© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
COAST COMMUNITY COLLEGE DISTRICT
EMPLOYEE BENEFITSMarket Trends and How to Maximize your Plan Benefits
Presented by:Vickie West
Senior Consultant
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
AGENDA
Section 1: Current Marketplace & Trend - The Increasing Cost of HealthcareWhy Costs are Increasing?Questions & Answers
Section 2: Employee Awareness - Maximize Your Health Plan Benefits!Tools and ResourcesMaintaining Affordable CoverageWhat You Can Do To Be Better Consumers
Section 3: Questions
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
CURRENT MARKETPLACE AND TRENDSWHY ARE COSTS INCREASING?
• Fact: Since 2002, health insurance premiums have increased by 117.5%, more than four times the 23.1% increase in California’s overall inflation rate
• Why?– Aging Population – Increasingly Sophisticated Medical Technology– Defensive Medical Treatment/Premiums for Malpractice Insurance– Increased Utilization– Consolidation of Health Care Providers– Prescription Drugs– Medical Inflation– Compliance & Legislation– Provider Cost Shifting– Recession– Fraud and Abuse– Wasted Expenditure – Lack of Employee Awareness– Healthcare Reform Fees
-Hoag and St. Joseph Health System
-Mandatory coverage – autism, sex change
-Reduction in Medicare payments – shifting payment to group and individual plans
-Over prescribing of high dollar diagnostic treatments no database to capture multiple prescribers
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© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
CURRENT MARKETPLACE AND TRENDSWHY ARE COSTS INCREASING?
Prescription drug costs and usage
Specialty Drugs – New cancer drugs can cost $100,000 per patient during the course of treatment, and the Specialty Drug sector is only expected to grow in the future
Half of all adults in the U.S. take at least one drug per day 7% of adults in the U.S. take at least five drugs per day 2/3 of people who walk into a doctor’s office, walk out with a
prescription Some Brand Name drugs, such as Lipitor and Nexium, have
gone Generic, so pharmacy trend is expected to go down for non-specialty drugs and expected to increase for specialty Pharmacy Trend for non-specialty – 5-7% Pharmacy Trend for Specialty – 25-40%
Source: National Coalition on Healthcare
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© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C368615
SPECIALTY DRUG SPEND – CA - SOLVALDI
HOW WELL DO YOU KNOW THE COST OF HEALTHCARE?
TEST YOUR KNOWLEDGE
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C368617
QUESTIONS
• Do you know the cost of a CAT scan with contrast (pelvis/abdomen)?1. $3712. $2,0003. $1,674
• Do you know the cost of a brain MRI (with or without contrast)?1. $6602. $8003. $5,013
• Do you know what the cost of a foot x-ray?1. $502. $333. $125
*Source: Anthem Blue Cross of CA – Orange County CA
The cost of a CAT scan with contrast is anywhere from $371 - $1,674 depending on facility.
The cost of a CAT scan with contrast is anywhere from $660 - $5,013 depending on facility.
The cost of a foot x-ray is anywhere from $33 - $125 depending on facility.
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C368618
QUESTIONS – WHAT DO PRESCRIPTIONS COST?
• Average cost for Diovan (high blood pressure/heart disease) per patient per year?
1. $452. $1783. $1,181
• Average cost for Nexium per patient per year?1. $7752. $1,8993. $163
• Average cost for Enbrel per patient per year?1. $21,4372. $2,4633. $11,592
• Is a Generic Drug equivalent to a Brand Drug?• Yes• No
*Source – Express Scripts
They can only differ by dye and binding agents. Chemical compounds must be the same.
