Maryland Government Finance Officers Association (GFOA)

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Maryland Government Finance Officers Association (GFOA)

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The Rising Health Care Cost Blues. Alex LeBlanc ... 'Shake Your Hips' (covered by the Rolling Stones) and 'I'm A King Be' (covered by ... – PowerPoint PPT presentation

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Title: Maryland Government Finance Officers Association (GFOA)


1
Maryland Government Finance Officers Association
(GFOA)
  • January 27, 2006

2
Agenda The Health Care Cost Blues
  • The Problem National and Local Health Care Costs
  • Are the Blues Going Away? The Prognosis
  • The Diagnoses Knowing what is wrong
  • Does Anyone have the Prescription?
  • 25 Ways to Treat the Blues
  • Most Common Treatment Plan

3
The National Blues Epidemic Continues
  • National health care costs just surpassed
    1,600,000,000,000
  • Nearly 15 of GDP
  • Costs will increase 14 on average in 2006(1)
  • Drivers
  • Increased utilization
  • medical technology
  • biotech drugs
  • aging population/retirees
  • hospital leverage
  • poor lifestyle choices
  • (1) Aon Fall 2005 Health Care Trend Survey

4
Nationally Is it Getting Better
Increases in Premiums vs. Other Indicators
5
The Prognosis for 2006
  • Fall 2005 Health Care Trend Survey
  • Medical w/o RX (Actives and lt65 Retirees)
  • HMO-12.7
  • POS -12.8
  • PPO -12.8
  • Indemnity-14.3
  • CDH-13.2
  • Pharmacy
  • General-11.8
  • Specialty-19.0

6
Who sang the song "The Thrill is Gone" a song
that made the top ten on the Rock, Country, and
RB charts at the same time?
Co-pays are goin up, employees are starting to
moan Cause the contributions, wont cover the
carriers dues
7
EEs have it Bad Ers have it Worse
Source Adapted from Kaiser Family Foundation
and Health Research and Educational Trust, 2004
8
How Are We Doing Locally?
Local HMO Premiums for 14 Public Sector Groups
Source Fall 2005 Bethesda Survey
9
How Are We Doing Locally?
Local PPO/POS/Triple Option Premiums for 14
Public Sector Groups
Source Fall 2005 Bethesda Survey
10
Which blues artist from New Orleans penned the
songs "Shake Your Hips" (covered by the Rolling
Stones) and "I'm A King Be" (covered by Muddy
Waters)?
I got the blues, those escalating health care
cost blues Gotta find a way to keep my sanity,
n cover those ol health care cost blues
11
Do you know your symptoms?
  • The Basics
  • Cost per active
  • Cost per under 65 retiree
  • Cost per over 65 retiree
  • Number of days per 1000 members
  • Number of admissions per thousand members
  • Average cost per day
  • Average cost per admission
  • Number of encounters per member (PCP vs
    Specialist)
  • Cost per encounter
  • Number of scripts per member
  • Cost per Script

12
25 Ways to Beat the Blues The Medicine
  • Financing
  • Self-funded vs. Insured/Stop Loss Insurance
    Evaluation (levels,risk, agg,specific)
  • Single Risk Pool
  • Opt-Out Incentives
  • Pay-related Contributions
  • Dependent Surcharges

13
Prescription Cocktail to Beat the Blues
  • Pharmacy
  • Move to Coinsurance Deductibles
  • Generic Mail Order Incentives
  • Smaller Networks Larger Discounts
  • Drug Exclusions Plan Limitations including Step
    Therapy
  • Specialty Rx Vendors

14
Can We help Ourselves Beat the Blues?
  • Consumerism
  • Get EEs involved in Managing their Health Care
    Dollars
  • Consumer Driven Plan Design Options
  • Health Risk Appraisals

15
Where/How to Buy our Solutions
  • Purchasing
  • Intense Care Management Programs
  • Consolidate HMOs
  • Comparative Network Discount Analysis
  • Evaluation of High Performance Networks HPNs

16
Which blues artist from New Orleans penned the
songs "Shake Your Hips" (covered by the Rolling
Stones) and "I'm A King Be" (covered by Muddy
Waters)?
I got the blues, those escalating health care
cost blues Gotta find a way to keep my sanity,
n cover those ol health care cost blues
17
Having the Right Plan of Attack
  • Plan Design
  • Copay to Coinsurance
  • Reintroduce Deductibles
  • Health Savings Arrangements (HSAs)
  • Health Promotion Incentives

18
Getting the Right Treatment at the Right Time at
the Right Place
  • Care Management
  • Optimum Disease Management
  • Optimum Care Management
  • Predictive Modeling
  • Smoking/Nutrition/Weight Management programs

19
Hottest Treatment
  • Require dependents to pay more if they have
    access to other coverage
  • ConsumerismMaking participants more responsible
  • Introduce greater Cost sharing through Copays
    Coinsurance
  • More intense care management
  • PBM managementMore Tiers, transparent contracts,

Taxpayers may start asking why they are providing
benefits that they no longer have in the private
sector
20
Oh What Can I Do?Got Them Escalating Health Care
Cost Blues
  • Co-pays are goin up, employees are starting to
    moan
  • Cause the contributions wont cover the
    carriers dues
  • I got the blues, those escalating health care
    cost blues
  • Gotta keep my boss happy, n cover those ol
    health care cost blues
  • They say they need some Viagra, and a chance for
    some invitro, too
  • But how can I make em understand, thats all
    about health care costs blues
  • I got the blues, those escalating health care
    cost blues
  • Gotta keep my employees happy, n cover those
    ol health care cost blues
  • The Rx card has no service, the call center just
    cant get through
  • Underwritings makin me nervous, feel like Im
    getting those
  • Escalating health care cost blues
  • CFOs getting real nervous, the Board of
    Directors are too
  • The stockholders are wantin some action, to
    combat those health care cost blues
  • I got the blues, those escalating health care
    cost blues
  • Gotta find a way to keep my sanity, n cover
    those ol health care cost blues
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