Health Industry Forum Overview of Discovery s CDH Experience. Scott Spiker President & CEO Destiny Health October 3, 2005

Transcription

1 Health Industry Forum Overview of Discovery s CDH Experience Scott Spiker President & CEO Destiny Health October 3,

2 Agenda Overview of Discovery & Destiny Health The Drivers of Pre-Care Cost Containment 5 Key Questions About Consumer Cost Containment 2

3 Group Structure 3

4 Overall Similarity of SA Private Sector to U.S. Market From a selection of 39 countries across 5 continents, the South African private sector has been found to be the most similar market to the U.S. U.S. SA Private SA Private Sector Brazil Canada Sw itzerland Hong Kong Chile Ireland Australia Uruguay Argentina Venezuela Netherlands Spain Taiw an France Singapore New Zealand Poland South Korea South Africa UK Germany México Morocco Malaysia Turkey Italy Czech Republic Colombia Belgium Namibia Sw eden Russia China Hungary Peru Algeria SA Public Sector Slovakia Philippines Kenya Ranking of Countries by Similarity of Healthcare System to U.S. Market Average Score Increasing Similarity to U.S. Weightings Used In Ranking Demand: 20% 5 variables, 4% each Supply: 20% 4 variables, 5% each Funding: 20% 9 variables, 2.2% each Regulatory Environment: 20% 14 variables, 1.4% each Outcomes: 20% 6 variables, 3.3% each Source: Discovery Health Global Health Plan Markets Database; Monitor Analysis 4

5 Discovery Health Membership 1,800,000 1,600,000 1,400,000 1,200,000 1,000, , , , As of 1 January 5

6 Discovery Industry Profile Ref: Discovery Health Data, 2003 CDHPs appeal to all industries 6

7 Discovery Age Profile 12.50% 10.00% 7.50% 5.00% 2.50% 0.00% 7 Under % of members Discovery Industry

8 Agenda Overview of Discovery & Destiny Health The Drivers of Cost Containment 5 Key Questions About Consumer Cost Containment 8

9 Destiny s Consumer-Driven Model High cost, non-discretionary events Fully insured Manage quality and cost of care Insurance Insured benefits MSA Vitality wellness program Use it or Keep it First dollar coverage Annual amount available upfront Network discounts apply Interest bearing Ownership Provide access to facilities for prevention and fitness Strong rewards and incentives for healthy lifestyle and disease management compliance Behavior Change 9

10 The Vitality Cycle 1. Get Healthy 2. Earn Vitality Points Fitness Preventive care Healthy lifestyle Education Bronze Silver Gold Platinum 3. Get rewards Financial Lifestyle & leisure 10

11 Agenda Overview of Discovery & Destiny Health The Drivers of Pre-Care Cost Containment 5 Key Questions About Consumer Cost Containment 11

12 5 Key Questions About Consumer Cost Containment 1. Is It Good for the Healthy and Sick? 2. Do People Change Their Behavior? 3. Is There an Adverse Effect on Health? 4. Is It a Deterrent to Preventive Care? 5. Does It Create a Sustainable Model? 12

13 1 Is It Good For The Healthy And Sick? 13

14 Expenditure Analysis Demonstrates Comprehensive Structure of CDH Model $10,000 $8,000 EE Benefits $6,000 $4,000 Healthy Transient Sick $2,000 $0 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Cumulative Membership Destiny Traditional Plan 14

15 Impact on Transient Demonstrates Success of the Model Longitudinal study of transient behavior Year Healthy Transient Sick 1 55% 35% 10% 2 12% 3 5% 5% of initial group of 35% of members remain as Transient 87% of initial group of members shift to position where they are better or no worse off than on traditional plans 15

16 2 Do People Change Their Healthcare Spending Patterns? 16

17 Drug Costs Reduced by 22% When Funded From a CDHP Comparison of Spending Patterns of Non-Chronic Prescription Drug Costs Relative cost/frequency 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 7% 16% Avg. cost per Rx Avg. number of Rx pm Overall Rx cost per member per month 22% Insured benefit Funded from HSA 17

18 Discretionary Spending Decreases by Up To 66% When Funded by a CDHP Relative costs per member per month 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Dermatologists Dieticians Homeopaths Physical Therapists 21% reduction 30% reduction 24% reduction 40% reduction Insured benefit Funded from HSA 18

19 Relative change in claims between day-to-day and managed benefits % Difference in 4 years Day-to-day Insured chronic and hospital benefits 19

