2017 HEALTHCARE STATISTICS AND TRENDS. Douglas C. Foust MBA, CEBS. SPHR Managing Director, County Employee Benefits Consortium of Ohio May 10, 2017

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1 2017 HEALTHCARE STATISTICS AND TRENDS Douglas C. Foust MBA, CEBS. SPHR Managing Director, County Employee Benefits Consortium of Ohio May 10, 2017

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4 HSA Contributions 70% < $1,500 Single 60% < $2,500 Family

5 $1,656 Note: Single = $615, based on 138 plans reported across 81 counties.

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10 13% higher

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13 Single Deductibles

14 Family Deductibles

15 In-network Coinsurance Levels

16 Out-of-Network Coinsurance

17 Out-of-pocket Maximums

18 Rx Co-payments - Retail

19 Rx Co-payments Mail Pharmacy

20 Dental and Vision Offered

21 Dental Cost Share

22 Vision Cost Share

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24 Cost Avoidance Opting Out

25 Spouse Deferral Prevalence 38%

26 Spousal Restriction - Type While 56% still have no restrictions, CEBCO s experience is that many are asking about it and interest continues to grow,

27 Currently CEBCO has 8 Counties that apply requirements to allow a working spouse to be eligible to be covered under the county health and prescription drug plans. Allen County: Spousal Eligibility Policy If an employee s spouse is eligible to participate in a group health insurance plan sponsored through his/her employer, enterprise and/or any public/private retirement plan, the spouse may NOT enroll in Allen County s Health and Prescription Drug Plan. Fulton County: Spousal Eligibility Policy If an employee s spouse is eligible to participate in a group health insurance plan sponsored through his/her employer, enterprise and/or any public/private retirement plan, AND the contribution requirement does not exceed 30% of that employers total cost of providing coverage for a single the plan, the spouse may NOT enroll in Fulton County s Health and Prescription Drug Plan. If the cost DOES exceed 30%, the spouse would then be allowed to enroll in the Fulton County s Health and Prescription Drug Plan.

28 Logan County: Spousal Eligibility Policy The Plan requires spouses of covered employees to enroll in other available group health insurance plans under the following conditions: 1. The spouse is eligible for Medical and Prescription coverage through his or her employer. 2. The spouse has retiree Medical and Prescription coverage available from any source. The Board of Logan County Commissioners, as administrators of the Logan County Employee Health Plan, shall have sole authority to determine spousal eligibility. Under this policy an employee s spouse is required to obtain at least single coverage beginning January 1, 2014 through his/her available plan. The spouse s plan will be considered primary coverage and Logan County Employee Health Plan will not provide coverage on a secondary basis. Eligible children will be permitted to enroll in either plan. Morrow County: Working Spouse Benefit Policy If an employee s spouse is eligible for, but not enrolled in, the care coverage offered by the spouse s employer, the County Health Benefit plan will NOT pay benefits (the spouse is not eligible to join the Morrow County Plan). However, if the Morrow County employee s spouse will incur an additional $150 per month insurance premiums in addition to the cost of the Morrow County Health Benefit plan, the employee s spouse is eligible for enrollment in the Morrow County health Benefit Plan.

29 Preble County: Working Spouse Benefit Policy If you are married and your spouse has group health coverage available through his or her employer, your spouse will only be allowed to enroll in the Preble County Group Health Plan if you agree to pay for that coverage at the spousal surcharge rate. The spousal surcharge is effective January 1, The spousal surcharge is $ per month and will be assessed bi-monthly. The spousal surcharge is assessed bi-monthly on a pre-tax basis. In other words, it will cost you an additional amount to cover your spouse under the Preble County Group Health Plan if your spouse is eligible to participate in his or her employer s group health plan. Note that the spousal surcharge does not apply if your spouse is enrolled in Medicare, Medicaid or TRICARE. If your spouse does not have other coverage available, your spouse will be allowed to enroll in the Preble County Group Health Plan at the regular applicable premium rate. That is, you will not have to pay the spousal surcharge. Putnam County: Working Spouse Rule If your spouse is eligible to participate in a group health insurance and/or prescription drug insurance plan sponsored by his/her employer, enterprise, or an any public or private retirement plan, your spouse will be required to enroll in that employer sponsored health insurance plan and if that employer s plan be his/her primary coverage as long as the monthly employee contribution for that coverage does not exceed $200.

