AICUM Symposium Using Data to Reduce Costs and Improve Health October 14, 2016
AGENDA • Introductions • Goals and Objectives of Session • Background of edHEALTH and MMA • Data Resources • Data Analytics and Informatics in Action • Questions & Answers
Goals and Objectives of Session • Demonstrate how edHEALTH uses data to address plan design and health plan costs • Discuss National, edHEALTH and local (school) level trends • Illustrate the collaboration between edHEALTH and MMA or with participating school’s broker and/or consultant • Identify future opportunities for collaboration 3
Overv rview • Since July 1, 2013 …. • 12 Educational institutions • 9,500 covered employees • Benefits paid exceed $100 million annually • Average rate increases in 2016 was 3.6% and the two-year average annual increase was 1.7% - well below industry trends • Retained over $4.5 million in savings in the edHEALTH Captive that would have otherwise gone to commercial carriers • edHEALTH paid $1.2M back to founding members of CEVoNE • $4M invested with Performa 4
Who Are We? Bringing a cost-saving and innovative solution that offers members collaboration, transparency, and a seat at the table, edHEALTH is the powerful answer to impact the trend in rising healthcare costs.
Who is Marsh & McLennan Agency? • Marsh & McLennan Agency (MMA) specializes in serving the risk management and employee benefit needs of colleges and universities throughout the United States • Our parent company is Marsh which is one of the largest insurance brokerage firms in the world • In New England, MMA has an Employee Benefits practice that focuses on higher education • Our team has been involved with edHEALTH and Healthy You since inception • MMA currently consults with 5 of the 12 participating edHEALTH schools • We provide edHEALTH with b enchmarking data using Mercer’s 2015 Employer -Sponsored Health Plan survey • We work collaboratively with edHEALTH, yet our solutions are design around the specific needs of the institution 6
Data, Data, and More Data GOAL : guide schools individually and collectively in choosing wellness initiatives and plan designs to impact cost and quality of healthcare • Benchmark analysis will be updated annually • Analysis of cost and utilization by types of service to include year over year results • Benchmarking of claims by diagnosis 7
Data, Da Da Data, an and More Da Data Services Cost Analysis Medical and Rx Demographics • Inpatient • $PMPM: • Total $PMPM Costs • Member Age • Cost Sharing • Outpatient - Top Diseases (Tufts) • Contract Size • Physician Services • $PMPM - Clinical Condition • Male/Female % • Ancillary Services (HPHC) - Utilization/member - Top Major Practice - Cost/utilization Categories (HPHC) • Claims Distribution • High Cost Claimants 8
Percent of Employers Offering Each Type of Medical Plan 9
Medical Plan Enrollment Trends National edHEALTH School • The University engaged in aggressive campaign to promote HDHP with HSA. PPO w/CHDP • “Town Hall” meetings were held, 10 educational sessions • University promised to fund HSA ($500 for HMO w/CHDP single, $1,000 for family) • Medical provider showcased transparency tools HMO • 25% of 800 eligible subscribers enrolled in HDHP PPO • Also changed to self funded medical plan • 0.0% 20.0% 40.0% 60.0% 80.0% Cost increase was substantially lower than previous years and well below industry trends 10 10
Expect to offer an account-based CDHP in next three years 11 11
Medical Services Trends National edHEALTH School 2016 2015 2015 (before Rx carve-out) (before Rx carve-out) Medical: 9.5% Medical: 8% Medical: -1% Rx: 14.5% Rx: 15% Rx: 13% Total: 9% Total: 9% Total: 1% 12 12
Annual Change in Cost per Employee for Prescription Drug Benefit 13 13
Rx Trends School National edHEALTH • Estimated annual savings (claims and • Rx Costs are rising 2x medical trend rebates) due to Carve-Out to be 2% of • Significant, strategic and important claims • For 2017, the savings is assumed to be move for edHEALTH 1% or $148,000 • Joining PURPC Coalition – OPTUM Rx • For 2018 and beyond, expectation is 2% savings of claim spend, or $310,000 in on 1/1/17 2018, $333,000 in 2019, resulting in • Savings of $3M first year with minimal potential 3-year savings of $791,000 • Rebates/claims savings based upon disruption historical Rx utilization/spend 14 14
Disease Trends – Ranked Average PMPM Cost edHEALTH National School 1. Cancer, All 1. Cancer, All 1. Cancer, All 2. Cancer, Breast 2. Depression 2. Depression 3. Chronic Condition 3. Osteoarthritis 3. Diabetes 4. Diabetes 4. Cancer, Breast 4. Hypertension 5. Multiple Sclerosis 5. Diabetes 5. Osteoarthritis 15 15
Data Analytics and Informatics in Action Proactively Impacting Plan Performance 16 16
Our Members 17 17
Please send your feedback to: 123 Interstate Drive 500 Boylston Street, Suite 300 West Springfield, MA 01089 Boston, MA 02116 1-866-692-7473 1-617-777-4762 info@educatorshealth.org Joan.cunnick@marshmma.com www.educatorshealth.org www.mma-newengland.com
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