The Evolution of Consumer Driven Health Plans
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Transcript of The Evolution of Consumer Driven Health Plans
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THE EVOLUTION OF CONSUMER DRIVEN HEALTH PLANS
5 RECOMMENDATIONS FOR BENEFIT DESIGN OPTIMIZATION
January 2016 © 2016 Paladina Health, LLC. All rights reserved. Proprietary and Confidential.
What are Consumer Driven Health Plans (CDHPs)?
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High Deductible Health Plan
Tax-Free Health Savings Account CDHP
Goal: drive smart healthcare consumerism by making consumers more responsible for the economic consequences
of their healthcare decisions
CDHPs are insufficiently addressing healthcare cost and quality needs
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Plan design alone is insufficient for consumers. Employers need to offer innovative solutions that go beyond shifting costs.
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The U.S. has higher incidence of chronic disease and lower life expectancy than other countries
The average family household now spends 20% of their
income on healthcare
The Catalyst for CDHPs
The CDHP solution has gained momentum with employers over the last decade
CDHPs aim to solve the problem that consumers have: Limited understanding healthcare decision economic impact
Little incentive to question advice they receive from providers
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Healthcare avoidance and dissatisfaction
CDHP participants utilize less healthcare services, including acute and preventive care, in
order to save on out-of-pocket costs.
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Potential benefits of CDHPs are unsustainable
Cost Savings
Health Outcomes
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Patient Satisfaction
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1 Low utilization with unknown health impact
Short-term savings, but unsustainable if long-term health declines
Low satisfaction; less than 30% CDHP enrollees would recommend to others
IMPACT OF CDHPs
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Overview Key Drivers and Growth of CDHP Movement
CDHP Impact
Recommendation and Conclusion
Agenda
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Empower Primary Care Providers (PCPs) 1
Better access to health services
Improved quality of care
Emphasis on prevention
Identification and early management of chronic conditions
Reduction in unnecessary specialist care
Lower PCP panel sizes (~1,000 patients) to allow time for patient-physician relationship
Paladina Health Solution
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VS.
Create a culture of transparency 2
Paladina Health Solution
Transparency database built from claims cost data, quality data, patient perception and physician feedback made available to all physicians
$3,296 per Procedure
$1,203 per
Procedure
Two colonoscopy providers: ~6 miles apart
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Improve access to care 3
Paladina Health Solution
24/7 access to physicians’ personal cell phones and secure virtual care delivery through patient portal and Healow app
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Improve cross-provider collaboration 4
Paladina Health Solution
Physicians empowered by closed-loop referral management system to quarterback all downstream care
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Align incentives through value-based compensation 5
Alternative methods of payment create incentives to encourage preventive care and better care coordination:
Paladina Health Solution
Physicians receive incentive compensation based on patient health and satisfaction
Bundled or capitated payments
Patient-centered medical homes
Accountable care
organizations (ACOs)
1 2 3
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Refined, comprehensive delivery models drive greater value
Cost Savings
Health Outcomes
2
Patient Satisfaction
3
1 Appropriate utilization of healthcare system Drive prevention Manage chronic diseases Improve health
Enhance value Reduce claims cost and drive short- and long-term savings
Arm patients with transparency Create access to the right care in the right setting
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“I became a Paladina Health physician because my philosophy really aligns with Paladina's philosophy. I'd like to see a change in healthcare in the United States. I'd like to see more prevention, more effective and efficient disease management.”
- Dr. Crocker-Sabbagh, AZ Paladina Health Physician
The Paladina Patient Experience
Lower healthcare costs
“I like that if I have something come up, I can reach out to my doctor outside of business hours and she can help me over the phone…It’s also a great benefit financially because all of my encounters have been covered. Relationships are important and I feel very strongly about this relationship with my new Paladina Health doctor.”
- Clarke, Paladina Health Patient
Improved healthcare experience
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Higher quality care
Better access to a physician
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The Catalyst for CDHPs
U.S. percent of GDP spent on healthcare more than
doubled since 1980, while other nations have
experienced increases more in line with economic growth
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Factors driving an increase in healthcare spending: Fee-for-service reimbursement Fragmentation of care delivery Provider consolidation Administrative burden on provider,
payers and patients Aging population Increasing incidence of chronic
disease Advances in medical technology Rising drug costs Overall lack of transparency Overuse of emergency services
The Catalyst for CDHPs
Clinical quality metrics for chronic conditions
Percent of members compliant
Notes: 1) Diabetic patients (n=665), Hypertensive patients (n=1752) and 2) All members must be active >180 days to be eligible for the measures 3) Source: NCQA HEDIS 2014 Benchmarks. * HEDIS uses >40 for Breast Cancer Screening and Paladina Health follows updated evidence-based medicine of >50 yrs.
72% 71% 68%
84% 79%
70%
58% 53%
59% 57%
0%
20%
40%
60%
80%
100%
Breast Cancer Screening(>50 yrs)*
Colorectal CancerScreening
Diabetes HbA1C <8.0 Diabetes BPManagement
Blood Pressure Control
Paladina Results 2015 PPO Average 2014
Our Results: Clinical Quality Measures
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Service Excellence Is Integral To Our Care Delivery
30%
49% 53%
12%
71% 73% 76% 72%
0%
25%
50%
75%
100%
Computer Hardware Grocery Online Shopping Healthcare
Industry Average NPS "Star"
Apple Trader Joe's Amazon.com
Net Promoter Score: outperforming the healthcare industry
Notes: Paladina NPS as of 2014; All Industry NPS scores from Satmatrix.com; Healthcare Industry score from: http://www.prnewswire.com/news-releases/kaiser-permanente-again-ranks-no-1-in-customer-loyalty-in-the-2015-satmetrix-net-promoter-benchmark-study-300061421.html
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