20 Relative change in claims between day-to-day and managed benefits by age band Average Relative Escalation in Claims Cost Across Age Groups ( ) 200% 175% 150% 125% 100% 75% 50% 25% 0% 18 To To To 59 >= 60 Day-to-day Insured chronic and hospital benefits 20

21 Overall Day-to-Day Spending Is Reduced by 50% on Average Average Out-of-Hospital Cost Per Member Age Band Traditional Consumer-Driven Source: Analysis of MSA s, 1999, Matisonn & Kallner 21

22 Destiny Health Plan Members Have Changed Their Healthcare Behavior in a Positive Way Analysis of Incidence of Physician Visit Frequency: HSA vs. Insured Benefits Physician visits per member per month Health plan funded The Health Plan experiences a 34% reduction in Physician visits when these are funded from the HSA compared to when these are insured and funded by the Health Plan HSA funded Source: Destiny Health, based on members who exceed the annual deductible 22

23 Impact on Rx Costs of Destiny Health Members 70% 60% % of scripts in class 50% 40% 30% 20% 10% 0% Months with Destiny Generic Branded Drugs 23

24 3 Is There An Adverse Effect On Health? 24

25 No Increase in Hospitalization Incidence Rates Is Experienced Relative to Traditional Models Incidence of hospitalization Age band Traditional Consumer-driven Source: Analysis of MSA s, 1999, Matisonn & Kallner 25

26 Analysis of Hospitalization Incidence by Duration of Discovery Membership Shows No Adverse Increase Over Time Hospitalization Incidence Rate Per Year 25% 20% 15% 10% 5% 0% 18.48% 16.78% 17.47% 18.30% 18.10% Avg. = 17.9% Membership Duration (years) Source: Discovery Health 26

27 4 Is It a Deterrent Against Preventive Care? 27

28 Utilization of Preventive Care Index of Preventive Care Usage 160% 140% 120% 100% 80% 60% 40% 20% 0% Prostate checks (men) Pap checks (women) Cholesterol screenings (both genders) Mammograms (women >45) Non-participants Wellness programs participants Source: Destiny Health Data,

29 Incidence of Hospitalizations 40% Hospitalization Incidence by Duration 35% Year of membership % 25% 20% 15% 10% 5% 0% Age band <

30 Comparison of Preventive Care Usage: HMO vs. CDHP 60% Destiny Health vs. Tufts Health Plan Preventative Measure Usage 50% 40% 30% Tufts Health Plan Destiny Health 20% 10% 0% Pap smears Mammograms Prostate check Colonoscopy or similar Note: Preventive care usage analysis excluded measures such as cholesterol screening where recommended testing frequency is less than once per year Source: Destiny Health 30

31 5 Does It Create a Sustainable Model? 31

32 Finding 1: Vitality membership is attractive to the healthy and the sick Members under age 60 with chronic conditions are at least as likely to earn Bronze, Silver or Gold status as members without chronic conditions 40% Percent of Members with Chronic Conditions 30% 20% All members Silver, Gold, Platinum 10% 0% Ages Ages Ages < Source: Milliman Study 32

33 Finding 2: Engaged Vitality members have lower claims Average Loss Ratios by Vitality Status (2004) For Primary Members Under Age 60 (Singles and Member + 1 dependant) 120% 100% Non-Vitality 80% 60% Bronze 40% Silver, Gold, Platinum Status 20% - Claims to Premium Ratio Source: Milliman Study 33

34 Finding 3: Impact of Vitality increases over time 105% Claims as % of Premium: Active Vitality Members vs Non-Vitality Over Time 100% 95% 15% improvement relative to non-engaged members over 3 years 90% 85% 80% Source: Adapted from Milliman Study Enhance rewards to create even stronger incentives 34

35 Impact of Vitality Wellness Program on Healthcare Costs Comparison of Healthcare Costs of Engaged Vitality Members vs. Non-Engaged Members Engaged Vitality member claims % of non-engaged members 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 97.8% 93.0% 83.5% 74.2% Nonengaged members Engaged Vitality members (Bronze, Silver, Gold status) 0% Source: Discovery Health 35

36 Impact on Long-Term Medical Trend Discovery Medical Trend vs. Industry Discovery 300 Industry 200 Salary

37 5 Key Questions About Consumer Cost Containment 1. CDHP is Good for the Healthy and Sick 2. People Do Change Their Behavior Using CDHP 3. There is No Apparent Adverse Effect on Health 4. There is No Apparent Deterrent to Preventive Care 5. CDHP Does Create a Sustainable Model 37

38 Health Industry Forum Overview of Discovery s CDH Experience Scott Spiker President & CEO Destiny Health October 3,