1 Wellness A Carrier’s Perspective. 2 HOW MEDICAL EXPENSES ARE MANAGED Precertification Case...
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1 Wellness A Carrier’s Perspective
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Transcript of 1 Wellness A Carrier’s Perspective. 2 HOW MEDICAL EXPENSES ARE MANAGED Precertification Case...
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Wellness A Carrier’s Perspective
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HOW MEDICAL EXPENSES ARE MANAGED
PrecertificationCase Management
Disease Management
Worksite NursesWellnessMEDICAL
RxDrug Safety
Formulary
Quantity Limits
Precertification
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Common Wellness Plan Features
Carrier Options Possible Additions
- Online HRA - Health Fairs- Online Health Improvement Programs - Biometrics- Smoking/Weight Loss Programs - Carrier Reports- Health Information - Worksite Nurses
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Wellness – Return on Investment
All Employers
Self Insured Employers
Fully Insured Employers
-Fewer Sick Days-More Productive Employees-It Sounds Like the Right Thing To Do
-Lower Claim Costs-Lower Trend for a Few Years
-Lower Premium-Lower Trend for a few Years
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PREMIUM AND CLAIM DRIVERS
Category Wellness Impact
Medical Loss Ratio 1 – 3 Year Lag
Risk Factors 1 – 3 Year Lag
Demographic Changes No Impact
Ongoing/High Dollar Claims No Impact on Some ClaimsLarge Impact on Other Claims
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YOUR CHALLENGES
- Impact the right people 1.0 4.9 .76 14.3 5.3 .97 3.2 .45
1.1 .85- Employee Turnover
- Employee Participation
- Dependents are 40% of Total Members
