Integrating ValueBased Benefit Design

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Integrating Value-Based Benefit Design

• eValue8 User Meeting
• July 15, 2009

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About Journal Communications

• 4,000 employees, 1,200 pre-Medicare and
  Medicare-eligible participants nationally.
• Our strategic plan focuses on providing quality
  benefits while maintaining shareholder value.
• Like other employers, we struggle with managing
• Affordable coverage (employer and retiree)
• The impact of medical inflation on our budget
• The health status of medical plan participants.

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5 years ago

• 4 benefit plans
• Copays for doctor appointments and pharmacy
• Low deductibles
• Cost per employee per year 30 above the
  Midwest average!
• Attitude of entitlement. Very passive, little
  engagement

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2004 Our Concerns

• Employer concerns
• How to afford exponential increases year over
  year.
• Participants did not understand how their
  benefits worked or how much procedures cost.
• Many had chronic disease driving frequent
  hospitalizations, ER visits and prescription drug
  use.
• High utilizers often non-compliant and driving up
  medical costs.
• Member concerns
• Participants did not know how expensive their
  care was no money saved.
• Patients did not understand benefits and relied
  on physician to steer.
• Patients with medication management needed more
  touch than plan would allow.

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Question

• What can we can do today, to improve the health
  status of our participants today AND tomorrow?

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Strategy for all Actives and retirees

• Improve the health status of the participants
• Provide access to qualified providers
• Offer medical plans that require engagement of
  participants
• Reduce the barriers to preventive care
• Give participants with chronic diseases tools and
  support to manage their condition
• Increase compliance for disease-specific
  medications
• Introduce wellness program that provides feedback
  and
• Communicate, communicate, communicate

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Step 1 Promote the right provider

• Implemented a Narrow PPO Network in SE Wisconsin
• Online Transparency Tools
• Compare providers
• Quality and Safety following safety practices
  developed by the Leapfrog group.
• Promote and provide incentives for patients to
  use cost-efficient providers within the network
• MRIs, CT Scans, Colonoscopies
• Commodity rebate of 100
• Use plan design to steer participants

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Step 2 Reduce Barriers to Care

• Integrated EAP (5 visits)
• Updated Mental Health Benefits (Parity)
• Implemented Transparency Tools, Nurse Line,
  Disease Management
• Preventive Care and Wellness
• Provide 100 coverage (deductible waived) for all
  preventive care
• HSA Plans - Waive the medical deductible for
  preventive prescription drugs
• Send wellness reminders to medical plan
  participants
• Offer free flu shots at all locations for
  employees, participants and spouses

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Step 3 Manage Chronic Disease and Increase
Prescription Compliance

• Traditional Disease Management in 2004
• Pharmacy compliance in 2008 (Based on Asheville
  Project)
• Members with a personal health coach (from a
  network of local pharmacists)
• Coordination with the patients physician or
  other healthcare providers to help effectively
  manage their Condition
• Diabetes
• High Blood Pressure
• Cholesterol
• Medication and supplies at no cost / reduced cost
• Partners Mirixa and Piedmont Pharmaceutical
  Network

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Coordination and Support for the Patient
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Patient Incentives Diabetes Cardiovascular

• Face-to-face coaching
• Improved reliability via direct observation
• Interpersonal connection
• Strengthens the patient-physician relationship
• HSA Medical plan deductible waived for preventive
  RX
• 100 coverage diabetes medication, test strips
  and supplies
• Reduce copays by 50 for medication
• Cholesterol
• Blood Pressure
• Free Glucometers Insulin Pumps

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A word about incentives

• Incentives are used in the beginning to get
  participants to engage
• Participants dont stay in the program because of
  the incentivesthey stay because
• More knowledge about their disease
• Improved Health
• Improved sense of well-being

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Testimonial
I signed up for HealthMapRx for Diabetes because
the medications were free. I had no idea how
much this decision would impact my life. I have
lost 70 poundsI am eating better, I am walking
and my A1C shows my diabetes is in control! I
feel better, I have more energy and now I can
keep up with my grandchildren! Brenda (my coach)
is great! Ive learned so much from her! Thank
you so much for offering this program.
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Better Outcomes Participant

