Incorporating a Medical Plan Decision Tool into your Benefit Program

Transcription

1 Incorporating a Medical Plan Decision Tool into your Benefit Program 1

2 2 Today s Goals Welcome to Incorporating a Medical Plan Decision Tool ( MPDT ) into your Enrollment Process Learning Goals Understanding MPDTs Real-world experience from Reta Trust Considerations for selecting an MPDT Q&A

3 3 Session Content Medical Plan Decision Tool ( MPDT ) Overview Art Taylor, President, Benefit Allocation Systems, LLC MPDT Demonstration Nolan Hughes, Dir. Programming Services, Benefit Allocation Systems, LLC A Real World Experience from Reta Trust Bob Burnett, Arthur J. Gallagher, Reta Trust Considerations for Selecting an MPDT Art Taylor Peer Feedback and Q&A

4 4 Medical Plan Decision Tool ( MPDT ) overview Art Taylor

5 5 Medical Plan Decision Tools ( MPDT ) an Overview (1 of 3) Tools to help employees make more informed medical plan decisions Tools that provide the evidence-based information that Help employees organize their thoughts Provide recommendations Picking the right plan can Save employees hundreds or thousands of dollars annually. If employees feel they ve made an informed choice of plans, they are more likely to take ownership for making that choice work.

6 6 Medical Plan Decision Tools ( MPDT ) an Overview (2 of 3) Employees value their health insurance, but Often, don t make the best plan choices Often, don t spend the time to understand their plans A plan comparison is better than nothing, but Static side-by-side plan descriptions are merely highlights & not focused on employees specific situations

7 7 Medical Plan Decision Tools ( MPDT ) an Overview (3 of 3) In contrast, a MPDT is Dynamic A step-by-step, guided Wizard through the decision process. Provides personalized recommendations Least expensive plans for the employees unique circumstances Value proposition for each plan

8 8 Factors to Consider in Selecting an MPDT Accessibility Be easy-to-use, online, & explain concepts clearly without distraction Integrate with other systems Utilize real-time employees detailed information Fully & seamlessly integrate into enrollment system Transparent costs Run different medical-spending scenarios How spending impacts plan costs (e.g. planning for a pregnancy or a surgery).

9 9 Reta Trust s MPDT demonstration Nolan Hughes

10 10 MPDT Integrated with Enrollment System Demonstration (1 of 6) Demonstration of Reta Trust s MPDT Clearview Logix MPDT within the BAS MyEnroll.com enrollment system 4 Simple questions Enrollment system provides a Wizard, step-by-step enrollment process Prior to the Medical Plan enrollment page, present MPDT Also available outside of the wizard, but still within BenAdmin system

11 MPDT Integrated with Enrollment System Demonstration (2 of 6) 11 Step 1 of 5 Who will be covered?

12 MPDT Integrated with Enrollment System Demonstration (3 of 6) 12 Step 2 of 5 How frequently will the coverage be used?

13 MPDT Integrated with Enrollment System Demonstration (4 of 6) 13 Step 3 of 5 Do you expect any specific medical events?

14 MPDT Integrated with Enrollment System Demonstration (5 of 6) 14 Step 4 of 5 Do you have any pre-existing conditions?

15 15 MPDT Integrated with Enrollment System Demonstration (6 of 6) Step 5 of 5 - Results

16 16 A Real World Experience Reta Trust Bob Burnett

17 17 The Reta Trust s Need for a Decision Support Tool Reta s Dioceses Diverse workforce Low technology quotient Different needs and they want to offer multiple plan options. Factors impacting employee plan decisions vary Reta also offers an optional Health Exchange platform Wide range of choices. Employees need assist members in making plan elections.

18 18 Factors Considered in Offering a Decision Support Tool When a Health Exchange platform was made available, a decision support tool was necessary. Without an Exchange, the tool would support Trustors desires to expand the options offered A range of affordable options could increase the number of enrolled employees and dependents.

19 Factors Considered that Showed Reta Trustors Wanted a Decision Support Tool 19 Reta conducted a survey and found wide support for including a tool in the enrollment process. Trustors generally like the idea of a Defined Contribution subsidy approach to establish set costs by covered classes Lay and religious Trustors want to offer multiple plan options.

