Y UR LIFE FE DE DEPE PEND ON ON IT. T. Overview Review TAC - - PowerPoint PPT Presentation

Y UR LIFE FE DE DEPE PEND ON ON IT. T.

Overview

Review TAC Health and Employee Benefits Pool’s Top Diagnostic Categories Explore cost differences between various medical and prescription treatment options Learn ways to save money and help achieve better health outcomes

HEBP’s Top Diagnostic Categories

• 1. Musculoskeletal (MSK)

Back, Neck and other Joint Pain or Injuries

• 2. Circulatory

Heart Disease, Stroke, Metabolic Syndrome (MetS)

• 3. Neoplasms

Breast, Colon, Lung Cancers

Musculoskeletal Disorder Prevention and Treatment Options

• Airrosti or Chiropractic Care
• MRIs and Steroid Injections
• Anti-Inflammatory and Pain

Medications

• Back and Joint Surgeries
• Lifestyle Changes (Exercise and

Weight Loss)

Unmanaged MSK can lead to decreased mobility, increase use of medications, and surgeries.

What is Airrosti?

Treatment for MSK issues

Assessment & Diagnosis

• A thorough clinical assessment to evaluate your

condition and determine the root cause of pain, while eliminating unnecessary imaging, injections, and surgeries.

Specific Manual Therapy

• Soft tissue/joint mobilization through a hands on

approach to improve function and range of motion.

Active Care

• Customized stretches and exercises prescribed to help

speed recovery time and prevent further injuries.

Airrosti vs. Traditional Musculoskeletal Care

Source: Airrosti reported outcomes for TAC, as of April 30, 2019

Airrosti- Surgeries Avoided & Condition Breakdown

DX Category Average Cost Surgeries Avoided Savings Back/Neck

$11,100 9 $99,900

Shoulder

$10,800 2 $21,600

Hip

$19,200

Knee

$17,800 4 $71,200

Hand/Arm

$6,000 3 $18,000

• Approx. Total Savings: $210,700

Source: Airrosti reported outcomes for TAC, as of April 30, 2019

Airrosti vs. Steroid Injections

Airrosti

• Avg. Office

Visit Copay: $40 Plan Paid: $143 avg./service

Injections

• Avg. Out of

Pocket Cost: $178.05 Plan Paid: $381 avg./service

Airrosti vs. Chiropractic Care

Airrosti

• Avg. Office Visit

Copay: $40 No Deductible 3 Visit Avg.

Chiropractic Care

Coinsurance AFTER deductible is met

10 Visit Avg.

Average Cost S t Savin vings per Condition:

Airrosti VS VS Non-Airrosti T Trea eatmen ent

43% Lower Overall Costs

Hip Savings: $2,389 Knee Savings: $1,506 Shoulder Savings: $1,093 Back/Neck Savings: $640

Airro rosti

Source: Airrosti Value Analysis

Circulatory Prevention and Treatment Options

• Maintenance Medications
• Lifestyle Changes (Exercise and Weight Loss)
• Metabolic Syndrome (MetS) Reduction Programs
• Heart Surgery

Unmanaged can lead to

Heart Attack, Stroke, Amputations, Surgeries, and Worse…

Metabolic Syndrome Financial Impact

Members with MetS

• Average 60% more annually in healthcare costs AND
• Have a 700% greater likelihood of having a high-cost claim in next

three years

Neoplasms Prevention and Treatment Options

• Preventive Cancer Screenings- Covered at 100%
• Healthy Lifestyle Choices
• Chemotherapy
• Radiation
• Surgery

Early Detection Matters Breast Cancer

Breast Cancer Stage Cost % Diagnosis % 5-year survival

$60,637 27.5 100 I/II $82,121 52.93 96.5 III $129,387 13.56 72 IV $134,682 5.99 22

Breast: Commercially Insured California Population Colon & Lung: Medicare California Population 5-Year Survival Rates From Multiple Sources

Early Detection Matters Colon Cancer

Colon Cancer Stage Cost % Diagnosis % 5-year survival

$49,189 25 90 I/II $66,613 29 90 III $83,980 26 70 IV $134,682 20 12

Breast: Commercially Insured California Population Colon & Lung: Medicare California Population 5-Year Survival Rates From Multiple Sources

Early Detection Matters Lung Cancer

Lung Cancer Stage Cost % Diagnosis % 5-year survival non-small cell % 5-year survival small cell

$60,038 20.5 1A: 92 1B: 68 31 I/II $73,509 4.17 2A: 60 2B: 53 19 III $84,980 25.18 3A:36 3B:26 8 IV $108,599 50.61 <1 2

Breast: Commercially Insured California Population Colon & Lung: Medicare California Population 5-Year Survival Rates From Multiple Sources

What Is One Thing That Can Help Address All 3 Diseases?

Lifestyle

Healthy Lifestyle Resources

What is Healthy County??

Smoking Poor Stress Management Insufficient sleep Excessive Alcohol Intake *Poor Standard

• f Care

Poor Diet Physical Inactivity Lack of Health Screening

Bending the Cost Curve – Prevention is Key

Meaningfully impacting as few as 3 behaviors and risks can save as much as $700 per employee/year.

These behaviors drive chronic conditions that account for 80%

• f total costs for all chronic illness, obesity being number one

Weight Loss Benefits

Diabetes, High Triglycerides

>3%

High Blood Pressure, Arthritis, Reflux

> 5% Cancer, Urinary Incontinence > 7% Fatty Liver, Sleep Apnea > 10% % of Body Weight Lost

Naturally Slim

Where you go for care matters…

Options When Seeking Care

Retail Health Primary Care Physician Telemedicine (MD Live) Urgent Care Hospital Emergency Room Freestanding Emergency Room

Office Visit vs. MDLive Visit

Office Visit MDLive

1.5-2 hours away from home or work 15-20 minutes

• ver the phone

$40/copay Cost to Plan: $100 avg. $10/copay Cost to Plan: $38 avg.

ER Visit vs. Urgent Care

ER Visit Urgent Care

• Avg. Wait Time:

4 hours

• Avg. Wait Time:

16-24 minutes $150/copay

• Avg. Cost to Plan:

$1,371 avg. $40/copay

• Avg. Cost to Plan:

$127

Source: www.smartERcareTexas.com

Copay Max for Specialty Drugs

What it does: Leverages manufacturer coupons to reduce both member AND plan costs Prescription qualifies for Copay Max program Pharmacy submits claim to Navitus Copay Max coinsurance is applied Lumicera Pharmacy coordinates copay assistance for member After copay assistance, member has a $0 copay

Key Take-Aways… Because Your Life Depends on It.

Get a yearly exam and age appropriate screenings Consider a Virtual Visit Instead of Urgent Care Go to Urgent Care instead of ER for non-emergent visits

Key Take-Aways… Because Your Life Depends on It.

Save money on prescriptions by using:

• Tier 1 Drugs
• Retail 90
• Copay Max or
• Mail order

Explore Airrosti as an alternative to surgery or steroid injections

Take an active approach in your healthcare decisions!

TAC He AC Heal alth & & Benefits S s Services (512)478-8753 ● (800)456-5974 www.county.org/healthycounty

Thank You!