High Performing Health Plan Case Study - …€¦ · Case Study . ARTHUR J. GALLAGHER ... Town...
Transcript of High Performing Health Plan Case Study - …€¦ · Case Study . ARTHUR J. GALLAGHER ... Town...
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Town of Mount Pleasant
• Our 2014 High Performing Health Plan Winner
• Led by Eric DeMoura, Town Administrator, Charlie Potts,
CFO, Meghan Kelly, Human Resource Officer, and
Lauren Sims, Assistant to Town Administrator
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Rose Marchek
7
Rose is the HR Director at Mitsubishi Polyester Film, Inc. Which is an Americas
affiliate of Mitsubishi Plastics, Inc. and offers a wide array of polyester films for
existing markets such as industrial labels and liners, flexible packaging, and also
for many of today’s new emerging markets in energy and electronics. Mitsubishi
Plastics, Inc. has additional polyester film assets in Germany, Japan, Indonesia and
China. Mitsubishi Plastics, Inc., the parent company of Mitsubishi Polyester Film,
Inc., manufactures and sells various high performance products and services including
functional films, electronics materials, industrial and construction materials. Mitsubishi Plastics, Inc. is part of the
Mitsubishi Chemical Holding Corporation, one of the largest chemical companies worldwide with annual revenues of
approximately $35 billion.
She started her career over 34 years ago as a process engineer at the same facility where she now works. She then
worked in Human resources followed by several years in Sales at the companies Chicago office. After returning to the
Greer plant she managed several different manufacturing areas until she was promoted to Manufacturing Director. Then
in 2010 she transferred to her current role as Human Resources Director and member of the Mitsubishi Plastics Global
Human Resources Committee.
Rose attended the University of Florida, where she obtained a BS in Chemical Engineering, and then attended Clemson
for her MBA. She is married with two children, and lives with her family in Greer, SC. She enjoys reading, sewing, and
dancing.
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Mitsubishi Polyester Film, Inc
Health Care Initiative
Updated Through 2012
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Co-
Insurance (Earn HRA $’s
to Cover)
MFA’s Health Care Model
Wellness Programs Health Assessment, Health Management, Smoking Cessation, Skin Cancer screening, Vaccines, Health publications On-Site : EAP, Medical Providers, Occupational Testing, Health Coach, Exercise Equipment, Weight Watchers, Exercise/Yoga classes,
Off-Site Gym Discounts
Consumer Driven Healthcare
Plan (CDHP)
Our Goal is to maintain and/or improve the health of our employees, retirees and their families while controlling our health care costs.
Keys: High Deductible with
earned HRA, free
preventative care, network
discounts.
Keys: Low cost and
convenient on site care
and health support.
High
Deductible (Earn HRA $’s
to Cover) Fre
e P
reven
tati
ve C
are
Convenient On-Site, Low Cost Medical Care
(Family Medical Center)
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Pharmaceuticals Co-Insurance
MPF Pays: Generic: 100%; Brand: 80%; Non-
Preferred: 60%
Co-Insurance
Portion
*80% paid by MPF
*20% paid by you
or
use HRA $’s you earned
MPF Health Care Plan-How it Works
Deductible
Portion
100% paid by you
or
Use HRA $’s you
earned
Earn and use HRA $’s to cover your deductible and
co-insurance on Medical and Pharmaceuticals.
If you don’t use it….save it until you need it.
Preventative Care
Paid by MPF
Begin
nin
g o
f Y
ear
End o
f Y
ear
*% is for In-Network
You do not pay more than your “Out of Pocket Max” each year.
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Family Medical Center
Helps Reduce Medical Costs
•Reduces the cost of Doctors visits
-Cost per visit (Nurse Practitioner)
-Time away from work (visits and illness)
-Reduces visits to specialists (Mole removal, Orthopedic, ENT, etc)
-Reduces trips/cost to ER or other after hours care since at work.
•Facilitates Health Management Program:
-Improves Health-reduces costs (less specialist, hospital and
pharmacy costs)
-Assure preventative care.
-Controls who earns HRA.
•Reduces cost of Labs:
-Done on site-much cheaper
-Less time away from work.
•Reduces Pharmacy Costs
-Prescribe generics when ever possible.
•Reduces cost of other services by referral to lower cost provider.
(colonoscopies, GI endoscopies, arthroscopy, mamograms, radiology rather than hospital)
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Health Management Program
•Formerly Disease Management
•Current Program covers:
• Diabetes
• Dyslipidemia (high cholesterol)
• Weight Management (BMI 30 and above)
• Hypertension (high blood pressure)
•Capped Drugs for Participants in Compliance:
•Generics: Free
•Preferred brand: Lesser of co-insurance or $35
•Non-preferred brand: Lesser of co-insurance or $45
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Health Management Program-Simplified
BMI 28 or less or
reduce weight by 2
BMI points
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
MFA Medical Costs vs. National Average Increase
Health Care Initiative CDHP started
Fully transition to CDHP and opened FMC
2006 increase in Retiree Medical sharing and number Of retirees.
2007 Provider issues Not good Data
Health Programs
CONFIDENTIAL
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Medical Costs per Employee/Retiree
Health Care Initiative CDHP started
Fully transition to CDHP and opened FMC
2007 Provider issues Not good Data
Health
Programs
Company Confidential
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1. Medical Cost Reduction Incentives:
-Consumer Driven Health Plan-High deductible
-One Health Care Provider-Higher Discounts
-On-Site Medical Care
-$1000 incentive to decline coverage.
-Surcharge for Spouse if they have other insurance available.
2. Wellness Incentives:
-Earn HRA dollars to cover employee’s cost.
-Annual Health Assessment
-Health Management Participation
-BMI Challenge-Healthy Weight
-Pay Less if non-Smoker.
