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 Savings Avoided $11,100 9 $99,900 Back/Neck $10,800 2 $21,600 Shoulder $19,200 0 Hip $17,800 4 $71,200 Knee $6,000 3 $18,000 Hand/Arm Approx. Total Savings: $210,700 Source: Airrosti reported outcomes for TAC, as of April 30, 2019
Airrosti vs. Steroid Injections Airrosti Injections Avg. Office Avg. Out of Visit Copay: Pocket Cost: $40 $178.05 Plan Paid: Plan Paid: $143 $381 avg./service avg./service
Airrosti vs. Chiropractic Care Chiropractic Airrosti Care Avg. Office Visit Coinsurance Copay: $40 AFTER deductible is met No Deductible 3 Visit Avg. 10 Visit Avg.
Average Cost S t Savin vings per Condition: Airrosti VS VS Non-Airrosti T Trea eatmen ent Knee Shoulder Savings: $1,506 Savings: $1,093 Hip Back/Neck Savings: Savings: $640 43% $2,389 Lower Overall Costs 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 Cost % Diagnosis % 5-year Cancer Stage survival 0 $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 Cost % Diagnosis % 5-year Cancer Stage survival 0 $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 Cost % % 5-year % 5-year Cancer Diagnosis survival survival Stage non-small small cell cell 0 $60,038 20.5 1A: 92 31 1B: 68 I/II $73,509 4.17 2A: 60 19 2B: 53 III $84,980 25.18 3A:36 8 3B:26 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
Bending the Cost Curve – What is Healthy County?? Prevention is Key Physical Inactivity Meaningfully impacting as few as 3 behaviors and risks can save as Lack of Health much as $700 per employee/year. Screening Excessive Smoking Alcohol Insufficient Intake sleep *Poor Poor Poor Stress Standard Diet Management of Care These behaviors drive chronic conditions that account for 80% of total costs for all chronic illness, obesity being number one
Weight Loss Benefits Diabetes, High Triglycerides High Blood Pressure, Arthritis, Reflux Cancer, Urinary Incontinence Fatty Liver, Sleep Apnea > 10% > 5% > 7% >3% % 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 15-20 minutes from home or over the phone work $40/copay $10/copay Cost to Plan: Cost to Plan: $100 avg. $38 avg.
ER Visit vs. Urgent Care ER Visit Urgent Care Avg. Wait Time: Avg. Wait Time: 4 hours 16-24 minutes $150/copay $40/copay Avg. Cost to Plan: Avg. Cost to Plan: $1,371 avg. $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: Explore Airrosti as • Tier 1 Drugs an alternative to • Retail 90 surgery or steroid Copay Max or • injections • Mail order Take an active approach in your healthcare decisions!
Thank You! TAC He AC Heal alth & & Benefits S s Services (512)478-8753 ● (800)456-5974 www.county.org/healthycounty
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