LOOKING AHEAD: EMERGING TRENDS IN HEALTH BENEFITS

Transcription

1 2008 Disease Management Colloquium David E. Edman LOOKING AHEAD: EMERGING TRENDS IN HEALTH BENEFITS Tuesday, May 20, 2008, 2:00 PM 175 Strafford Avenue Suite One Wayne, PA

2 Manager of Health Benefits 175 Strafford Avenue Suite One Wayne, PA

3 WHY DOES HEALTHCARE COST SO MUCH? Primarily because 25% to 30% of healthcare costs are wasted on: Unnecessary Care Inappropriate Care Poor Quality Care 175 Strafford Avenue Suite One Wayne, PA

4 Annual Cost of Poor-Quality: $2500 Per Employee (est.) MOST COSTLY QUALITY PROBLEMS 1. Drug misuse 2. Overuse of antibiotics 3. Overuse of inpatient care 4. Preventable hospital-acquired infections 5. Diabetes direct and indirect costs 6. Depression total economic burden 7. Inadequate care after heart attack 8. Underuse of influenza and pneumococcal vaccinations 9. Asthma direct and indirect costs 10.Congestive heart failure direct costs Source: Midwest Business Group on Health, in collaboration with Juran Institute, Inc. and The Severyn Group Inc., Strafford Avenue Suite One Wayne, PA

5 The Quality of Health Care Delivered to Adults in the United States Medical Condition % Adherence To Quality Indicators Breast Cancer 75.7 Low Back Pain 68.5 Hypertension 64.7 Congestive Heart Failure 63.9 Depression 57.7 Asthma 53.5 Diabetes 45.4 Headache 45.2 Alcohol Dependence 10.5 Source: RAND Corporation Study, published by New England Journal of Medicine, June 26, Strafford Avenue Suite One Wayne, PA David@rmpllc.biz

6 THE MYTH OF BEST IN THE WORLD BY SHARON BEGLEY, NEWSWEEK, March 22, 2008 How does the US infant mortality rank among industrialized countries? 28 th of 30 countries (7 deaths per 1000 live births) The five-year survival rate for cervical cancer? Worse than Italy, Ireland, Germany, and others. The survival rate for breast cancer? You would do better in Switzerland, Norway, Britain, and others. Asthma mortality? Twice the rate of Germany s or Sweden s. Source: Organization for Economic Cooperation and Development (OECD), Strafford Avenue Suite One Wayne, PA

7 THE SHAPE OF THINGS TO COME From Dec 11th 2003, The Economist print edition. 175 Strafford Avenue Suite One Wayne, PA

8 Insurance (definition) Main Entry: 1in sur ance Pronunciation: in-'shur-&n(t)s also 'in-" Function: noun 1 a : the business of insuring persons or property b :coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril c :the sum for which something is insured 2:a means of guaranteeing protection or safety <the contract is your insurance against price changes> 175 Strafford Avenue Suite One Wayne, PA David@rmpllc.biz

9 HSA Concept From: Traditional Health Coverage To: Traditional Health Coverage Member Responsibility Health Savings Account (HSA) 100% For In-Network Preventive Care

10 Insured Claims Experience 55% of insureds have claims < $1,000 70% of insureds have claims < $2,000 80% of insureds have claims < $3,000 Milliman USA (2002)

11 Population Management Segmented By Individual s Level of Risk Healthy Acute Illness Chronic Illness Catastrophic Prevention: Health Coaching & Wellness Programs On-line Prevention: Portal: Health Patient Coaching Education, & Wellness Information Programs Gathering & Sharing On-line Portal: Patient Education, Information Gathering & Sharing 24 Hour Nurse: On-Line & Telephone Coaching 24 Hour Nurse: On-Line & Telephone Coaching Intermediate Care Programs Intermediate Care Programs Disease Management Programs Disease Management Transition Programs of Care Catastrophic Case Case Management Management Source: 11

12 HEALTH BENEFITS FROM PATERNALISM TO SHARED RESPONSIBILITY Paternalism Employer Pays The Premium EE Pays Little or Nothing At Point of Care Doctor Knows Best Shared Responsibility Employer/Individual Buys A HDHP Patient Pays From HSA Up To High Deductible Doctor Recommends, Patient Decides 175 Strafford Avenue Suite One Wayne, PA

13 BENEFITS OF SHARED RESPONSIBILITY Greater Efficiencies From Appropriate Application of Insurance Principles Lower Costs and Great Value For Purchasers Employee Incentives: Healthy Lifestyles and Appropriate Utilization Greater Employer Control Over Future Healthcare Costs (Carrier Agnostic) 175 Strafford Avenue Suite One Wayne, PA

14 CRITICAL ROLE FOR PURCHASER DRIVEN ADVOCACY Focus on Consumerism Promote Enhanced Transparency Centers of Excellence/Certificate of Need (CON) Emphasize Primary Patient Care Offer Association (Like) Health Plans 175 Strafford Avenue Suite One Wayne, PA

15 SPARK THE REVOLUTION: Health Reform is Gaining Traction in the Marketplace HSAs put individuals in charge of their own cost containment, rather than the government or HMOs. The latest news is that they have been proving their attractiveness in the marketplace more rapidly than supporters expected. --Wall Street Journal, December 27, 2005, A Strafford Avenue Suite One Wayne, PA

16 Will This Be déjà vu All Over Again? 175 Strafford Avenue Suite One Wayne, PA