-Pay Less for Medication if in Health Management Program
3. Wellness Support:
-Free On-Site Health Coach
-Free On-Site Counseling
-Free, On-site Weight Watchers Program
-Free, On-Site Nutritionist
-Free Smoking Cessation Program
Mitsubishi’s Healthcare Initiatives
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Mitsubishi’s Healthcare History
CDHP
(Consumer Driven Health Plan)
FMC
(On-Site Medical Clinic)
Health Improvement
(Wellness Programs and support)
• 2005
• Transitioned from 3 plans to one with high deductible and earned HRA.
• Incentives to get people off plan.
• 2006
• Increased retiree % cost.
• 2007
• Changed Carrier for deeper discounts.
• 2008
• Change Carrier for better service with CDHC.
• Added Tobacco Surcharge
• 2009
• Increased Retiree Prem.
• 2010
• Increased Dental Premiums
• Added Vision
• 2011
• Modification for Obama Care
• >65 supplement changed to CDHP
• Retiree Reinsurance
• 2005
• Opened FMC-$20 per visit
• Developed system to do HA’s for HRA $’s
• Added EAP and Dietitian.
• 2007
• Added on site EAP.
• Introduced Health Management.
• FMC Bonus for results on health improvement of Employees Health.
• 2009
• Added Occ. Health and Pre-employment to FMC resp.
• 2010/2011
• Improved HA & HM
• Modified FMC Bonus
• Added Medicare/other Ins. Billing.
• 2002
• Voluntary Health Assessment
• 2005
• HA required for HRA $’s
• Health Support Wt. Watchers-Free and on site.
• Voluntary Tobacco Succession Program.
• 2007
• On Site/Free Health Coach & EAP.
• 2008
• Smoke Free Site
• 2009
• Health Mgt. Participation to earn HRA $’s.
• BMI initiative for HRA $’s.
• 2010 Capped drugs with HA and Health Mgt. Participation.
• 2011
• Increased exercise activities/equip.
• Health Management Kaizen
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ 18
Live Better!-MFA Health Mgt. Process
Health
Assessment
Health
Management
Program
Earn HRA $’s
and Capped
Drugs
BMI
Challenge
Hypertension Lipidemia Weight
Mgt. Diabetes
Health
Issue?
Yes
Follow-up
as
required?
Yes
Health
Assessment
(Weigh In)
<28 BMI
or loose 2
pts. From
last HA?
Earn BMI
HRA $’s
Do Not Earn
BMI HRA $’s
Yes Yes
No No
No
No
Do Not Earn
HRA $’s and
Capped Drugs
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ 19
MFA’s Health Care Process
*Supervisor’s
Meeting
Aug. 17th
*Employee
Meetings
Aug. 17-19 A/B/E
Aug. 22-24 C/D/E
Retiree
Meetings
Sept.
Letter to Homes
August
PET Press Article
Sept.
(Aug. 15th
deadline)
Employee/Retiree
Completes
Enrollment Form
“ONLY IF CHANGE”
Return Forms to
HR by Sept. 26th
Confirmation
Statement Mailed
to Homes Nov.
Schedule Health Assessment
(HA) and Blood Work (BW)
*Mandatory
Enter Changes into
the Payroll System
Oct.
HRA/Capped Drugs
Compliance List from
FMC
Enter Benefit
Information into
CIGNA system.
Earn HRA and
Capped Drugs
Earn Extra
HRA
NO HRA or
Capped Drugs
(Letter to Home)
-Diabetes
-Hypertension
-Dyslipidemia
-Wt. Mgt.
Issues
Discuss HA
Results
No Complete
BW and
HA on
Time.
Yes
Do
You
Have?
Complete
Req. Health
Support
Visits?
BMI<28
or 10%
Wt.
Red.
No
No
Yes
Yes No
Extra
HRA
Yes
Data
Benefit Enrollment Benefit Administration Live Better
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• We have many support systems available to help employees and spouses
be successful in reaching and maintaining good health.
• On-site medical facility
• Preventative care is paid 100% by the company
• Annual Company-paid health risk assessments/physicals
• Health Management Program -- Registered Dietician and Diabetes
Educator
• BMI incentive for working towards a healthy weight
• Drug costs capped for diabetes, lipids, and hypertension disease
management patients
• EAP-Free through CIGNA (life insurance/LTD insurance benefit)
• Free Tobacco Cessation Program
• On-site wellness coach
• On-site exercise classes and exercise equipment
• Exercise Facility Reimbursement
• Weight Watchers
• Annual flu shots
• Annual skin cancer screenings
Support Systems
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MPF Health Care Plan-Details
Coverage Employee Only
Employee Plus One Employee Plus Family
Basic HRA $1000 $1500 $2000
*Extra BMI HRA $300 $600 $600
Cap on non-Generic
Pharmaceuticals
Pharmaceuticals for High Cholesterol, Diabetes and High Blood Pressure
Brand: Less of Co-Pay or $35; Non-Preferred: Less of Co-pay or $45
*BMI HRA Earned- $300 employee and $300 Spouse
Coverage Employee Only Employee Plus One Employee Plus Family
Deductible $2000/$3000 $3000/$4500 $4000/$6000
Co-Insurance 80%/60% MPF
20%/40% Employee
80%/60% MPF
20% /40% Employee
80%/60% MPF
20%/40% Employee
Maximum out of Pocket
(Deductible plus Co-
Insurance)
$4000/$8000 $6000/$12000 $8000/$16000
Pharmaceuticals Generic: 100%; Brand: 80%; Non-Preferred: 60%
Health Management Program - Participation Incentives
MPF Medical Coverage (In Network/Out of Network)
CONFIDENTIAL