• With weight management, exercise and better diet
  and medication compliance
• Control blood sugar
• Control blood pressure
• Control of blood lipids (good and bad
  cholesterols)
• Care of feet, eyes, kidneys
• Live a healthy, active lifestyle

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Better Outcomes Plan

• Reduced costs to employer for health care
• Lowers hospital admissions, length of stay as
  well as ER visits
• Reduced risk of serious disease events (prevent
  complications)
• Participants are more knowledgeable about
  self-care
• Increased medication expense (compliance)
• Collaboration with patients physician

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Step 4 Integrate Wellness

• Partnered with Quality Health Solutions
• Health Risk Assessment that measures
• health status,
• readiness to change (Prochaska model)
• personal health history and
• health care utilization data
• Coaching
• On-line wellness tools
• On-site health screenings (glucose,
  triglycerides, blood pressure and BMI)

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Putting it all together
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Keys to success???

• Partner with a TPA that can/will support your
  initiatives.
• Find a trusted resource to assist with managing
  eligibility of plans to maintain HIPAA
  compliance.
• Integrate the data from all of your resources
• Sick time/LOA/FMLA
• Disability
• Wellness
• Medical
• Take the time to create links between processes.
• Make sure the communication is relevant.

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Partner with your TPA

• Spend time to determine what your TPA can do for
  you. Find out what they are doing for other
  customers. (Products, initiatives, plan design)
• Share your plan initiatives with your TPA so they
  can support you.
• Analyze your experience. Ask what will make the
  biggest impact.
• Leverage economies of scale when it makes sense.
• Dont be afraid to ask for assistance.
• Dont be intimidated by the answer no.

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Outsourced Eligibility Administrator

• Protect confidentiality/PHI
• Manage eligibility of all HW plans
• Employee enrollment
• Online feeds to vendors
• Liaison between employer/vendor/health plan
• Provide service center for questions/concerns
• Send communications to participants under company
  brand focus on opportunity
• Manage employee appeal process

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Integrate your data - make it work for you!

• Ask your vendors to share data with each other.
• Find benchmarks that show improvement toward your
  goals.
• Create a report card and share with your vendors,
  staff and E-team.
• Use this data to help provide timely connections.

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Getting to the right place at the right time

• Educate your vendors so that they understand all
  of the resources you offer to employees.
• Make sure they refer patients to the best
  resource.
• Patients should feel helped, not threatened.
• Help them learn so they can stay engaged.

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Communication is key

• Show executive buy-in
• Communicate often
• Provide multiple ways to learn
• Print
• Teleconference/Webinar
• On-line resources
• Video
• E-mail
• Make it relevant

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Still more to do

• Expand beyond HealthMapRxTM for Diabetes and CV
  Health
• Depression
• Asthma
• Develop more value-based purchasing opportunities
• Continue to create incentives for patients to use
  efficient providers

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Our Goal Improving Health

• Encourage patient to work with MD to tailor and
  monitor medication regimen, promote adherence.
• Use HRA to help the patient assess, identify key
  issues. Guide them to the correct resource so
  they may develop working plan of care.
• Provide coaching to motivate, inspire toward
  better behaviors develop mutually agreeable
  goals, provide support in meeting them, rewards
  for achievement
• Provide tools and advocates guide, provide
  assistance with coordination, navigation,
  integration of overall care of key resources.

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Resources - Connections

• Center for Health Value Innovation
• Cyndy Nayer 314-422-4385, cyndyn_at_vbhealth.org
• Mirixa (HealthMapRx)
• Cindy Schaller, 703.865.2035, cschaller_at_mirixa.com
  
• www.HealthMapRx.com
• Piedmont Pharmaceutical Care Network
• Larry S. Long RPh, 336-202-7146,
  Larry.Long_at_emailMM.com
• Quality Health Solutions
• Brian J. Thomas, 888-747-0708 ext 102,
  BThomas_at_qualityhealthsolutions.com

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Questions?

• Christine Reichardt
• creichardt_at_journalcommunications.com
• 414-224-2069