Four Forces Forecast

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Four Forces Forecast

• Accountability Making it Count
• Rich Niemeyer
• The Scheller Bradford Group
• September 18, 2003

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Accountability Making it Count

• Practical tips to foster employee responsibility
  and accountability for health
• How can employers foster responsibility and
  accountability in the system for patient health

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Health Care System
Providers
Patients / Employees
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Health Care System
Health Plans
Providers
Patients / Employees
Employers
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Accountability and Responsibility
Health Plans
Providers
Employees
Employers
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Vision

• Providers publish usable consumer quality and
  cost data (and are rewarded for improved quality
  and cost)
• Health Plans redesign plans that reward both
  providers and patients for quality and cost
• Employees become better consumers by acting on
  quality and cost information

7
Provider Accountability and Responsibility

• Iameter
• Leapfrog
• Specific disease/procedure initiatives
• Centers of Excellence
• Diabetes
• Asthma
• Depression
• Cardiac

8
Health Plan Accountability and Responsibility

• NCQA
• Cincinnati Health Care Plan Value Project
• Competitive bidding
• Risk-adjusted premiums
• Performance measures (at risk)
• Evidence based medicine

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Employee Accountability and Responsibility
What greater incentive is there to act
accountably and responsibly than to enjoy good
health?
10
What happened in the late 80s?

• 20 annual increases in employer costs
• Employers went to managed care for cost reduction
  through network development
• To ensure HR tranquility, plan designs went from
  20 coinsurance to 10 copayments

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What happened to consumers?

• For 20 years, health care has been virtually free
  to employees
• Employees act like entitled children
• Employees are not concerned about value.

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Value Equation
Quality Cost
Value
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Value Equation
Quality Minimal Cost
Value
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What are Employers doing?

• Treating the employee (patient-consumer) as an
  adult
• Designing programs that force accountability and
  responsibility

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Patient Accountability Focus
Healthy Behavior
Quality Providers
Cost Responsible
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Healthy Behavior

• Support healthy behavior
• Risk-based premiums
• Develop healthy plans (i.e., non-smoking)
• Provide health coaches (One Care Street)
• Encourage chronically ill to focus on treatment
  and compliance (disease management programs)
• Better research tools (i.e., WebMD, online second
  opinions, etc.)

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Select Quality Providers

• Develop consumer-based data that identify top
  providers
• COE
• NCQA recognized providers
• Leapfrog recognized hospitals
• Provide patients with financial incentives to
  select quality
• Waive copay

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Cost Responsible

• Overall, employees must recognize that health
  care expenses are a problem
• Must get employee Skin in the Game
• Total cost sharing must increase
• Must increase both employee OOP costs and
  contributions

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Employee OOP Costs

• Increase copayments / deductibles and coinsurance
  users pay the increases
• Increase copayments or place limits on services
  where utilization is now unchecked

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Employee Contributions

• Must increase contributions so there is a
  financial reason to question value
• Providing choice allows a value decision to be
  made
• Need enrollment modeling support to help
  employees estimate the value of each plan

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Ultimate Design

• Significant cost sharing with patients
• Tier providers based upon quality with
• Quality ranking showing through to patient
• Differentiated reimbursement
• Differentiated copayments
• Improved, clinically-based disease management
  programs that educate and enforce compliance
• Better research tools for disease and treatment
  options

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Questions and Answers
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