v alue b ased i nsurance d esign and low wage workers
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V alue B ased I nsurance D esign and Low Wage Workers. April 24, 2008. It’s Time for Comprehensive Health Care Reform. The efforts of HCAT to improve the health of our low wage worker members are patches on a dysfunctional system still leaving them underinsured - PowerPoint PPT PresentationTRANSCRIPT
Value Based Insurance Design and Low Wage Workers
April 24, 2008
It’s Time for Comprehensive Health Care Reform The efforts of HCAT to improve the health of our
low wage worker members are patches on a dysfunctional system still leaving them underinsured
Employer sponsored coverage falls short for these members and many other Americans
Only through a reform plan that ends the fragmentation in our medical system leading to overuse, misuse and underuse can we begin to match the general health care outcomes and realize similar savings as the other industrialized nations
GENERAL INFORMATION More than half of employees or their dependents have
a chronic health condition that will require ongoing care1
– Chronic illnesses drive approximately 75% of health care costs2
Wellness is increasingly important in fighting obesity, which is associated with a 35% increase in spending on health care services4
– Estimates of ROI for obesity wellness programs is up to 1:54
Preventive health screenings continue to play an important role in managing health costs – About ⅓ of diabetics do not know they have the disease3
– A 10% reduction in cholesterol levels can result in a 30% reduction in the incidence of heart attacks and strokes5
Sources: 1) Hewitt Associates Research, April, 2008 2) American Medical Association, “Strategies to Address Rising Health Care Costs”, 12/07 3) “Weights and Measures: What Employers Should Know about Obesity”, The Conference Board, 2008 4) Centers for Disease Control and Prevention (CDC), “Preventing Diabetes and Its Complications” 5) Cohen, JD. “A Population Based Approach to Cholesterol Control,” American Journal of Medicine, 1997, as reported by the CDC
What We Know
SEIU Health Care Access TrustA Taft-Hartley Plan
Set up to take in newly organized low wage workers– Child Care – Home Care– Janitors
Average income before organizing– Janitors and Home Care workers –
minimum wage – $6.50– Child Care Workers – $9.00 to $20.00
per child care day
Health Care Access Trust Members OUR MEMBERS’ PROFILE
45 – 48 years old
80 – 90%+ female
Largely Latino, African, African-American, Rural Caucasian
Inconsistent or no previous health care
Multiple untreated chronic diseases
Have learned how to use the ER as their doctor
Why There Will Be High Cost in the Future THESE MEMBERS HAVE SERIOUS UNTREATED ILLNESSES
In one bargaining unit 45% of the members surveyed self-identified as having one or more chronic diseases – mostly high blood pressure and diabetes
They are likely to have undiagnosed acute problems such as cancers and serious heart disease
Members tend to have multiple jobs and serious economic strain leading to high stress
Members usually do not have leave to take care of their health without losing income
Why Are These Members Low Cost Today? Employers are unwilling or unable to provide
adequate funding for health care:– Little or no money in early contract years– Tend to favor high deductible/high co-insurance
plans
Therefore members are at best underinsured If they have insurance
– Cannot afford the co-pays and co-insurances for necessary services
– Are constantly afraid of high bills if a doctor finds something wrong
Sources: *2006 Center for Disease Control, **UnitedHealth Claims Data, 2007
Opportunity for Greater EngagementTHE PARADOX How much to spend preventing future expenses and
how much to spend controlling today’s highest costs?
59%of future high cost population comes from today’s low cost population*
95%
70%
Claims Costs**
20% of Members
5% of Members
Recognize you can’t do it all with $175 pmpm
Try to get chronic disease treated
Make it easy to see the doctor
Have at least some drug and diagnostic covered
Short change hospitalization and hope you can find community resources to help
Our Philosophy
Walking the SEIU Talkin Our Own Sponsored PlansIF WE ARE WALKING THE TALK
We have to look seriously at evidence-based medicine
We have to encourage personal responsibility
We have to address chronic disease more creatively
We have to realistically address smoking and weight control
Value Based Insurance Design
WHY TRY IT?
VBID overlays a quality of life calculation on evidence based medicine
It differentiates copayment rates based on the value of the medical service to the individual and to the system
It drives patients into essential services by eliminating financial barriers to those services – critical to low wage workers
University of Michigan Department of Public HealthDr. Mark Fendrick
UnitedHealth Care Value Based Insurance Design Team
SEIU Locals 1 and 26Milwaukee and Minneapolis Janitors Respectively
Our Partners
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Challenges to Implementing VBID for Low Wage Workers
Our members are on limited plans due to financing from employers
Some of our employers do not see it as their responsibility to improve their employees' health or explore new avenues for health care provision
Our members have little or no experience with the health care system
A challenge to insurers even with ASO contracts
Incentives – how do we do that in a Taft-Hartley?
OTHERS SEIU HCAT
APPROACH
Plan design ensures access
for targeted clinical services
Whole person approach: Ensure access via plan design Education and engagement via
integrated care/coaching programs Incentives for success: Healthy
actions and outcomes
FOCUSChronic population
and Rx costs
Encourage prevention and compliance across broad population Unique strategies for high/low cost populations Reflects all costs of maintaining health
CONSUMER ENGAGEMENT
Pharmacy gaps, care management
Consumer level – customized communications, retail marketing approach
How Is This Different?VBI D
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Implementing a VBID Plan
IDENTIFYING HEALTH ISSUES
Health Risk Assessment Biometric Screening Age appropriate physical exams
GETTING MEMBERS TO THE RIGHT PROGRAM
Healthy and want to stay that way Smoking and weight issues Chronic disease issues Acute illness
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Benefit Design and Incentives
Enrollment Options with additional options for those with identified chronic conditions
– Option 1 – Preventive
– Option 2 – Weight and/or smoking cessation
– Option 3 – Chronic disease control
Eliminate Barriers to Care – to the extent possible zero co-pays for necessary services and drugs
Incentive Plans that are clear and actionable by members – if you do this, you get that
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Care and Coaching Programs
Enhancements to existing disease management programs based on voluntary enrollment using incentives
For selection of program option – “best fit” review of care based on Biometric Screening, Health Assessment, prior claims
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Value Based Insurance DesignTHE QUESTIONS WE ARE ASKING Will the Local leadership be receptive? How will the members receive these kinds
of plans and how do we make them understandable?
Will the employers be willing to work with us on implementing these plans?
How do we implement this kind of plan for workers who have very limited coverage?
Will the insurers we work with be able to administer this kind of program?
Could VBID actually help this population control its chronic disease?
PREVENTIVE CARE PROGRAM WELLNESS LIVING WITH
CHRONIC DISEASE
ACCESS Utilization Data Utilization Data Utilization Data
HEALTH LITERACY Survey Survey Survey
SELF-EFFICACY Survey Survey Survey
OUTCOMES HRA HRA HRA
Evaluation of the Program
Optimal Results
Positive member experience
More engaged, knowledgeable members
Richer, more effective but still affordable benefits package
Maximize SEIU HCAT’s member and employer health investment
What About VBID for Excellent Comprehensive PlansTHE BENEFITS
Should reduce acute incidences due to chronic disease – good for the system and the patient
Provides better value for the health care dollar – financial drivers move patients to high value services
THE CHALLENGES
Is seen as a reduction in benefits because of added cost to low value services
Requires commitment on the part of employers to having a healthy workforce, not just saving money
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Health Care Access Trust