Year 1: August 2011-July 2012 Year 2: August 2012-July 2013 Year 3: August 2013-July 2014 Year 4: August July 2015

Transcription

1 mployee Health Center (HC) HC: Insurance Advisory Committee Annual Review July 20, 2016 Year 1: August 2011-July 2012 Year 2: August 2012-July 2013 Year 3: August 2013-July 2014 Year 4: August July

2 OVRVIW Utilization Highlights Appointments Utilization Participation Diagnoses HRA & Chronic Prescriptions Health Plan Highlights 2

3 Appointment Utilization Summary Inception (August 2011) July 2015 Lake County School District Appointment Utilization 08/01/2011 through 07/30/2015 Lake County School District Appointments mployees Dependents Other No Shows Clinic Capacity # % # % # % # % # % Ancillary Visits ustis 6,359 6, % 5,531 87% 323 5% 91 1% 413 6% Ancillary Visits Clermont 6,357 6, % 5,603 88% 352 6% 59 1% 318 5% Ancillary Visits Leesburg 2,465 2, % 2,113 86% 145 6% 35 1% 172 7% Health Center ustis 28,259 27,315 97% 23,733 84% 1,685 6% 351 1% % Health Center Clermont 24,495 22,648 92% 19,915 81% 1,348 6% 208 1% % Health Center Leesburg 14,744 13,291 90% 11,497 78% 912 6% 170 1% 710 5% Occupational ustis % % 5 1% 9 2% 14 4% Occupational Clermont % % 10 2% 18 4% 21 5% Occupational Leesburg % % 5 2% 29 9% 3 1% Totals 83,794 79,433 95% 69,276 83% 4,785 6% 970 1% 4,374 5% Does not include xt. Pat. Svcs. *(xamples include patient and lab follow up calls, patient referral calls, pharmacy call backs, etc.) 3

4 30,000 25,000 20,000 15,000 10,000 5, /11 07/12 08/12 07/13 08/13 07/14 08/14 07/15 Ancillary 1,603 3,394 5,111 5,656 Medical 6,866 14,305 19,770 22,672 Occupational Totals 8,546 18,155 25,215 28,566 Total appointment utilization has increased 234% since the first year of operation 4

5 /11 07/12 08/12 07/13 08/13 07/14 08/14 07/15 Leesburg Clermont ustis ustis Location Opened 8/2011 Clermont Location Opened 7/2012 Leesburg Location Opened 2/2013 5

6 Unique Patient Participation Analysis Year 1 HC Visits: Participation 33% Year 2 HC Visits: Participation 41% Year 3 HC Visits: Participation 48% Year 4 HC Visits: Participation 52% (2418/4661) 0 August 2011 July 2012 August 2012 July 2013 August 2013 July 2014 August 2014 July 2015 Retired Other Dep Child Dep Spouse mployee Other Category consists of DO, pre employment and occupational patients 6

7 mployee % (3383/4661) of ligible mployees have visited the HC during first 3 years of operation Other 44 Retiree 37 Dep Child 340 Dep Spouse 85 mployee Dep Spouse Dep Child Retiree Other 7

8 % Participating ligible mployees 70% of those completed an HRA HRA Participation 41% Participating ligible mployees 69% of those completed an HRA 48% Participating ligible mployees 72% of those completed an HRA 52% Participating ligible mployees 75% of those completed an HRA August 2011 July 2012 August 2012 July 2013 August 2013 July 2014 August 2014 July 2015 August 2011 July 2012 August 2012 July 2013 August 2013 July 2014 August 2014 July 2015 mployee Dependent Spouse Dependent Child Retired

9 Health Risk Assessment Participants Age Banded August 2014 July 2015 Gender August 2014 July Retired mployee DepSpouse DepChild Dependent Dep mployee Retired Child Spouse Female Male

10 mployees 2700 Spouses 68 mployees Spouses DepChild Retired Retired 30 DepChild

11 mployee Health Center Top Diagnoses Aug 2014 Jul Most Conditions in the Top 10 are Chronic 11

