Transcript Document

Future of Health Care Delivery
and Benefits
Mark Donahue
Regional Vice President, Labor
Anthem BCBS
Strategic Platforms for the Plan of the Future
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Affordability
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
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%
By eliminating 50-70% of waste,
we can reduce medical costs 15-20%
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Thomson Reuters, 2009 White Paper: Where Can $700B in
Waste BE Cut From the US Healthcare System
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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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Member
Noncompliance
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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*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.
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Low Compliance Drives
Higher Cost
Member
Low Compliance
Increase in compliance leads to reductions in total
healthcare costs
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Article: Medco Health Solutions: Medical Care - Volume 43m #6, June 2005
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Member
Cost Share
Member Cost Share Impacts Compliance
For every $1 increase in copay for insulin products,
compliance decreases by 1%
Member Copay (Adjusted to 30-Day Supply)
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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 “ *
* Osterberg L. Blaschke T. Adherence to Medication. NEJM
2005;353:487-497
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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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*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.
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Value Based Purchasing Design
•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
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*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.
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Access
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?
The Hallmarks of a Patient (Consumer) Centered Care Model
Support for high risk
patients
Shared decision
making &
accountability with
patients and their
caregiver
Coordination of care
across the delivery
system
Facilitated & ensured
access
Promotion of wellness
and prevention
Outcomes and
compliance with
evidence based
guidelines is
measured and
monitored
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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
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:
Quality
Cost
Coverage
•
Does my
insurance
cover this at
all?
•
How much
does health
care actually
cost?
•
How do you
compare
facilities or
providers?
•
How does my
health
insurance
cover this?
•
What will be
my real
out-ofpocket cost?
•
What quality
measures
should I
consider?
Patient
Satisfaction
•
How do other
patients feel
about their
own similar
experiences?
•
What do the
ratings
mean?
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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
Key Tactics
• Electronic & print toolkit
• Member Incentives
Campaign Metrics
Web registrations
Estimate Your Costs tool utilization
Zagat Health Survey completes
Timing
• First Quarter 2013
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Establish New View of Health
Insurance
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” Example
What 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
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