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Expanding Health Coverage A CHT Forum on New,
Private Sector Health Insurance Products
February 4, 2009 Atlanta, Georgia
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Wayne OliverProject DirectorCenter for Health
Transformation
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Senator Judson HillSenatorGeorgia State Senate
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Ron BachmanSenior FellowCenter for Health
Transformation
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Newt Gingrich FounderCenter for Health
Transformation
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Ron BachmanSenior FellowCenter for Health
Transformation
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Chris Schubart Regional Vice PresidentBlue
Cross Blue Shield of Georgia
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Center for Health Transformation ConferenceBlue
Cross Blue Shield of Georgia Chris Schubart,
Regional Vice President Local Group
SalesFebruary 4, 2009
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Isnt it time for Georgia to have more control
over our healthcare costs?

• We think so, too.

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Discussion Topics

• Healthcare Costs
• Consumerism
• Lumenos (Consumer Driven Healthcare Solution)
• Cost Estimators

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Rising Costs The Big 4 Risk Factors

• The majority of the rise in private insurance
  costs is
• due to population risk factors and their
  treatment

• 28,000 or 24 of children in the third grade in
  Georgia are obese
• Percentage of Adults who are obese has been
  constantly increasing since 1990 from 10.8 to
  28.7 in 2007
• In 2007, there were 1.9 million obese adults in
  Georgia
• In 2007, approximately 1.3 million (19.4) adults
  in Georgia smoked cigarettes
• Average 10 of total claims costs attributable to
  tobacco
• 60 perform no substantial activity or exercise

• Two-thirds of all office visits to family
  physicians are due to stress-related symptoms
• More than one in four workers have taken a
  "mental health day" off from work to cope with
  stress
• Costs U.S. businesses 300 billion annually in
  direct indirect costs

Stress
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Consumerism
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Consumerism

• Imagine having greater control over health care
  costs while improving and maintaining your health
  a win-win scenario.
• Now you can. BCBSGa-Anthem is revolutionizing
  health care by expanding our industry-leading
  Lumenos consumer-driven health plans and making
  them available to everyone all markets, all
  segments, and all 35 million current members
  nationwide.

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Consumers Are Becoming More Engaged in Their
Health Care

• Survey of consumers enrolled in CDHPs
• Value Conscious
• 50 more likely to ask about cost
• Prevention-Oriented
• 25 more likely to engage in healthy behaviors
• 30 more likely to get an annual checkup because
  they thought it would save money in the long run
• Control Costs
• 20 more likely to follow treatment regimens for
  chronic conditions
• Information Needs
• Many were dissatisfied with information available
  to them to make health decisions

Source McKinsey Company, June 2005
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Our Solution

• Anthems Lumenos plans give consumers the control
  and information they want while rewarding them
  for being more engaged in their health.
• Our approach combines unique account-based plan
  designs with sound clinical strategy then tops
  it off with bold and proactive communications to
  engage consumers before and after enrollment.
• Consumers will better understand how they can get
  more value from their health care dollars and
  will be rewarded for healthy behaviors.

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Our Experience
Lumenos plans are super-charging
account-based solutions

• Lumenos

• Anthem

• Leading healthcare company
• Provider network advantage
• 360? Health

• CDHP Industry Benchmark
• Innovative Technology
• High Touch Proactive health improvement

• A marriage of a fuel-efficient engine with less
  expensive gas.

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Prescription Drug Cost Estimator
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Prescription Drug Cost Comparison
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ProviderFinder Treatment Costs

• Estimate the costs of specific health care
  services or episodes of care
• In-network and out-of-network costs based on the
  most common medical procedures
• Connecting members to high value health care
  facilities based on the following
• Individual Preferences
• Quality indicators
• Outcome measures
• Costs

- 95010
95
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How Do We Do It?

• Our plan designs come with the largest national
  network of participating providers with no
  referrals necessary
• You get a 24/7 NurseLine, health coaching
  programs, 100 coverage of nationally recommended
  preventive care services, and an online health
  site with tools and information to help you get
  the most value out of your dollars
• Our integrated plans make it easier on everyone
• Our turnkey communications help companies create
  a new culture around health improvement
• Working together with our brokers/consultants we
  help customers to make better engaged employee a
  top down initiative
• And, we can even include financial rewards for
  healthy behaviors

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Does It Work?

