Employer Perspective on the Evolution of Consumerism CCA Session

1
Employer Perspective on the Evolution of
Consumerism CCA Session 44

• October 25, 2006

Brad Bailey
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HISD Characteristics

• 306 schools, with a very diverse work force,
  including about 13,000 teachers, food service
  workers, bus drivers, police, trades staff,
  custodial, administrative, nurses and
  psychologists.
• Largest single employer in Houston
• 29,000 employees, which include 25,000 benefits
  eligible employees
• About 18,000 employees elect medical coverage
• 70 of employees participating elect employee
  only coverage
• About 2/3 of employees and plan participants are
  female
• Average age of employees is 45
• Benefits philosophy is to provide good medical
  coverage, but not to be an attractor because of
  the medical plan

3
History of Consumerism at Houston ISD

• Disease Management, Nurseline, Wellness and EAP
  services were implemented in 2001
• Consumer plans first introduced in 2004 in
  reaction to high premium increases in 2003, and
  an out-of-control medical trend far higher than
  salary increases
• Prior to 2004, HISD offered 3 HMO plans and a PPO
  plan, with 95 participation in the three HMO
  plans
• HISD offers two Consumer plans with one EPO plan
  and a PPO plan
• Aggressive communication promotion of Consumer
  Plans and advantageous features was conducted in
  the first year. Another school district had a 9
  Consumer Plan enrollment in first year, and a 45
  in second year after strong promotion of the
  consumer plans. Communication is key.
• In 2004 Consumer plan participation was 35, and
  has risen to 47

4
2006 Performance by Plan first six
monthsPremium Expense Ratio

• Through the first six months of 2006, below is
  the plan performance for the various medical
  plans offered by Houston ISD
• Open Access/EPO (49 participation) .85
• Choice POSII/PPO (7 participation)
  1.21
• Consumer Plus (24 participation) .78
• Consumer Basic (20 participation) .58
• All Plan Options .82
• While it can reasonably be assumed that
  employees that perceive themselves and their
  covered dependents as healthy, will tend to elect
  less costly benefit options, the loss ratios
  demonstrate that plan performance in Consumer
  plans is even better than plan pricing and are
  helping to maintain overall plan cost.

5
Wellness Programs

• Implemented wellness programs in 2001. These
  programs included
• Health Risk Assessment (HRA) and Wellness
  Initiatives
• Disease Management
• Nurse Advice Line
• Employee Assistance Program
• An Incentive of 120 per year has been given for
  participation in the HRA and/or other parts of
  the program
• Wellness Results (2002-2005 Time Period)

6
New Initiatives for 2007

• With overall medical plan performance exceeding
  expectations, HISD looked at ways to invest
  available funds in programs to help manage
  overall plan costs. Some of the initiative
  changes include
• Incentive Program was simplified to provide 5
  off premiums per paycheck (24 per year) if Health
  Risk Assessment is completed during Open
  Enrollment
• Generic Medications for Hypertension, Diabetes
  and Injectable Insulin available with no co-pay
• Diabetes Centers of America (DoCA) incentives
  for diabetics to utilize treatment through DoCA.
  
• No cost if in OpenAccess (HMO)
• 50 co-pay if in POSII
• 300/250 additional HRA Contribution per quarter
  and compliant with DCoA program

7
Taking Consumerism Further Dealing with
Preventive Care

• There is a risk that those in Consumer Plans will
  avoid needed routine care and routine medical
  exams and screening to avoid expenses.
• We have addressed this concern a few ways
• A 1,000 Preventive Care Allowance that is
  use-it or lose-it
• Health Risk Assessment promotion that reminds
  participants about needed routine medical exams
  and other potential health risks
• Improving communication on the need for Primary
  Care Physicians
• Reduced cost for Flu Shots (10) and considering
  making them free in future years
• Promoting mobile mammography units and other
  mobile health screenings
• Houston ISD is also reviewing a limited HRA or
  similar product to provide employees a limited
  set of funds to access selected primary providers
  for basic medical needs as an alternative to
  on-site clinics.

8
Taking Consumerism Further Finding a Provider

• Many employees and covered dependents find new
  doctors through referrals from friends,
  co-workers or other medical providers. There is
  a need for better tools to help members find an
  appropriate provider
• High Performance Provider Coding need to
  consider concentric network development with
  incentives/disincentives to utilize high
  performing providers
• Quality Data during provider searches add
  independent quality data as a part of the
  provider search tools
• Include provider web links when available as part
  of provider search information
• Include cost comparison data Aetna is releasing
  provider cost comparison data on the top 20
  procedures
• More robust provider searches based on quality
  and/or cost criteria
• Health Grades or other tool for obtaining more
  detailed information on a provider

9
Taking Consumerism Further Managing Medical
Information

• Personal Health Record providing a more
  detailed medical record system for employees to
  manage health information. The system provides
  feedback on areas of concern for the employee.
• Allow self-reporting of medical issues (ex.
  Penicillin allergy)
• Use with new medical providers to ease new
  patient forms
• Access to evaluate best medical plan based on
  current expenses
• Outbound targeted Emails Employees identified
  with risk issues receive email communications to
  bring concerns to their attention.
• Pharmacy usage communications summary of usage
  during the year with specific opportunities for
  saving on particular medications identified and
  quantified for the member.
• Speed navigation between secure websites through
  single sign-on systems

10
Taking Consumerism Further Engaging High Cost
Members

• Once a member has exceeded their annual
  out-of-pocket maximum, there is no longer a
  financial incentive to manage their medical costs
  for the year. In fact, there is a built-in
  incentive to get all of their needed medical
  needs completed by the end of the plan year.
• Improved communication and involvement of case
  management with high cost/risk employees
• Centers of Excellence
• Rising number and cost of Specialty Pharmacy
• Requiring step-therapy where appropriate
• Eliminating some specialty pharmacy meds
• Change to co-insurance for specialty pharmacy

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Taking Consumerism Further Providing more tools
for medical information

• With the growth of the web and Google, there is
  an over-abundance of information available on the
  web for virtually every medical issue (real and
  imaginary). How do you help employees get good
  information?
• Currently we have implemented on our Benefits
  website (www.hisdbenefits.org)
• Medical Animations product from consumer
  medical atlas
• Links to other good paid or free medical
  information websites
• General medical information ( such as WebMD)
• Specialized Medical Information (such as the
  American Cancer Society)
• Teledoc Firm that provides a low-cost phycisian
  contact service 24/7 via the telephone