The Future is Now. Controlling the Out of Control
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1 The Future is Now Controlling the Out of Control Presented by Shawn Gibbons VP Sales & Marketing Indiana Health Network State Legislative Chair- ISAHU October 24, 2008
2 The Rule of 72
3 U.S. Medical Costs Are Rising Drastically Medical Inflation Rose 112.5% General Inflation Rose 28.8% '98 '99 '00 '01 '02 '03 '04 '05 '06 Year Kaiser Family Foundation, Health Care Costs A Primer, August 2007; OECD Stats, 2007
4 Supply & Demand Consumer vs. Payer Supply & Demand Pricing Cost vs. Perceived Value
5 What Drives the Demand Bus? 87.5% of health care claim costs are due to an individuals lifestyle! Indiana University-Purdue University Fort Wayne Study, 2006
6 Constraining Medical Costs Behavior & Lifestyle: The Cost of Smoking 180 Dollars (Billions) $88.8 B. Product Taxes & Revenue Tobacco Revenue $75 B. Direct Medical Costs $92 B. Lost Productivity Cost to Country Centers For Disease Control & Prevention, Tobacco Use Fact Sheet (July 2007)
7 Constraining Medical Costs Behavior & Lifestyle: Weight Gain No Country Can Fund All the Consequences: Hypertension Type 2 Diabetes Osteoarthritis Stroke Coronary Heart Gallbladder Sleep Apnea Respiratory Issues Some Cancers Obesity Trends Among U.S. Adults (BMI>30%) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Centers for Disease Control & Prevention, 2006 Behavioral Risk Factors Surveillance System
8 Constraining Medical Costs Behavior and Lifestyle: Solutions Incorporate wellness and disease-management into all government employee programs Federal employees State employees Medicaid Medicare SCHIP Veteran Health System Encourage employer wellness programs Legal protection Tax incentives Premium incentives
9 Constraining Medical Costs Government Cost-Shifting to Hospitals 20.0% 15.0% 14.3% 10.0% Commercial Margin Profit Margin 5.0% 0.0% -5.0% -10.0% -15.0% Breakeven Medicare Margin Medicaid Margin Hospital Breakeven Point -20.0% -18.2% -18.5% -25.0% Premera Blue Cross, May 2006: Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
10 Work Comp Costs
11 Work Comp- Employer Costs Source: USDOL BLS "Employer Costs for Employee Compensation - March 2007" Table 1; released June 21, 2007
12 WC Results Claim Frequencies Private Industry updated Sources: Country: BLS annually reports on the number of workplace injuries, illnesses, and fatalities. "Workplace Injuries and Illnesses in 2006," Tables 1 & 2, US Dept of Labor, released 10/16/2007 Incidence Rate = nonfatal recordable cases Indiana: Indiana DOL, BLS data for Indiana by year in reports "Indiana Occupational Injuries and Illnesses (year)." The table shows incidence rate by year from Table 1 or 4 of the reports.
13 Claim Costs Up Frequencies Down Sources 1. Claim costs: NCCI AIS State of Line Report, May 2007, pages 37, 39 p = Preliminary based on data through 12/31/2006; developed to ultimate through 12/31/2005 Based on states where NCCI provides ratemaking services; Excludes the effects of deductible policies 2. Frequency: USDOL BLS reports "Workplace Injuries and Illnesses in (year)
14 Total Written Premium Indiana and Countrywide totals by year Source: Best's Data Services State/Line Report - Property/Casualty, 2007 Edition (2006 Data), August 2007 copyright A.M. Best Company
15 The Biggest Trend
16 Fundamental Change Impacting Costs Patterns On-Site Clinics
17 29 percent of large employers had an on-site health center or planned to open one by 2009, up from 27 percent in survey released this year by Watson Wyatt Worldwide (NYSE:WW) Inc., a human resources consulting firm, and the National Business Group on Health
18 What do Clinics offer All associates and dependents covered by Health Plan are eligible to use clinic No office co-payments No deductible No prescription co-payments Free diagnosis & treatment Free lab work Free generic drugs 20 minute appointment No waiting
19 Employers with 3 plus years of on-site clinic experience see medical inflation for their entire employee health plan consistently under 3% annually (national Health Plan trends range from 8% to 15%)
20 96 months of data on nearly 42,000 employee lives shows cost running at $62.58 pepm Compared to average cost of $150-$200 per employer for the same service currently spent under the health plan
21 Brand / Generic Drug Cost Drug Brand Generic Clinic Nexium Allegra D Actos Lipitor Altace Paxil Cost comparisons from actual client pharmacy report for 2007
22 Laboratory Testing Costs Test Retail Clinic Complete CBC W/Auto Diff $37.00 $3.30 Lipid Panel Comprehensive Metabolic Panel Hepatic Function Panel Assay of PSA Assay of Thyroid Stimulating Hormone Prothrombin Time Blood Glucose
23 Does it really work? Cost per appointment $ Doctor & Nurse $18.53 Medications $11.27 Lab work $ 2.36 Equipment & Supplies $63.30 Total Rx purchased at 34% of retail Labs purchased at 20% of retail Plan 1-91%, now 42% Plan 2-9%, now 58% Smokers 55%, now 47%
24 What does it save associates? Estimated saved office co-pays - $46,643 Estimated saved Rx co-pays - $88,300 Estimated saved lab work - $140,644 Estimated saved wages - $72,555 (2.5 hrs) Estimated Total saved - $348,142 (35,525 hrs) No contributions increase since 2006 Eliminate appointment scheduling hassle Anxiety about not being able to afford care Waiting until critical to make appointments
25 Legislative Trends Elections will drive what happens Pooling Mandates Employer vs. Individual policies Expansion of FPL % U&C guidelines- Work Comp Hospital & Physicians Information Technology Disease management/ Wellness Competitive Options
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For your convenience, and to simplify the billing process, our practice keeps credit cards securely on file This is done to cover incidental charges, such as copayment, coinsurance, and deductible. Please
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PLAN FEATURES Deductible (per calendar year) $5,000 Individual $10,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate toward