prescriptions $4 billion
Source: PWC’s Health Research Institute. The Price of Excess: Identifying waste in healthcare spending
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receive, while helping to control skyrocketing medical costs. It also leads to more engaged, activated employees.
are faced with increasingly large out-of-pocket expenses. Access to price and quality information helps employees save money. It also empowers them to get the best care.
the recognition they deserve.
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1% 10% 27% 30% 37% 42% 53% 57% 73%
Other Move to a defined contribution model Add or expand high performance networks, ACOs, PCMHs or similar delivery models Eliminate high cost plans Reduce spousal subsidy or implement spousal surcharge Increase employee cost sharing Add or expand incentives/disincentives to 3 engage employees in wellness programs Implement or expand account-based CDHPs Add or expand tools to encourage plan participants to be better consumers
Employer Actions to Minimize the Impact of the Excise Tax
Source: 2014 National Business Group on Health Plan Design Survey
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52% 66% 71% 71% 73% 80% 84% 85%
Employee advocacy tools/services for claims assistance Data warehouse Self-service decision support tools Price transparancy tools Nurse coaching for lifestyle management Prior authorization for selected services Disease management Nurse coaching for care/condition management
Employer Tools and Programs
Source: 2014 National Business Group on Health Plan Design Survey
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$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 Unique Cases
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22 Category Total Procedures Total Spend Opportunities to Save Potential Savings Savings Percent
Gener al Di agnost i cs 4, 624 $7, 896, 920 2, 459 $2, 735, 785 35% I P / OP Sur ger y & Pr
es 736 $3, 740, 544 402 $1, 140, 354 30% W om en' s Heal t h 6, 800 $5, 008, 379 3, 704 $1, 078, 265 22% Bone & Joi nt 696 $7, 769, 613 436 $2, 173, 131 28% CT I m agi ng 3, 263 $3, 183, 473 1, 911 $1, 733, 976 54% M RI I m agi ng 3, 193 $4, 004, 932 2, 005 $1, 990, 632 50% Ul t r asound 6, 701 $1, 774, 499 3, 082 $703, 976 40% Xr ay I m agi ng 18, 396 $1, 798, 777 9, 396 $945, 085 53% Labs ( Top 30) 104, 914 $3, 331, 610 64, 695 $1, 863, 897 56% Tot al 149, 323 $38, 508, 746 88, 090 $14, 365, 101 37%
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0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
56 Hospitals in the Greater Philadelphia Area NATIONAL QUALITY RANK
27 City Rank Hospital City Rating Score National Rank 1 Christiana Care Health Services, Inc. Newark
98.7 44 2 Thomas Jefferson University Hospital Philadelphia
98.5 50 3 Doylestown Hospital Doylestown
167 4 Shore Medical Center Somers Point
94.5 184 5 Atlanticare Regional Medical Center- City Division Atlantic City
90.9 293 6 Pennsylvania Hospital of the University of Pennsylvania Philadelphia
89.5 366 7
Langhorne
88.4 406
National Percentile Rankings
√++ 90th percentile √ 26th – 74th percentile √- 11th – 25th percentile √+ 75th – 89th percentile
√-- 10th percentile
28 City Rank Hospital City Rating Score National Rank 50 Mercy Fitzgerald Hospital Darby
13.2 3,036 51 Crozer Chester Medical Center Upland
10.7 3,122 52 Memorial Hospital of Salem County Salem
7.8 3,225 53 Chestnut Hill Hospital Philadelphia
7.4 3,239 54 Cape Regional Medical Center, Inc. Cape May Court House
6.1 3,284 55 Cooper University Hospital Camden
5.3 3,313 56 Roxborough Memorial Hospital Philadelphia
0.8 3,470
National Percentile Rankings
√++ 90th percentile √ 26th – 74th percentile √- 11th – 25th percentile √+ 75th – 89th percentile
√-- 10th percentile
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across different sites of care; and identify the specific sites where these services--including high- tech imaging and the administration of specialty medications and outpatient procedures--are being
care that have lower-cost alternatives.
informed decisions regarding site of care.
appropriate.
injectables from the medical benefit and moving them to the pharmacy benefit
the importance and benefits of seeking care at high-value settings.
cost sites of care. This strategy will become more important as the market moves to integrated delivery systems like accountable care organization with structured referral channels and risk- sharing contracts that reward providers for reducing costs.
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