• 53 of Lumenos consumers report increased
  knowledge in managing their healthcare
• 62 switched to a generic prescription drug
• Preventive care services doubled - 5.4 compared
  to industry average of 2-3
• And, Lumenos consumers tell us that theyre
  happy, more engaged and healthier
• 93 consumer satisfaction, 92 would renew, and
  93 would recommend
• 95 cite greater flexibility and control in
  managing their health
• 93 cite that our Lumenos plan was the best value
  for their money

Source Results from Lumenos book of business 2005
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Thank you!
23
Todd Slawter Senior Vice President, Aetna, Inc.
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Health Care Reform Understanding Aetnas
Perspective
Expanding Health Coverage A CHT
Forum February 2009

• Todd Slawter
• Sr. VP, Southeast Regional Head of Sales

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Presentation Roadmap
Health Care Reform Understanding Aetnas
Perspective

• Aetnas Position on Health Care System
  Transformation To Your Health!
• Enable the Consumer
• Plans and Products

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To Your Health! Aetnas Proposal for Health Care
System Transformation
Health Care Reform Understanding Aetnas
Perspective

• Get and keep everyone covered
• (1) Transform health insurance into a civic
  responsibility
• (2) Strengthen public programs and the safety
  net for those most in need
• Maintain the employer-based system and export its
  strengths to make the individual market function
  better
• (3) Leverage the strengths of the current
  health care system to advance the goal of
  universal coverage
• (4) Use the tax system to expand access and
  increase affordability
• (5) Promote greater portability of health
  insurance
• Reorient the system toward prevention, value and
  quality of care
• (6) Promote preventive care and wellness
• (7) Improve health care quality and patient
  safety
• Use market incentives to improve coverage, drive
  down costs and make the system more
  consumer-oriented
• (8) Create a legislative and regulatory
  environment conducive to affordable insurance
  options
• (9) Make the health care system more
  transparent and consumer-friendly
• (10) Harness the power of health information
  technology to reduce costs and improve quality

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Do consumers really understand the cost of health
care?
Health Care Reform Understanding Aetnas
Perspective

• Price of a Honda Accord
• within 300
• Cost of a 4-day Hospital Stay
• off by 8,100!!

Gap between guess and actual cost
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Our health care transparency availability (as
of January 2009)
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Products with Purpose
Health Care Reform Understanding Aetnas
Perspective

• Aetna Affordable Health Choices (SRC)
• Limited benefits plans
• Targets part-time, seasonal and temporary workers
• Available in 47 states
• Middle Med Plans
• Niche product piloted
• Could fill a gap between Limited Benefit plans
  and Traditional comprehensive benefits
• Aetna Student Health
• 450,000 Undergraduate and Graduate students
• more than 170 institutions

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The Issue
Health Care Reform Understanding Aetnas
Perspective

• 47 million uninsured in the US
• 1.7 million uninsured in Georgia
• 380,000 work for Small Businesses
• 800,000 Small Businesses in Georgia
• 62,000 without Insurance

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Value Pick Program
Health Care Reform Understanding Aetnas
Perspective

• Targeted to Small Businesses with Working
  Uninsured
• 4 or more minimum enrolled employees
• Open Access HMO (plan 709)
• Open Access POS (plan 708)
• HDHP Open Access POS (713)
• Dual Triple Option available depending on
  case size
• Lowered Employer Contrib. level (25)
• Lowered Participation Requirement (50)

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Finally
Health Care Reform Understanding Aetnas
Perspective

• Thank you!
• Center for Health Transformation
• Speaker Gingrich
• Mr. Ron Bachman
• Mr. Wayne Oliver
• Sen. Judson Hill

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Joe Ochipinti Regional Vice PresidentUnitedHealt
h Care
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UnitedHealth Premium, UnitedHealthcare EDGESM
Health Savings Account A Quality Path to
Affordability
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Improving care variation
Cost Variation
Care Variation
Studies show that quality and efficiency of care
designated physicians have lower costs per
episode, on average, compared to non-designated
physicians
The New England Journal of Medicine reports that
adults are receiving recommended treatments only
55 of the time
Evidence-based Care
Lower Costs
Procedure Re-dos 2x the re-do rate of designated
physicians for CVS
Complications 70 higher than expected compared
to designated physicians for CVS
Orthopedics 31.2 lower than non- QE designated
physicians
Cardiovascular Surgery 20.4 lower than non- QE
designated physicians
Endocrinology 32.4 lower than non- QE
designated physicians
SOURCE UnitedHealthcare claims analysis,
November 2007
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UnitedHealth Premium Designation