30 Union County: Working Spouse Rule If your spouse is eligible to participate in the a group health insurance and/or prescription drug plan sponsored by his/her employer, enterprise and/or any public or privates retirement plan, your spouse will be required to enroll in that Employer Sponsored health insurance plan and have that Employers Plan be his/her primary coverage. Washington County: Spousal Surcharge Policy If your spouse is eligible to participate in a group health insurance and/or prescription drug insurance plan sponsored by his/her employer, enterprise, or an any public or private retirement plan, your spouse will be required to enroll in that employer sponsored health insurance plan. However, if that employer s plan monthly contribution costs the employee less than $300 per month, the member may choose to enroll the spouse to the county plan but the member must acknowledge and understand they are responsible to pay the appropriate tier rate and an additional payroll deduction in the amount of $100 bi-weekly. Each Plan requires annual completion of a Spousal Affidavit or Verification Form

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34 Final questions and comments? and thanks for joining!

35 The American Health Care Act The AHCA s proposed changes to the ACA include: 1. Repeal of the individual mandate and employer mandate penalties; 2. Repeal of the essential health benefits requirement; 3. Adoption of a 30% premium penalty in the individual market for failure to maintain continuous health care coverage; 4. Adoption of an age-related and income-based tax credit for purchasing health care coverage from the public exchange and in the individual health insurance market; 5. Preservation of certain ACA provisions (e.g., the pre-existing condition exclusion ban and the adult child rule);

36 The American Health Care Act The AHCA s proposed changes to the ACA include: 6. A six-year delay in the Cadillac tax and a repeal of the ACA s taxes and fees; 7. Increased health savings account (HSA) contribution limits; 8. Repeal of the actuarial value standards and an increase in permitted age variation in health insurance premiums; 9. Federal grants to states to stabilize the individual and small group health insurance market; and 10. Reforms in the expansion and funding of Medicaid.

37 Data Security O Patient privacy issues (including concerns about data breeches) will continue to be top-of-mind for providers, payers, and consumers, especially with ongoing data breeches in the news. Providers and payers will need to step up data security to avoid the type of Health Insurance Portability and Accountability Act (HIPAA) violations that can negatively impact an organization.

38 O Patient-Centered Care O A significant change in the healthcare industry s approach to providing care is underway putting the patient at the center of care. The goal is to improve patient satisfaction scores and engagement. O But, this is new territory, and the industry as a whole is just starting to look into ways to engage with patients outside of a traditional office visit. For example, many providers haven t yet tapped social media to build relationships with their customers. This will need to change, especially as patients begin to shop for healthcare the way they shop for cars or electrician services by searching the Internet, looking for quality metrics and patient reviews, and comparing prices.

39 O Wearable Tracking Devices O I heard on the radio there are now 70 million people in the U.S. are using wearable tracking devices to monitor their physical activity, sleep patterns, calorie consumption, and a whole lot more. This is an exciting new frontier with so much potential to improve patient care. It will be fun to see the impact this trend has on improved patient engagement.

40 Outcomes are Improving O O I was excited to see an article in Modern Healthcare that showed improvements in patient safety in U.S. hospitals. In fact, approximately 1.3 million fewer patients were harmed between 2010 and That represents a 17 percent reduction in adverse events and the prevention of 50,000 deaths. The largest improvement was in CLABSI (central line-associated bloodstream infection), which showed a 49 percent reduction from One of the driving forces behind improved outcomes is CMS s emphasis on reducing hospital readmission rates. From 2007 to2011, the all-cause 30-day readmission rate among Medicare fee-for-service beneficiaries held steady at between 19 and 19.5 percent. Once CMS introduced readmissions penalties in 2012, the rate dropped to 18.5 percent. Then in 2013, it fell further to approximately 17.5 percent. The net result is roughly 150,000 fewer readmissions from January 2012 to December Once the 2014 figures are released, I expect to see even more reductions in readmissions and have already seen significant reductions from the health systems we ve worked with. For example, one health system reduced its heart failure readmission rate by 29 percent. By using analytics and an EDW, the organization was able to capture necessary data elements and then track various interventions quickly and adjust as needed.

41 Q&A SESSION

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