12 mployee Health Center Top Diagnoses Inception (August 2011) Jul

13 HRA: Aggregate Lab Value Highlights Specimen Collection Period from: August 1, 2014 July 30, 2015 Measure Cholesterol Good # Good % Border Border line # line % High # High % Total Total Cholesterol % % % 1984 Total Cholesterol/HDL Ratio % % % 1982 Triglycerides % % % 1984 LDL Cholesterol Calc % % % 1980 HDL Cholesterol % % % 1984 Diabetic Measures Hemoglobin A1C % % % 894 Glucose, Serum % 0 0% % 1994 Hormonal Assays Counts & Percentages Prostate Specific Antigen, Serum % 0 0% % 226 Thyroid Stimulating Hormone % 0 0% % 1647 Vitals Systolic Pressure % % % 2761 Diastolic Pressure % % % 2762 Body Mass Index (BMI) % % %

14 HRA: Lab Insight Analysis Total Cholesterol Total Cholesterol/HDL Ratio Good% Borderline% High% 0 Good% Borderline% High% 8/11 7/12 8/12 7/13 8/13 7/14 8/14 7/15 8/11 7/12 8/12 7/13 8/13 7/14 8/14 7/15 14

15 HRA: Lab Insight Analysis Hemoglobin A1C Body Mass Index (BMI) Good% Borderline% High% Good% Borderline% High% 8/11 7/12 8/12 7/13 8/13 7/14 8/14 7/15 8/11 7/12 8/12 7/13 8/13 7/14 8/14 7/15 15

16 HRA: Lab Insight Analysis Systolic Pressure Diastolic Pressure Good% Borderline% High% 0 Good% Borderline% High% 8/11 7/12 8/12 7/13 8/13 7/14 8/14 7/15 8/11 7/12 8/12 7/13 8/13 7/14 8/14 7/15 16

17 Claims Value of Top Conditions Condition Lab Test Criteria Instances Lake County Schools All Groups Health Conditions Potential Savings Data Range: August 1, 2011 through July 30, 2015 Possible Savings Total Possible Savings Source Diabetes Glucose, Serum >= $10,683 $7,178,976 National Institute of Health (1 Yr Cost) High Cholesterol Total Cholesterol >= $944 $1,096,928 American Journal of Cardiology (18 Month Cost) Hypertension Marker for Prostate Cancer Systolic Pressure Prostate Specific Antigen, Serum >= $7,428 $10,644,324 >= $42,570 $893,970 Milliman and MedStat (1 Yr Cost) Journal of Clinical Oncology (5 Yr Cost) Obesity Body Mass Index (BMI) >= $1,615 $3,548,155 Obesity Review (1 Yr Cost) Total 5485 $23,362,353 17

18 Disease Management Review of common diseases: asthma, congestive heart failure, diabetes, hyperlipidemia, hypertension, and morbid obesity. Claims information is from the health plan and excludes CareHere related costs Gross claims costs are reflected (excludes any reimbursements if applicable) More patients are being identified with chronic conditions through CareHere More patients are migrating their treatment to CareHere The average claims cost is significantly less expensive for those engaged with CareHere than those who are not 18

19 Top 10 Chronic Conditions by Member % 08/13-07/14 Top Chronic Conditions (08/13 07/14) (08/14 07/15) Hyperlipidemia: 1, Hypertension: 1, Blood Disorders: Diabetes: /14-07/15 19

20 Prevalence: Diabetes Number of Members Non Participating Participating 20

21 Per Dx Member Per Year Cost: Diabetes Claims Cost Per Member Per Year $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 $14,321 $10,971 $10,189 $10,124 $6,545 $6,638 $3,130 $3,072 Aug09 Jul10 Aug10 Jul11 Aug11 Jul12 Aug12 Jul13 Aug13 Jul14 Non Participating Participating 21

22 Prevalence: Hyperlipidemia Number of Members , , , Non Participating Participating 22

23 Per Dx Member Per Year Cost: Hyperlipidemia Claims Cost Per Member Per Year $10,000 $9,000 $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 $9,375 $8,208 $7,648 $6,563 $5,536 $5,094 $2,786 $2,795 Aug09 Jul10 Aug10 Jul11 Aug11 Jul12 Aug12 Jul13 Aug13 Jul14 Non Participating Participating 23