20 20 Factors Considered to Believe Employees Would Benefit from a Decision Support Tool Reta Trust s survey Identified how employees made enrollment choice without a decision tool Gallagher Marketplace experience Demonstrated that more employees choose HDHPs when they have a decision support tool identifying the advantages

21 Trustor Survey Feedback 21

22 22 Employer Survey Feedback Survey Example If the Reta Trust implements Decision Support Tools, provide your opinion on the impact this may have: Strongly Agree with the Statements: Help employees determine the total cost for each medical option Help employees understand the value of their benefits Help employees make more cost effective decisions Enable us to offer our employees more choices

23 23 Operational Considerations System integration with enrollment platform Staffing to manage vendor & tool New costs vs. benefits of expanded enrollment Implementation timing and coordination

24 24 MPDT Support Finalists Based on the unique structure of Reta Trust Support a potential phase-in approach Support Offering an Health Care Exchange model Support challenges of incorporating MPDT into Reta Benefit Center RetaEnroll Narrowed selection to best-fit

25 25 Overview Cost Incorporates employee specific (medical and Rx) claims data Can be used with employee specific data for existing employees OR national claims data for new hires (claim free mode) Summarizes bottom-line costs & benefits of each choice Uses customized scoring system Produces a rating based on known and expected employee projected medical and Rx expenses Drives HDHP participation with HSA tax-savings calculator MPDT Setup and integration..$50,000 Enrollment System Integration.~$10,000 - $12000 (high $25,000 MPDT On-going Support $2.00 PEPM ~$42,000/year

26 26 Overview Cost Basic Decision Support model with results based purely on expected costs using national average data - No client specific claims data Medical ONLY no Rx or other lines of coverage Simple, easy to use tool consisting of 4 questions - Only takes 2 3 minutes MPDT set up and integration..$36,000 Enrollment System Integration.. ~ $10 $12,000 (high side $25k) MPDT On-going Support.$0.65 PEPM ~ $142,000/year

27 27 Overview Cost Voice (Natural Response) or avatar (Virtual Assistant) based guided support Information support Technology agnostic sits on top of any existing technology platform MPDT set up and integration..$30 - $50,000 (~$5k - $7,500 per page) Enrollment System Integration...TBD based on functionality MPDT On-going Support. $10,500 - $15,000 annual

28 Conclusions 28 1 st Choice 2nd Choice Add-On When Appropriate User friendly and easy to use but relatively generic results based on average claims cost Middle of the road in terms of cost A good introduction to Decision Support for groups offering multiple plans Most detailed and sophisticated predictor of future costs and access to care Most Expensive May be perceived as Big Brother More of a communications tool to articulate features of a program Least Expensive Good tool to describe the benefits of a HDHP with HSA or other plan/ benefit features Very valuable when offing a HDHP with HSA, ACO

29 29 Selecting an MPDT considerations Art Taylor

30 30 Speed and Ease of Use Speed and ease of use should be top-of-mind Avoid questions that require research, estimation or calculations. Effective decision support does not create work or waste time. The tool should take less than five minutes

31 31 Accessibility Available during Open Enrollment Mid-Year Life Event Enrollment New Hires Open Enrollment Special Open Enrollments Any time regardless of a specific enrollment period or not

32 32 Real-time vs Pre-Loaded Data MPDT should incorporate Real-time e.g., Reta & BAS APIs: Requires programmers (but is the future) Relative to next slide Data never shared/stored with MPDT Non-API (be careful) Pre-loaded data Updatable? Ease, Frequency, Automation

33 33 Expected Cost of Medical Care Consumers need to understand the total expected cost of medical care to make a rational selection. Total cost is the employee s share of premium plus Estimated out-of-pocket cost for each plan option Taking into account variances in copays, deductibles, OOP maximums, etc.

34 34 Adaptable & Precise Decision MPDT must be adaptable for family discussions or counselor/enroller support e.g., run spend multiple scenarios Output must be informative but not overwhelming Shouldn t make a blanket recommendation Provide relevant information Rank options by best-to-worst fit

35 35 Customizable vs. Configurable Customizable Solution will accommodate your wishes Configurable Solution includes specific modifications via buttons, checkboxes, etc.

36 36 Ancillary Sales The MPDT should create consumer peace of mind The feeling you get when you make an informed choice Model must be unbiased, credible and independent Models that lead the consumer to consider purchasing ancillary products may not have the rigor or impartiality to make the right health plan choice

37 37 Security How does solution store & redact your employees data PII (e.g., HIPAA-based practice) Claims Data Data destruction How is data transmitted from your enrollment system to the MPDT system and back? HTTPS (encrypted transport) SFTP with disk encryption

38 Q&A 38

39 Thank You! 39