Health Plan Initiatives, Trends and Research in ConsumerDriven Care

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Health Plan Initiatives, Trends and Research in
Consumer-Driven Care
National Consumer Driven Health Summit October
20, 2008
Maureen E. Sullivan Senior Vice President
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Market Enrollment in CDHPs
Launched as a way to increase consumer
engagement, CDHP enrollment is up more than 25
in the last year
Members Enrolled in Millions
Blue CDHP Profile
12.5

• Blues serve approximately 4.4 million CDHP
  enrollees, up more than 50 from a year ago
• 2.9 million covered by HSA-qualified plans
• 1.5 million members in HRA-based products

10.0
Sources American Association of Preferred
Provider Organizations, Blue Cross and Blue
Shield Association
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CDHP Offer and Uptake Rates
Growth is being driven by increased employer and
health plan offerings of CDHP products
Percentage of ConsumersOffered a CDHP Option
CDHP Uptake for Consumerswith a Choice of a CDHP
Product
HRA
HSA-eligible
Sources 2005, 2007 and 2008 BCBSA CDHP Member
Experience Surveys
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CDHP Demographics
CDHP members increasingly mirror non-CDHP
population
Age Distribution
Income Distribution
HSA-eligible
Non-CDHP
HSA-eligible
Non-CDHP
18-29
30-44
45-54
55-64
Sources 2005, 2007 and 2008 BCBSA CDHP Member
Experience Surveys
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CDHP Consumer Engagement
Are we creating a more savvy shopper?

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

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Rewards and Incentives

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA-eligible enrollees are offered more incentives
Consumers Receiving Incentives or Rewardsfor
Health and Wellness Participation
Examples of Rewards/Incentives

• Cash
• Contributions to account
• Lower premiums, copays and deductibles
• Points redeemable for merchandise

Percentage of Enrollees
Statistically different from non-CDHP results
at a 95 confidence level Sources 2008 BCBSA
CDHP Member Experience Survey
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Opening Rates of Health Savings Accounts

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

More employees open HSAs when offered incentives
HSA-eligible Consumers Opening Accounts
Percentage of Enrollees
Statistically different from Without
Contribution results at a 95 confidence
level Sources 2008 BCBSA CDHP Member Experience
Survey
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Consumer Attitudes

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA-eligible enrollees want more control over
costs, utilization
Consumer Attitudes
Percentage of Enrollees
Statistically different from non-CDHP results
at a 95 confidence level Sources 2008 BCBSA
CDHP Member Experience Surveys
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Cost-Sensitive Behaviors

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA-eligible consumers more cost-conscious and
cost-driven
Behaviors Considered Because of Cost
Percentage of Enrollees
Statistically different from non-CDHP without
Account results at a 95 confidence
level Sources 2008 BCBSA CDHP Member Experience
Survey
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Healthcare Financial Behaviors

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA-eligible enrollees are more actively engaged
in tracking and estimating their healthcare costs
Healthcare Financial Behavior
Percentage of Enrollees
Statistically different from non-CDHP results
at a 95 confidence level Sources 2008 BCBSA
CDHP Member Experience Survey
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Health and Wellness

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA-eligible enrollees more engaged in health and
wellness
Participation in Health or Wellness Programs
Percentage of Enrollees
Statistically different from HSA-eligible
results at a 95 confidence level Note
Participation among those offered health or
wellness program Sources 2008 BCBSA CDHP Member
Experience Survey
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Healthcare Utilization

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA-eligible enrollees use more preventive
services, and their use of necessary care mirrors
non-CDHP population
Healthcare Utilization
Percentage of Enrollees
Statistically different from non-CDHP results
at a 95 confidence level Sources 2008 BCBSA
CDHP Member Experience Survey
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Healthcare Utilization Study

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

Savings due to reduced utilization are observed
in CDHPs, however, CDHP enrollees are not
foregoing needed care
Savings Due toReduced Utilization
Member Healthcare Compliance
Chronic Compliance
Preventive Compliance
Full Replacement
Choice
Full Replacement
Choice
Statistically different from Traditional PPO -
Choice results at a 95 confidence level
Statistically different from Traditional PPO
Full Replacement results at a 95 confidence
level Note CDHC study population restricted to a
subset of 1,364 members from an original CDHC
enrollment base of 57,365 members in
2006 Sources Blue Cross Blue Shield of
Tennessee, CDHC Impact on Utilization, Costs,
Quality, June 2008
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Successes
CDHPs appear to be successfully aligning
incentives and engaging consumers around cost and
health decisions
Non-CDHP
HSA-eligible
Engaged Consumer
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Information Needs

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA users want more cost information, and their
interest in quality information is on par with
non-CDHP enrollees
Information Useful When Making Healthcare
Decisions
Percentage of Enrollees
Statistically different from non-CDHP results
at a 95 confidence level Sources 2008 BCBSA
CDHP Member Experience Survey
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Quality Information Key

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

National Blue Distinction program created to
educate consumers and engage them based on quality

• Blue Distinction Centers for Cardiac Care
• Blue Distinction Centers for Bariatric Surgery
• Blue Distinction Centersfor Transplants
• Blue Distinction Centers for Complex and Rare
  CancersSM

Source BCBSA
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Quality Information Key

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

Blue Distinction facilities delivering better
quality results
32
18.7
14.2
Percentage of Patients Readmitted in 90 Days
n 1741
3584
Note All cardiac and cardiac related
readmissions during the initial admission through
90 days, 90 day eligibility required for patient
cohort Source HealthCore Analysis of WellPoint
Data, July 2008
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Likelihood to Recommend

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

Member recommendations starting to reflect the
increased maturity of the product
Likelihood to Recommend Coverage
Percentage of Enrollees
Statistically different from non-CDHP results
and HRA results for 2008 at a 95 confidence
level Note 2005 and 2007 non-CDHP results
include 4 largest carriers only Sources 2005,
2007 and 2008 BCBSA CDHP Member Experience Surveys
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Drivers of Recommendation

• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making

HSA-eligible enrollees require more health plan
support
Drivers of Recommendation
HSA-eligible Enrollees
Non-CDHP Enrollees
Primary Drivers
Out-of-pocket cost
Out-of-pocket cost
Access to preventive care
Claims payment
Secondary Drivers
Information on health plan benefits
Information on health plan benefits
Network
Network
Claims payment
Help to manage healthcare costs
Tertiary Drivers
Service
Website
Sources 2008 BCBSA Member Experience Survey
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Consumer Engagement
HSA users are more savvy shoppers, and HSA
learnings can be leveraged to better engage all
consumers
HSA-eligible
Engaged Consumer