24 Prevalence: Hypertension Number of Members ,640 1,609 1, Non Participating Participating 24

25 Per Dx Member Per Year Cost: Hypertension Claims Cost Per Member Per Year $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $3,186 $3,082 $9,206 $9,673 $5,979 $6,048 $11,673 $8,166 $0 Aug09 Jul10 Aug10 Jul11 Aug11 Jul12 Aug12 Jul13 Aug13 Jul14 Non Participating Participating 25

26 Prevalence: Morbid Obesity Number of Members Non Participating Participating 26

27 Per Dx Member Per Year Cost: Morbid Obesity $25,000 $23,778 Claims Cost Per Member Per Year $20,000 $15,000 $10,000 $5,000 $8,840 $12,294 $15,993 $12,687 $6,804 $11,431 $7,550 $0 Aug09 Jul10 Aug10 Jul11 Aug11 Jul12 Aug12 Jul13 Aug13 Jul14 Non Participating Participating 27

28 CareHere Connect Highlights 28

29 **nrolled = Provider enrolled patient in a health education program **Completed= Patient completed all steps in their health education program 4% completed programs **Many patients are still actively working on completing their plan, thus will not count as completed 29

30 Active= Participants who have logged in at least one time in the past 30 days. Peaks show participation in a wellness challenge through the site such as a Walking Challenge or Nutrition Month Challenge, etc. Tasks= Health related suggestions and recommendations participants are asked to complete and report on. ach participant may complete one or more tasks each day. Physical Activity Hours= data pulled from participants self-reporting their activity hours when prompted. Pounds Lost= Data accumulated from participants self-reporting their weight and/or weight data pulled from patients medical record at the wellness center (staff checks vitals with each visit) 30

31 Healthies = Points participants earn for using the program and engaging in activities. Number of Healthies arned per Patient Number of Healthies Individuals > TOTAL

32 TAVARS Lake County Schools has been named a Florida Healthy School District Bronze level by Florida Coordinated School Health Partnership (CSHP). Lake County Schools demonstrated its highest scores related to policies and processes in the areas of Health Services, Nutrition Services and ducation, and mployee Wellness, and was recognized at the Bronze level. 32

33 August 2011 July 2015 August 2014 July 2015 Cetirizine Hydrochloride Allergies 1693 Health Center Dispensed & Prescribed Meds (All Meds) 4, % 69, % Fluticasone Propionate Allergies 1343 Vitamin D Vitamin supplement 890 Levothyroxine Sodium Thyroid replacement 859 Ibuprofen Pain 800 Pantoprazole Sodium GRD 669 Lisinopril Hypertension 668 Guaifenesin DM Cough 661 Dispensed Prescribed Atorvastatin Calcium Hyperlipidemia 624 Montelukast Allergies

34 mployee Health Center Rx Analysis 30,000 25,000 20,000 15,000 10,000 5, /11 08/12 08/13 08/14 07/12 07/13 07/14 07/15 Rx Prescribed 238 1,030 1, Rx Dispensed 7,161 18,252 20,290 23,756 $400,000 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $ 08/11 08/12 08/13 08/14 07/12 07/13 07/14 07/15 Rx Cost $74,942 $182,131 $286,148 $376,691 34

35 Insurance 35

36 Health Plan Membership Trend B A S L I N B A S L I N mployee (subscribers) Total Members mployee (subscribers) Total Members 07/10 06/ /11 06/ /12 06/ /13 06/ /14 06/ Total plan membership has decreased 2.6% since the baseline year 36

37 Condition Days Admissions Ulcerative Colitis Gangrene 69 3 Congestive Heart Failure 43 4 ncephalitis 58 2 Septicemia 46 4 ndocarditis B A S L I N Inpatient Facility ALOS: ALOS: ALOS: 4.2 ALOS: ALOS: B A S L I N Inpatient Days/1000 Mbrs 07/10 06/ / / /13 06/ /14 06/ Inpatient Admissions/1000 Mbrs 07/10 06/ /11 06/ /12 06/ /13 06/ /14 06/ % decrease in Inpatient Days over the baseline Admissions have decreased 25% over the baseline period