• Leverages transparency to improve quality and
  lower costs
• Physicians are first assessed on quality we
  identify specialists who meet or exceed quality
  standards established by third party professional
  societies such as the American College of
  Cardiology and the American Academy of Orthopedic
  Surgeons
• Only if they meet quality standards, are they
  assessed on efficiency of care, based on peer
  comparison and third party evaluations, i.e. most
  appropriate treatment, less complications and
  re-dos
• With UnitedHealthcare EDGE, employees who use
  specialists designated for both quality and
  efficiency receive increased coverage in the form
  of lower copays and coinsurance
• Here is a small listing of the collaborators used
  to establish quality criteria
• - American College of Cardiology (ACC)
• - American Board of Internal Medicine (ABIM)
• - National Committee for Quality Assurance
  (NCQA)
• - Society of Thoracic Surgeons (STS)
• - Virtually every other State Society

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2009 EDGE Plan Overview

• EDGE Plans Overview
• Access to entire UnitedHealthcare Choice Plus
  Network
• Open Access POS Plans
• Significantly lower priced than our base plans
• Can be paired with an HSA
• Current EDGE plans in good alignment with market
  preferences
• Employers want EDGE deductibles between 1.5K and
  2K, so fits with HDHP plan
• Excluding primary plan design elements of PCP
  Copay and Deductible, 100 preventive care is the
  most important feature, so we included it in all
  new EDGE plan designs
• Employers prefer to see lower OOP Maximums, so we
  developed plans that lowered OOP Max down to 3K,
  4K and 5K without significant PMPM impact
• Employers want EDGE plans to be paired with an
  HSA, so we are offering five national HSA plans
• EDGE Plans Benefit Differences
• Provides members with lower copays and higher
  coinsurance when using specialty physicians
  receiving quality and efficiency UnitedHealth
  Premium designation
• Per occurrence deductibles apply to inpatient
  hospitalization and outpatient surgery
  (Calculated to go toward out-of-pocket maximum)
• Lab and X-ray applies to deductible coinsurance
  except for Preventive Care when plan covers
  preventive benefits at 100
• Covers MH/SA Chiropractic at state mandate
  levels

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Georgia Broker Feedback

• Platinum Broker
• United HealthCares EDGE program effectively
  delivers differentiated value at lower cost for
  our clients. Offering an EDGE HSA provides even
  more savings for the Employer. United
  HealthCares EDGE plans are making a positive
  difference for the healthcare consumers market
  place.

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Georgia Customer Feedback

• Small Business Employer
• Smaller businesses such as ours are eager to
  provide benefit packages in order to attract and
  retain valuable employees. UnitedHealthcares
  EDGE enables us to offer comprehensive,
  affordable health care benefits increased tax
  advantages for our employees. We believe our
  employees will have peace of mind knowing they
  have access to Premium-designated physicians who
  deliver quality, cost-effective care.

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Robert Wolfkiel Market Vice PresidentHumana
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Working Well Health Promotion and Workplace
Wellness Strategies
Bob Wolfkiel Market Vice President February 4,
2009
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Wellness The Good
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Wellness The Bad
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Wellness The Ugly
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Just the Facts, Maam
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Georgia The Peach State or the Couch Potato
State?
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Georgia An Expanding Population
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The Evolution of Man
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Obesity trends among U.S. adults
BRFSS, 1985-2006
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity a costly disease
53.2
51.6
Direct Cost of Chronic Diseases in the United
States
38.7
Direct Cost ( Billions)
18.4
18.1
Type 2Diabetes
Obesity
CoronaryHeart Disease
Hyper-tension
Stroke
Wolf AM, Colditz GA. Obes Res. 1998697-106. Hodg
son TA, Cohen AJ. Med Care. 199937994-1012.
Adjusted to 1995 dollars.
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Current Status of Wellness Strategies
Information from 2007 survey of 555 organizations
with an average of 12,500 employees
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Top Strategic Objectives for Wellness Programs

• Reducing Health Care Costs
• Improving Worker Productivity
• Reducing Employee Absences
• Improving Workforce Morale
• Attracting and Retaining Employees
• Employers spend an average of 135 per employee
• per year on Wellness programs, and an additional
  
• 100 per employee on incentive rewards

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Panel Questions Answers
Panelists Ron Bachman, Senior Fellow
Center for Health Transformation Chris
Schubart, Regional Vice President Blue Cross
Blue Shield of Georgia Todd Slawter, Senior Vice
President Aetna Joe Ochipinti, Regional Vice
President United Healthcare Robert Wolfkiel,
Market Vice President Humana
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Expanding Health Coverage A CHT Forum on New,
Private Sector Health Insurance Products