Transcript BLUE CROSS/BLUE SHIELD Management Meeting

Blue Cross and Blue Shield of New Mexico Presentation
Insure New Mexico! Council
Deborah Dorman-Rodriguez
Vice President and General Counsel
Dorane Wintermeyer
Vice President, Marketing and Sales
November 4, 2004
Blue Cross and Blue Shield of New Mexico,
A Division of Health Care Service Corporation,
A Mutual Legal Reserve Company,
An Independent Licensee of the Blue Cross and Blue Shield Association
Introduction and Overview
• Products
• Utilization – Education – Wellness
• Charitable Giving
• Partnering with Government
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Understanding New Mexico’s Uninsured –
396,000
11,000 of New Mexico’s
uninsured are
unaccounted for1
Approximately 112,000
New Mexicans may be
considered short-term
unisured2
Approximately 73,000 of
New Mexico’s uninsured
have incomes of $50,000
or more and may be able
to afford coverage1
Source:
1 HRSA White Paper on Unisurance in New Mexico;
Synopsis, 2004
2 Extrapolated from NM Health Care Coverage and
Access Study, 2002
U.S. Census Bureau, 2003; BCBSA analysis
Approximately 200,000
New Mexicans may be
considered long-term
unisured2
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New Mexico’s Uninsured: BCBSNM’s
Perspective
There is no single solution for New Mexico — the diversity of the uninsured
necessitates multiple public and private solutions
Uninsured
Segments
Product
Innovation
Wellness
Financial
Support
Health
Screening
Health
Education &
Services
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Health Care Costs – Understanding Cost
Trends
Private Insurance Healthcare Dollar
30¢
Physician
Services
31¢
Hospital
Care
Source: CMS, BCBSA analysis March, 2003
14¢
11¢
10¢
Prescription Admin Other
Drugs
Medical
Services
3¢
Nursing
Home &
Home
Health
1¢
Durable
Medical
Products
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Factors Driving Healthcare Cost Increases
Fraud
and Abuse
Increased
Consumer
Demand
5%
15%
Litigation and
Risk Mgmt
General
Inflation (CPI)
18%
7%
22%
15%
Government
Mandates &
Regulation
Drugs,
Medical Devices
& other Medical
Advances
18%
Rising Provider/
Hospital Expenses
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Employer Cost Per Employee By Age
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
83
80
77
74
71
68
65
62
59
56
53
50
47
44
41
38
35
32
29
26
23
$0
20
$1,000
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A Market in the Midst of Change
Rapidly Rising Healthcare Costs and Increasing Consumerism Reshaping
the Industry
Employees and
Consumer Directed
Employers
Consumers
Healthcare
Cost
Value

Shouldering burden
of rising medical
costs

Covering 70% of
premium increases

Looking for ways to
manage short and
long term costs

Struggling to
balance employee
satisfaction and
pressure on bottom
line
+

Shielded from true
cost of healthcare

Wanting more value
from their benefits as
out of pocket costs
increase

Looking for more
information and
control over
healthcare decisions
=

Greater accountability

More cost
transparency

Consumers need to
understand the cost
implications of their
actions

More informed
decision making

Empowered to make
good healthcare and
health plan decisions
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Product Innovation - Current
BCBSNM has designed new products to improve access for
the most vulnerable populations
• Programs targeted towards:
− Low-income adults
Product
Innovation
− Children
− Small employers
• Provider partnerships are key
to success
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Product Innovation - Results
Preliminary results show that HSA products are helping with
the uninsured problem
• AHIP survey June 2004
• Conducted by Hey Group
Product
Innovation
• Preliminary results
• 20% of individual HSA sales
are for previously uninsured
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Consumer Driven Health Plans:
Wave of the Future?
•
Approximately 80 - 85% of those insured have claims from $0 - $2,500
•
60% of people who had Medical Savings Accounts (MSAs) had a balance at
the end of the year
•
“One size fits all” group medical benefits no longer work
•
Baby boom generation in best position to participate in and benefit from
Health Savings Accounts (HSAs)
•
Other options include Health Reimbursement Accounts coupled with
Flexible Spending Accounts
•
With proper tools, Americans can become the center of their health care
and can decide for themselves what’s best for their families.
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Product Innovation - 2005
BCBSNM is developing programs to cover the short-term
uninsured and the middle-class uninsured
Short-term Products
Value Products
• Targeted at individuals between
jobs
• Targeted at working uninsured
and small employers
• Low monthly payments
• HSA’s for Individuals
• Limited eligibility – usually six to
nine months
• Products without mandated
benefits
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Consumers Can Play Significant Role
• The Long Term: Consumers can play a significant role over their
health and future health expenses
50%
20%
20%
Genetics
Environment
10%
Access to Care
Behavior
Source: IFTF and Center for Disease Control and Prevention, Health and Healthcare 2010, January 2000
How Can We Encourage and Support Behavior Change?
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Healthcare Cost Campaign
Started the campaign focusing on drivers of cost
Hospital
Cost Drivers
Physician
Cost Drivers
Administrative
Cost Drivers
Supplier
Induced Demand
Cost of
HIPAA
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Healthcare Cost Campaign
Emphasizing what works to address affordability and quality
in local Plan markets through BlueWorks
Partnership with Harvard Medical School
Partnerships
Consumer
Engagement
Product
Innovation
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Health Education and Services - 2005
BCBSNM will sponsor the Care Van program to provide health
screenings, immunizations and educate children
Goals:
• Partner with DOH, Providers, and non-profit health groups to provide a
diverse range of health services in New Mexico.
• Educate children and families throughout New Mexico about good health
and choosing a healthy lifestyle.
• Support state-wide DOH health initiatives and provide health awareness
outreach to underserved communities.
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Health Education and Services
BCBSNM provides education and services to other individuals
in the uninsured community
BCBSNM provides:
Health
Screening
Health
Education
& Services
• Multilingual materials to Hispanic
communities
• Outreach to underprivileged
groups
• Health screenings
• Educational materials to all groups
on maintaining healthy lifestyles
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Charitable Giving
BCBSNM administers more than $250K in charitable giving
to help the uninsured
Blues issue grants to:
• Non-profit organizations that
address community health issues
Health
Grants
• Groups that provide education and
health resources to families and
children
• Forums on the uninsured and
improving access
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