38 Condition Paid Amount Ulcerative Colitis $697,238 Gangrene $478,217 Congestive Heart Failure $374,573 ncephalitis $367,863 Septicemia $146,999 ndocarditis $139,980 Total: $2,204,864 $10,000,000 $8,000,000 $6,000,000 $4,000,000 $2,000,000 $0 B A S L I N Inpatient Facility Inpatient Facility 07/10 06/11 $7,647,331 07/11 06/12 $7,058,109 07/12 06/13 $7,719,860 07/13 06/14 $6,875,146 07/14 06/15 $9,080,440 Inpatient Facility Inpatient Facility Payments have increased 19% over the baseline period $20,000 $18,000 $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $ B A S L I N Inpatient Payments Per Day Inpatient Payments Per Admission 07/10 06/11 $3,381 $12,043 07/11 06/12 $3,642 $14,116 07/12 06/13 $3,845 $16,150 07/13 06/14 $4,441 $15,211 07/14 06/15 $4,565 $19,570 Inpatient Payments Per Day have increased 35% and 38 Payments Per Admission 63% over the baseline period B A S L I N

39 Outpatient Facility B A S L I N Outpatient Visits/1000 Mbrs 07/10 06/ / / /13 06/ /14 06/ % decrease in Outpatient Visits since the baseline year 39

40 Outpatient Facility $10,000,000 $1,600 $1,400 $8,000,000 $1,200 $6,000,000 $4,000,000 $2,000,000 $0 B A S L I N $1,000 $800 $600 $400 $200 $0 B A S L I N Outpatient Facility 07/10 06/11 $8,073,253 07/11 06/12 $8,415,692 07/12 06/13 $7,576,971 07/13 06/14 $8,285,108 07/14 06/15 $9,565,714 Outpatient Payments/Visit 07/10 06/11 $1,084 07/11 06/12 $1,154 07/12 06/13 $1,156 07/13 06/14 $1,334 07/14 06/15 $1, % Increase over the baseline period 40% Increase over the baseline period. 40

41 Rx Utilization Trends: Health Plan and mployee Health Center 100,000 80,000 60,000 40,000 20,000 B A S L I N 0 07/10 06/11 07/11 06/12 07/12 06/13 07/13 06/14 07/14 06/15 07/10 06/11 07/11 06/12 07/12 06/13 07/13 06/14 07/14 06/15 Total HC Prescriptions Dispensed 0 6,060 14,946 20,290 23,756 Total Health Plan Prescriptions 85,664 82,200 72,976 68,070 65,468 Over the past 4 plan years; prescription utilization of the health plan has decreased while dispensed medications through the HC have increased reflecting a shift in filling patterns 41

42 Rx Utilization Trends: Health Plan B A S L I N /10 06/11 07/11 06/12 07/12 06/13 07/13 06/14 07/14 06/15 07/10 06/11 07/11 06/12 07/12 06/13 07/13 06/14 07/14 06/15 HC Average # Rx PMPY Average # Rx PMPY Prescription utilization through the health plan has decreased 21.5% per member per year over the baseline; while utilization through the HC has increased 295% since year one. 42

43 Health Plan and Health Center Rx Costs $7,000,000 $6,000,000 4,951,546 5,125,226 $74,942 $182,131 5,787,499 $286,148 6,603,361 $376,691 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $4,920,276 $4,876,604 $4,943,095 $5,501,351 $6,226,670 $1,000,000 $0 Jul10 Jun11 Jul11 Jun12 Jul12 Jun13 Jul13 Jun14 Jul14 June15 Total Health Plan Rx Costs Total CareHere Rx Costs 43