EMPLOYEE AWARENESS – MAXIMIZE YOUR HEALTH PLAN BENEFITS
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
DELTA HEALTH SYSTEM/ANTHEMMAXIMIZE YOUR HEALTH PLAN BENEFITS!1
• Members on the PPO have access to host of tools with Anthem• www.anthem.com/ca
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© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C3686111
GET COST ESTIMATES
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C3686112
FIND THE MOST APPROPRIATE CARE
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
MANAGE YOUR PRESCRIPTIONS AT EXPRESS-SCRIPTS.COM
• Review your plan benefits and coverage
• Look up drug information
• Learn about opportunities to save
• Order refills
• Check on shipments
• Review your prescription history
• Look up health and wellness information
• Locate retail pharmacies in your network
At Express-Scripts.com you can log in and complete the one-time registration. You are then routed to the member website for a personalized, plan-specific experience.
Open 24 hours a day, 7 days a week
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© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
KAISER PERMANENTEMAXIMIZE YOUR HEALTH PLAN BENEFITS!
The Power of Connection My Health Manager
E-mail your doctor View most test results as soon as they become available Order prescription refills (most can be mailed and it’s postage paid) Request, cancel, or review routine appointments Act on behalf of a family member (e-mail your child’s doctor and more)
Reshape Your Life Healthy living classes [kp.org/healthyliving]
Tai chi, yoga, stress management, nutrition, weight management, asthma, diabetes, etc.
On-line health programs [kp.org/healthylifestyles] Succeed for a total health assessment Balance for weight management and physical fitness Relax for stress reduction Nourish for good nutrition Breathe for smoking cessation
Alternative care and fitness [kp.org/choosehealthy] Reduced rates for massage therapy, acupuncture, and chiropractic care Reduced rates and free shipping for on-line health products Preferred rates on select fitness club memberships
10,000 Steps program [kp.org/10000steps] Get in better shape, one step at a time
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© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
UHCMAXIMIZE YOUR HEALTH PLAN BENEFITS!
UHC Health Discount Programs Non-Covered Health and Wellness (10%-25% off) for Dental care- teeth whitening,
Vision care-Laser eye surgery, Alternative care-acupuncture, chiropractic care, massage therapy and natural medicine, Long-term care- Skilled nursing facilities, assisted living and respite programs, Infertility treatment and Hearing devices
Fitness Club Discounts (10%-25% off) for Bally Total Fitness, Snap Fitness, Gold’s Gym, Curves, Anytime Fitness and MyGym (for children)
Weight loss (10%-25% off) for Jenny Craig, Nutrisystem and Nutrition counseling Fitness equipment and apparel Smoking cessation programs
UHC Health and Wellness Resources Healthy Mind Health Body Newsletter-Can be personalized based
topics of interest, offers videos and seminars during the year Nurse Health Information Program-available 24 hours, 7 days a week
speak with a registered nurse about your specific needs Personal Health Record-track medications, procedures, test results Online Health Trackers and Tools: Personal health record, exercise
and weight loss trackers, Body Mass Index tool, calorie calculatorshealth quizzes
Preventive Care Guidelines-schedule for health screenings and vaccinations Comprehensive Library of Health and Wellness Information Online Health Assessment and Health Coaching Healthy Pregnancy Program
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© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C3686116
WHAT CAN I DO TO BE A BETTER HEALTHCARE CONSUMER
• Pick a primary care physician and build a relationship
• If diagnosed with a condition and surgery or aggressive treatment is recommended – get a second opinion and research your options
• Understand the cost of services and impact to you and the plan• Use tools and resources to educate yourself
• Choose other alternatives of care when prudent • Use urgent care instead of emergency for non-emergent conditions• Ask your doctor if you can use a generic drug versus a brand• Use Minute Clinics or retail clinics for acute care
• Retail outlets are about ½ the cost of an office visit and typically take less time (CVS Minute Clinics, Rite Aid walk in clinic, Walgreens healthcare clinic, etc.)
• Be a better consumer by understanding the cost of treatment and overall impact to our plan
• “You” as consumers make healthcare decisions and will ultimately drive the cost of our plan
• Stay healthy and be well!
© 2014 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
QUESTIONS
Questions??
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