Transcript Slide 1

State & School Employees’ Life
& Health Insurance Plan
Presented to the
John D. Bower, M.D.
School Health Network
April 18, 2007
State and School Employees’
Health Insurance Plan
• Consists of Active and Retired employees (and their
covered dependents) of agencies, school districts,
community/junior colleges, public libraries, and
universities of the State of Mississippi
• Self-insured
• CY2006 - Health premiums collected $624.9 (million)
• CY2006 - Health claims incurred $533.6 (million)
• 189,167 Total Covered Lives (December 2006)
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Enrollment as of
December 31, 2006
• 119,396 Active and COBRA employees
+44,555 dependents
• 19,980 Retirees
+5,236 dependents
189,167 Total Covered Lives
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Facts
• Chronic diseases are the most prevalent, costly
and preventable of all health problems.
• Seven out of ten Americans who die each year
die of a chronic disease.
• Smoking, obesity and physical inactivity are
three risk factors that are modifiable through
behavior change.
Source: National Center for Chronic Disease Prevention and Health Promotion – “Chronic Diseases: The Leading Causes of
Death”, Center for Disease Control and Prevention, November 2005
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State of Mississippi Facts
• Cardiovascular Disease (CVD)
 Mississippi’s CVD mortality rate is the highest rate in the nation
 CVD is the leading cause of death in Mississippi, accounting for
45% of all deaths in 2001
• Obesity
 Mississippi has the highest rate of adult obesity in the nation
 Mississippi has the highest combined level of obese plus
overweight adults at 67.3%
• Diabetes
 Diabetes contributes to the deaths of 1,600 Mississippians each year
 Main cause of death in persons with diabetes is heart disease
Sources: MS Department of Health – “Chronic Disease Fact Sheet”; “Trust For America’s Health, How Obesity Policies are
Failing in America, August 2006”, “American Heart Association-Mississippi State Fact Sheet”
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How have diabetes and cardiovascular
disease impacted the Plan?
Plan Payments
Plan Participants
$18,300,000
$45,500,000
$63,800,000
13,325
13,993
27,318
$15,350,000
$40,000,000
$55,350,000
13,968
13,170
27,138
Calendar Year 2005
Diabetes
Cardiovascular Disease
Total
Calendar Year 2006 (Jan-Nov)
Diabetes
Cardiovascular Disease
Total
Source: MEDSTAT, Incurred Medical and Pharmacy Claims, includes Medicare
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2006 Wellness/Preventive Benefit
• First-dollar coverage up to $250; no deductible
• 100% coverage for office visits and certain
diagnostic tests
• Must use AHS State Network provider
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Motivating Mississippi Keys to Living Healthy
• The Plan has contracted with APS Healthcare to provide a
wellness and health promotion program designed to help
participants live a healthy lifestyle
• Available at no cost to all Plan participants, age 18 or older.
• Web based at www.healthytogether.net/mississippi or call
1-877-289-9109
• Increased wellness benefit of additional $50 (total of $300)
for participants completing a Succeed Health Risk
Assessment (HRA)
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Components of the Program
• Succeed Health Risk Assessment
• 4 Lifestyle Management Programs
• On-line tools and education
• Access to personal wellness coaches
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Succeed Health Risk Assessment
• Takes about 30 minutes to complete questionnaire
• Completely confidential-individual information is
not provided to Plan or the school district
• Find out how social, environmental, and family
history may affect health
• Learn more about preventive care
• Receive individualized action plan
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Lifestyle Management Programs
• Balance: Weight Management
• Nourish: Nutrition
• Breathe: Tobacco Cessation
• Relax: Stress Management
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Balance
• Six-week program that helps participants
work toward achieving successful weight loss.
• Looks at health and medical history, body
image, prior weight loss experiences, and
much more.
• Teaches each participant how to make their
own smart decisions about managing weight.
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Nourish
• Eight-week nutrition program that helps
participants make healthy eating decisions and
change unhealthy eating behaviors by
exploring eating patterns and providing tips
for dealing with obstacles.
• Explains different aspects of nutrition, such as
appropriate serving sizes based on a
participant’s health needs and how to prepare
healthy meals.
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Breathe
• Provides each participant customized
strategies for overcoming barriers and
effective steps for managing withdrawal.
• Designed specifically to help participants stop
smoking based on their chosen quit date.
• Teaches the participant about the seven key
characteristics that predict success, such as
ability to cope with stress, prior quitting
experiences, and support from family and
friends.
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Relax
• Five-week program that can help reduce stress
and anxiety.
• Helps participants identify their sources of
stress.
• Teaches different techniques to manage stress
and stress-related symptoms like headaches,
irritability, and sleep problems.
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Other Tools
• On-line medical library
• On-line exercise and stretching videos
• On-line cookbook and recipes
• Access to personal wellness coaches to provide
guidance and support with the programs and
tools
• Access to APS staff located in Mississippi
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How to Benefit
• Complete Health Risk Assessment
http://knowyourbenefits.dfa.state.ms.us
click on link to Health Risk Assessment
• Use AHS State Network providers for annual
visit
• Take list of allowable wellness/preventive
services to physician
• Remind physician to code with a wellness visit
diagnosis
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School Site Champions
• Requesting that your school’s Wellness
Coordinator also serve as the Site Champion
for this program
• Site Champions will receive email
communications including posters,
informational materials, and newsletter
articles
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How can APS help your
Site Champions?
• Provide “lunch and learn” presentations
• Provide information on how to plan a health
fair and a list of resource organizations
• Attend large staff meetings and/or
organizational meetings
• Serve as a resource for ideas and activities that
promote wellness within your school
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APS Wellness Coordinators
• Peggy Cother
Phone: 662-436-2126
Email: [email protected]
• Keith Parker
Phone: 662-528-3555
Email: [email protected]
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What do we hope to accomplish?
• Improve the health of Plan participants,
thereby preventing chronic disease.
• Reduce the complications for those already
diagnosed with chronic disease.
• Reduce the healthcare costs for participants as
well as the Plan.
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Contact
Teresa Planch
State Insurance Administrator
Department of Finance and Administration
Office of Insurance
P. O. Box 24208
Jackson, MS 39225-4208
Phone: 601-359-3411
Email: [email protected]
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