44 Rx Spend By Type $10,000,000 $9,000,000 $8,000,000 $7,000,000 $6,000,000 $5,107,521 $699,970 $5,769,726 $1,121,464 $6,584,367 $6,433,786 $1,468,653 $1,683,910 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $4,407,551 $4,648,262 $5,115,714 $4,749,876 $1,000,000 $ Jul12 Jun13 Jul13 Jun14 Jul14 Jun15 Jul15 May16 Non Specialty Specialty Total Rx Spend Total Spend Scripts Avg Spend / Script Unique Members Brand Name July 2012 July 2013 July 2014 July 2015 July 2012 July 2013 July 2014 July 2015 July 2012 July 2013 July 2014 July 2015 July 2012 July 2013 July 2014 July 2015 Harvoni $0 $0 $0 $47, $0 $0 $0 $23, Syprine $0 $0 $40,382 $63, $0 $0 $20,191 $21, Gleevec $110,598 $127,332 $202,747 $237, $9,216 $10,611 $11,926 $13,

45 Rx Spend by Type Per Member Per Year $1,600 $1,400 $1,200 $1,000 $815 $112 $921 $179 $1,051 $1,027 $234 $269 $800 $600 $400 $703 $742 $816 $758 $200 $0 Jul12 Jun13 Jul13 Jun14 Jul14 Jun15 Jul15 May16 Non Specialty Specialty Total Rx Spend 45

46 Health Plan Rx Utilization: Paid Cost Trend $1,000 $900 $800 $700 $600 $500 $400 $300 $200 $100 $0 B A S L I N Jul10 Jun11 Jul11 Jun12 Jul12 Jun13 Jul13 Jun14 Jul14 Jun15 Jul10 Jun11 Jul11 Jun12 Jul12 Jun13 Jul13 Jun14 Jul14 Jun15 Health Plan Rx Claims Costs PMPY $ $ $ $ $ Average Health Plan Cost per Rx $57.44 $60.30 $67.73 $80.82 $95.11 Average HC Cost per Rx $ $12.37 $12.19 $14.10 $15.86 Average Prescription Cost through the Health Plan have increased 66% over the baseline period, offsetting the decreased utilization. Prescription spend per members on the plan has increased 30% over the same period of time 46

47 Separating Out High Cost Claimants to Gain Better Visibility Into Cost Drivers $35,000,000 (Claimants <$50k and >$50k) $30,000,000 $25,000,000 $20,000,000 $9,603,690 $10,056,706 $10,816,799 $10,642,527 $12,974,221 $15,000,000 $10,000,000 $5,000,000 $19,977,686 $19,215,439 $18,533,435 $18,585,978 $19,960,201 $ Jul10 Jun11 Jul11 Jun12 Jul12 Jun13 Jul13 Jun14 Jul14 Jun15 Total Gross for Claimants <$50k Total Gross for Claimants > $50k Condition Paid Amount Ulcerative Colitis $697,238 Gangrene $478,217 Congestive Heart Failure $374,573 ncephalitis $367,863 Septicemia $146,999 ndocarditis $139,980 Total: $2,204,864 Total Number of claimants w claims >/= $50,000 Jul10 Jun11: 78 Jul11 Jun: Jul12 Jun:13: 98 Jul13 Jun14: 98 Jul14 Jun15: 95 47

48 High Cost Claimants Per Member Per Year (Claimants <$50k and >$50k) $6,000 $5, % $4,000 $3,000 $1, $1, $1, $1, $2, $2,000 $1,000 $3, $3, $2, $3, $3, % $0 Jul10 Jun11 Jul11 Jun12 Jul12 Jun13 Jul13 Jun14 Jul14 Jun15 Total Gross for Claimants <$50k Total Gross for Claimants > $50k Average cost per member for claimants under $50,000 has increased 2.64% over the baseline period. Claimants over $50,000 has increased 38.8% of the same period 48

