SolutionOriented Approaches to Control Health Care Costs - PowerPoint PPT Presentation

Title: SolutionOriented Approaches to Control Health Care Costs


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Solution-Oriented Approaches to Control Health
Care Costs Alpha Benefits March 31 April 1,
2004
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HealthAmerica HealthAssurance Overview

• HealthAmerica HealthAssurance
• Subsidiary of Coventry Health Care, Inc.
• Statewide health plan founded in 1975
• Licensed in 59 of 67 counties
• Over 715,000 members
• 474 inpatient facilities 19,000 providers
• Revenue run rate of 1.6 billion in 2004
• Full product spectrum
• Progressive medical management philosophy

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The Perfect Storm
Health Delivery System Consolidations
Unhealthy Lifestyles
Rising Premium Rates
Aging Baby Boomers
Medical Malpractice
Increased Uninsured Unemployment
Recovering Economy
Clinical Labor Shortage
Cost Shifting - Public Sector To Private Sector
End-of-Life Issues
Emerging Expensive Technology
Federal State Budget Deficit
Insatiable Appetite for Health Care Services
Lack of Checks and Balances
Increased Federal State Regulation
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Solutions That Work
Controls currently in place

• Network management

• Effective utilization management

• Disease management programs

• Quality improvement

• Evidence-based medicine

• Administrative efficiencies

• Benefit plans featuring cost-sharing

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Solutions That Work

• Network management

• Controlling unit cost demands

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Solutions That Work

• Network management

• Effective utilization management

• Appropriate service, appropriate place, fair
  reasonable price

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Solutions That Work

• Network management
• Effective utilization management
• Appropriate service, appropriate place, fair
  reasonable price

• Containing Rx costs

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Containing Rx CostA Case Study
Comparison of Rx Trends
Industry trend information is from Buck Surveys.
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Solutions That Work

• Network management
• Effective utilization management
• Appropriate service, appropriate place, fair
  reasonable price
• Containing Rx costs

• Disease management programs

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Effective Disease ManagementA Case Study
Cardiac Case Management HealthAmerica and
HealthAssurance
2003 Report
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Solutions That Work

• Network management
• Effective utilization management
• Appropriate service, appropriate place, fair
  reasonable price
• Containing Rx costs
• Disease management programs

• Quality improvement

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Solutions That Work

• Network management
• Effective utilization management
• Appropriate service, appropriate place, fair
  reasonable price
• Containing Rx costs
• Disease management programs
• Quality improvement

• Evidence-based medicine

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Solutions That Work

• Network management
• Effective utilization management
• Appropriate service, appropriate place, fair
  reasonable price
• Containing Rx costs
• Disease management programs
• Quality improvement
• Evidence-based medicine

• Administrative efficiencies

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Solutions That Work

• Network management
• Effective utilization management
• Appropriate service, appropriate place, fair
  reasonable price
• Containing Rx costs
• Disease management programs
• Quality improvement
• Evidence-based medicine
• Administrative efficiencies

• Benefit plans featuring cost-sharing

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Solutions Long Overdue
Opportunity still exists

• Lifestyle choices

• Emphasis on prevention and wellness

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Solutions Long Overdue

• Lifestyle choices

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Big Spending The Price We Pay
States with the highest burden of the countrys
75.1 billion in estimated medical expenditures
attributable to adult obesity.
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Solutions Long Overdue

• Lifestyle choices

• 7 in 10 Americans do not exercise regularly
• 4 in 10 Americans are not physically active
• 64 of all Americans are overweight
• 440,000 people die each year from smoking

• Its time to walk the talk

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Solutions Long Overdue

• Lifestyle choices

• Emphasis on prevention and wellness

• One way to control the demand for health care
  services

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Opportunity for Improvement

• Changing health care systems economic
  orientation from treatment to prevention

• Inefficiencies in the health care system

• Eliminating medical errors

• Fixing reimbursement

• Regional planning approach to new technology
  expansion and health care services

• Medical malpractice reform

• Modify physician and consumer behavior

• End-of-Life issues

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Final Take-Aways
Health benefit costs are only one component
employers need to be heard

• Embrace evidence-based medicine

• Insist on regional planning for new technology
  and expansion

• Speak out against new benefit mandates

• Support tort reform

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Final Take-Aways

• Base employee cost sharing on lifestyle

• Accept that you cannot have access to every
  provider, unlimited coverage, and control costs
  at the same time

• Accept a little noise from your employees (Rx
  formulary)

• Engage employees in true cost of health care

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The Solution .

• Pursue cost controls privately
• Fix what we have today before putting in a new
  system
• Terrific opportunity still exists
• Make a goal for all constituents to work for
  single-digit medical trends
• Allow businesses to retain health care choices
  for their employees

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Future

• Real cost containment requires real sacrifice
• If we are to cover everyone, we cannot cover
  everything
• We ration care now
• Challenge is to ration in a way that is more
  efficient and equitable.