Future of Health Care Delivery and Benefits Mark Donahue Regional Vice President, Labor Anthem BCBS.
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Transcript of Future of Health Care Delivery and Benefits Mark Donahue Regional Vice President, Labor Anthem BCBS.
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Future of Health Care Delivery and Benefits
Mark Donahue
Regional Vice President, Labor
Anthem BCBS
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Strategic Platforms for the Plan of the Future
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Affordability
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Waste in the System
Of the $2.7T spend on health care in the US, it is estimated that one-third of these costs – $700B – are waste1
1 Thomson Reuters, 2009 White Paper: Where Can $700B in Waste BE Cut From the US Healthcare System
By eliminating 50-70% of waste,we can reduce medical costs 15-20%
Administrative and system inefficiencies 4-6%
Provider inefficiencies and errors 3-4%
Lack of care coordination 1-2%
Unwarranted use 11-21%
Preventable conditions and avoidable care 1-2%
Fraud and abuse 5-8%
% of total medical costs that is wasted 30%
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How to Improve Affordability
Current State▪ network access & discounts
Developing▪ Consumer Engagement
▪ Transparency for consumers to make better decisions
▪ Care Comparison & other tools
Next Phase▪ Payment Reform
▪ Value Based Benefit Designs• Diabetes example
▪ Value Based Purchasing Design
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Examples of VBBD
Marriott• 3,000 employees ID’ed with Chronic conditions, lower co-payments for
specific conditions
Pitney Bowes▪ 22,000 employees, reduced or consolidated preventive screenings
(dental, hearing, vision plus removal/reduction of chronic condition copays
PPG Industries▪ 60,000 employees, plants compete against each other to achieve
program goals. May include weight loss, smoking cessation, walking, etc.
State of Washington ▪ 125,000 employees, eliminated all cost sharing (OOP) for preventive
visits, tobacco cessation counseling, and purchase of glucometers
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Key Concepts for increasing Rx Compliance
Member noncompliance is a serious issue and is generally the rule rather than the exception.
Low compliance drives higher overall health care cost.
Member cost share impacts member compliance.
Plan designs that reduce cost share decrease overall health care costs.
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MemberNoncompliance
*Robyn Tamblyn, Rejean Laprise, James A Hanley, “Adverse Events Associated with Prescription Drug Cost -Sharing Among Poor and Elderly Persons,” Journal of the American Medical Association, May 8, 2008.
Noncompliance is a Serious Issue
Literature findings: ▪ Medication Possession Ratio (MPR) is between 50 percent and
65 percent in the general diabetic population*
▪ Average individual diabetic-related costs are approximately $5,500 per year*
Anthem findings:▪ MPR for oral diabetes drugs is approximately 65 percent
▪ Average individual diabetic-related costs are approximately $4,700 per year
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9 9Article: Medco Health Solutions: Medical Care - Volume 43m #6, June 2005
MemberLow ComplianceLow Compliance Drives
Higher CostIncrease in compliance leads to reductions in total healthcare costs
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For every $1 increase in copay for insulin products, compliance decreases by 1%
MemberCost Share
Member Cost Share Impacts Compliance
Member Copay (Adjusted to 30-Day Supply)
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11* Osterberg L. Blaschke T. Adherence to Medication. NEJM 2005;353:487-497
Investing in members for better health
Richer benefits for medications that treat chronic conditions:
▪ Promotes member compliance
▪ Improves member health
▪ Decreases avoidable hospitalizations or costly procedures
▪ Increases employee productivity
“Of all medication-related hospital admissions in the United States, 33 percent to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion a year “ *
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12 12 *Robyn Tamblyn, Rejean Laprise, James A Hanley, “Adverse Events Associated with Prescription Drug Cost -Sharing Among Poor and Elderly Persons,” Journal of the American Medical Association, May 8, 2008.
Literature findings: ▪ Medication Possession Ratio (MPR) is between 50 percent and
65 percent in the general diabetic population*
▪ Average individual diabetic-related costs are approximately $5,500 per year*
Anthem findings:▪ MPR for oral diabetes drugs is approximately 65 percent
▪ Average individual diabetic-related costs are approximately $4,700 per year
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13 13 *Robyn Tamblyn, Rejean Laprise, James A Hanley, “Adverse Events Associated with Prescription Drug Cost -Sharing Among Poor and Elderly Persons,” Journal of the American Medical Association, May 8, 2008.
•Value-Based Purchasing Design for Hip and Knee Surgeries-CalPERS
•In June 2010 the CalPERS Board approved a cost-savings program for hip and knee replacements for its PPO health plans administered by Anthem.
•Established a $30,000 threshold for knee and hip surgeries and worked with Anthem to identify facilities throughout California that were highest quality and most cost effective.
•Program successful, expanded to other insurance carrier partners
Value Based Purchasing Design
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Access
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Care Delivery Innovations
• Global Payments
• Accountable Care Organizations
• Patient Centered Medical Home
• Bundled Payments
• Gain Sharing
• Pay for Performance
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Why a Primary Care Patient Centered (P2) Approach?