49 Gross Claims Liability Trend $45,000,000 $40,000,000 $35,000,000 $30,000,000 $25,000,000 $20,000,000 $15,000,000 $10,000,000 $5,000,000 $0 $29,324,254 $29,324,254 B A S L I N $31,407,388 $33,730,752 $36,524,681 $28,893,982 $28,218,284 $29,005,941 $40,294,115 Jul10 Jun11 Jul11 Jun12 Jul12 Jul13 Jul13 Jun14 Jul14 Jun15 Projected Claims Liability Actual Claims Liability $32,986,220 Condition Paid Amount Ulcerative Colitis $697,238 Gangrene $478,217 Congestive Heart Failure $374,573 ncephalitis $367,863 Septicemia $146,999 ndocarditis $139,980 Total: $2,204,864 49

50 Gross Claims Liability PMPY $8,000 $6,000 $4,000 $2,000 $0 $4,555 B A S L I N $5,412 $6,430 $4,555 $4,965 $5,899 $4,568 $4,527 $4,684 $5,263 Jul10 Jun11 Jul11 Jun12 Jul12 Jun13 Jul13 Jun14 Jul14 Jun15 Actual Medical + Rx Claims Baseline Costs/Projections 50

51 Gross Claims + Care Here Operating Costs (includes High Cost Claimants) $40,000,000 $30,000,000 Actual Claims Gross Liability $31,045,098 $32,473,858 $30,596,238 $29,324,254 $1,702,256 $2,826,814 $3,467,917 $35,725,784 $2,739,564 $20,000,000 $10,000,000 $29,324,254 $28,893,982 $28,218,284 $29,005,941 $32,986,220 $0 Jul10 Jun11 Jul11 Jun12Jul12 Jun13 Jul13 Jun14 Actual Claims Liability CareHere Operating Costs Jul14 Jun15 51

52 Average Cost Per Patient Appointment ncounter (includes: program costs, all staff, Rx, x rays, labs, supplies, etc.) $250 Average Inclusive Cost $200 $150 $100 $50 $227 $154 $141 $96 $0 Aug11 Jul12 Aug12 Jul13 Aug13 Jul14 Aug14 Jul15 Aug11 Jul12 Aug12 Jul13 Aug13 Jul14 Aug14 Jul15 As utilization ramps up, the inclusive cost per appointment had decreased -58% Year-over-Year) 52

53 Claims Avoidance Summary Actual Health Plan Gross Paid Projected Health Plan 9% Average # of Members Average Cost Per Member Per Year Cost Per 9% Medical Trend Savings/ cost avoidance Difference Per Member Total Savings/Cost Avoidance Health Center xpenses Claims Medical Jul10 Jun11 $29,324, $4, Jul11 Jun12 $28,893,982 $31,407, $4, $4, $ $2,513,383 $1,702,256 Jul12 Jun13 $28,218,284 $33,730, $4, $5, $ $5,512,465 $2,826,814 Jul13 Jun14 $29,005,941 $36,524, $4, $5, $1, $7,518,760 $3,467,917 Jul14 Jun15 $32,986,220 $40,294, $5, $6, $1, $7,307,886 $2,739,564 $22,852,494 $10,736,551 Net Savings/Cost Avoidance = $12,115,943 ROI= $1: $2.13 stimated mployee Out of Pocket Savings Totals Co Pay Office Visits (@$20) Medical Visits Only: 22,672 $ 453,440 Rx Co Pay (@$10) Dispensed: 23,756 $ 237,560 $ 691,000 Health Plan Costs are limited to medical and prescriptions claims only and exclude Reinsurance Premium, Administration Service Only (ASO) costs, and others that may be applicable. 53

54 In August of 2011, Lake County School District opened a comprehensive health and wellness center to service the medical needs of their employees and members on their health plan. This strategy supported: comprehensive services such as primary care, chronic disease management, wellness, prescription dispensing, imaging and occupational health services aimed at improving medical outcomes and mitigating the double digit, annual cost increases the health plan had previously experienced. They currently have three health centers after four years. 52% HRA participation by employees 69,450+ prescriptions dispensed 63,600+ provider appointments 16,800+ ancillary and occupational appointments Overall Annual medical trend mitigated Awarded Bronze Florida Healthy School District Florida Coordinated School Health Partnership (CSHP) 54

55 Thank YOU! 55