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? My deal is better than yours • PPO Discounts • PBM Deals • Case Management Programs • Reporting Packages • Size of Company • Stop Loss Programs (Captives) Sky- -Rocketing Costs Rocketing Costs Sky Average Annual Premiums for Single and Family – KFF 2011

Sky- -Rocketing Costs Rocketing Costs Sky Distribution of Deductibles – Distribution of Deductibles – KFF 2011 KFF 2011 Deductibles Continue to Climb Average PPO Deductible for Individual, In-network Coverage Source: Mercer’s National Survey of Employer-Sponsored Health Plans, 2010

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 The future of solving our health care COST crisis is up to you. We must engage patients in: � Their health through: -Culture - Habits and Environment -Wellness - Population Health � The economics through: -Consumer Driven Plan Design -Transparency of Provider Value 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 ourselves or a loved one. The Economics - - Transparency Transparency The Economics Today’s system (continued): � 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!!!!

What is the solution???? What is the solution???? FocusHealth FocusHealth Did you know there is a difference in price? 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 quality? 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% This information is available to the public but is virtually unusable.

FocusHealth FocusHealth � FocusHealth’s proprietary scoring system creates relevant transparency consumers can understand. � Methodology: � Combines charge and discount data for all hospitals, statewide – over 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 Scores La Crosse � Cost and Quality 35 28 scores are combined to Hospital A Cost Hospital B Cost create Total Hospital Values. 99 55 Hospital A Quality Hospital B Quality � The result is simple 67 42 Hospital A Value Hospital B Value

FocusHealth FocusHealth Scores Eau Claire � Cost and Quality 47 24 40 scores are combined to Hospital A Cost Hospital B Cost Hospital C Cost create Total Hospital Values. 98 31 90 Hospital A Quality Hospital B Quality Hospital C Quality � The result is simple 73 27 65 Hospital A Value Hospital B Value Hospital C Value Make it Simple Make it Simple 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 How to “Drive” Provider Utilization Sample Plan Design - Example 1 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- $1,000 $2,000 Preferred Plus Hospital (per confinement)

How to “Drive” Provider Utilization Sample Plan Design - Example 2 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 3 HSA/HRA 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 $1,000 $0.00 Preferred Plus Hospitals only are utilized

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 FocusHealth � 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!

Questions? Questions?