To change the way our members access and receive health care services to optimize value
More patient participation in
medical decision making
Increased physician
satisfaction with medical practice
Increased patient
adherence to treatment plans
Cost-efficient management of
chronic and complex
conditions
Coordination of patient
preventive, acute and
chronic needs
Ability to foster value-based
referrals
Looming shortage of
primary care physicians
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What is Transformation to Patient Centered Care?
Support for high risk patients
Coordination of care across the delivery
system
Facilitated & ensured access
Shared decision making &
accountability with patients and their
caregiver
Promotion of wellness and prevention
Outcomes and compliance with evidence based
guidelines is measured and
monitored
The Hallmarks of a Patient (Consumer) Centered Care Model
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Anthem Patient Centered Medical Home Pilots
What is it?
▪ Redesigns PC reimbursements to reward physicians for aspects of care most important for good outcomes
Ten Pilots; three cited in Health Affairs article
▪ September 2012; Volume 31, Issue 9
▪ Payment Reform To Achieve Better Health Care
Different by state; key component’s include care coordination fees, quality recognition, enhance reporting for clinical management
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Anthem Patient Centered Medical Home Pilot Results
Colorado
▪ -18% reduction admissions
▪ 15% reduction ER visits
▪ ROI range 2.5:1-4.5:1
New Hampshire
▪ ER visit reduction
▪ 5% trend vs. 12% for in traditional practices
New York
▪ Increased compliance (example-diabetes patients HemoA1c testing)
▪ Lower inappropriate use antibiotic
▪ Reduced ER
▪ Lower monthly costs
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Anthem Patient Centered Medical Home Pilot
Anthem Status▪ Pilot status ongoing in 2012; continued investment and
development
▪ 2013-growth of “PC2” in Anthem and Blue markets
▪ 2014-growth across all Blue Plans
▪ Pass-through of “bulk” or bundled payments to ASO clients will begin in 2013, 2014.
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Consumer Experience
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Defining & Enhancing the Consumer Experience
Consumers are looking for an ally to help explain their benefits and guide them through their health care experience▪ A health plan that had advocacy level service would ‘delight’
members and be perceived on going above/beyond.
▪ Consumers want accessible, relatable, reliable service, and knowledgeable representatives.
▪ Some want to have immediate access.
▪ All consumers expect a variety of options for getting help, including phone, email, web and live online chat.
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How do members make informed decisions?
Four Types of information required:
• How much does health care actually cost?
• What will be my real out-of-pocket cost?
• How do you comparefacilities or providers?
• What quality measures should I consider?
• How do other patients feel about their own similar experiences?
• What do the ratings mean?
• Does my insurance cover this at all?
• How does my health insurance cover this?
Coverage Cost QualityPatient
Satisfaction
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Start with the Basics
Easy, secure access to personalized member services
Quick access to the most common member tasks
Seamless transition from public to private site for secure content
Tone is consumer friendly, helpful, simple language without insurance jargon
One-click access to high-value transparency and health improvement tools
Ability to access your health dashboard
Integrated benefits summary for all plans, including specialty products
Quick links to find a doctor, refill a prescription and check claim status
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The Website – A Vital Consumer Resource
Research has shown that online is an important channel of information and tools for consumers.
▪ Consumers want information and tools available 24/7
▪ They want the information available anywhere and everywhere they go
▪ They prefer personal, up to the minute information and data that printed materials often cannot provide
This is true for insurer websites as well. Through our research we have learned:
▪ A majority of consumers prefer to access information online, which leads to over 7 million core transactions on our website each month
▪ Communicating about the tools, services and information available on our website is an important driver of member communication satisfaction
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Sample Web Registration Campaign
Overview• Campaign to drive registrations,
tell the cost of care story, & provide timely reminders to members when to use tools
Objective• Drive registrations• Increase utilization of
transparency tools
Timing• First Quarter 2013
Key Tactics• Electronic & print toolkit• Member Incentives
Campaign MetricsWeb registrationsEstimate Your Costs tool utilizationZagat Health Survey completes
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Establish New View of Health Insurance
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Healthcare Management to Well-Being
Current World▪ UM, case management, pre-certification
Evolving▪ Care coordination
▪ Personal health coaches
▪ Incentives
Overall Well-Being▪ 360 approach-integrate all components of health
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Blue Zones –A “Well Being” ExampleWhat are they?
• Verifiable parts of the world where people live the longest and have the highest levels of Well-Being, in other words, the healthiest people on the planet
Where are they?▪ Okinawa, Japan; Sardinia, Italy; Loma Linda, CA; Nicoya, Costa
Rico; Ikaria, Greece
What makes them so healthy?▪ Move naturally, eat wisely, have the right outlook, and are
connected
Application?
Google is creating an environment for employees to take steps to create company “Blue Zones” on path to overall Well-Being.
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Summary
• The Health Plan of the Future is going to require a paradigm shift for all of us
• Willingness to change
• Patient centered, member focused create activities & plan designs to support “Well Being”
• Key concepts• Value Based Plan Design, Value Based Purchasing
• Network re-configuration to PC2 type delivery models
• Focus on total health (Well Being) vs. managing care
• Partnership-Fund, vendors, leadership, membership