ASO, Self-funding

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A Consumer Centered Health Plan
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Our Vision
Mercy Health Plans is an innovative health
management company. We facilitate the effective
delivery of healthcare and provide services that
empower members to make healthy choices. We are
driven by the need to increase access to quality
care, provide excellent service and demonstrate
significant value to those we serve.
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The cost of unhealthy behaviors

• 30 of US adults --or 60 million people-- 20
  years of age and older are obese.
• The cost of heart disease and stroke in the US
  is projected to be 403 billion in 2006.
• Cigarette smoking is the leading preventable
  cause of death in the US, accounting for
  approximately 1 in every 5 deaths each year.

according to the Centers for Disease Control
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Health costs CEOs number one expense challenge
A 2005 Kaiser Family Foundation survey of 2,995
employers showed that the average medical plan
premium for family coverage is 10,800 a
year This costs now exceeds the annual pay for
a minimum wage employee.
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Does this sound familiar?

• Huge premium increases year after year.
• Jumping from insurer to insurer.
• Constant adjustments of benefit options to help
  control healthcare costs.
• Unhealthy employees and increased absenteeism.

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Consumer directed healthcare Is it the answer?

• Key Components
• Reduced benefits
• Increased copayments
• Cost-shifting to the consumer
• The Outcome
• Consumers forgo needed medical care
• Harms patients with chronic conditions
• Cost of bad behavior is shared by all

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The Right Solution
Instead of shifting costs or blame, we need to
shift our thinking Employees need to view
health insurance as contract with mutual
responsibilities, NOT just an employer-sponsored
benefit.
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MyChoice is the Solution

• Its designed to engage employees, and emphasize
  their need to take personal responsibility and
  accountability for their health and lifestyle
  choices.
• Its a way for employers to influence better
  health, while protecting their ability to offer
  high-quality, smarter health coverage.

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Why is MyChoice the solution?

• It will improve the overall health of an entire
  member population
• - including those consumers who are not currently
  at serious risk and are not major drivers of
  healthcare costs.
• Over time, you would be able to systematically
  reduce the cost element of the healthcare system.
  
• Lower costs, in turn, translate to lower
  premiums and more affordable coverage for
  employers.

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Why its a smart choice for employers

• Higher productivity and job performance
• Lower absenteeism and presenteeism
• Improved morale
• Lower health care costs
• Higher employer job satisfaction and retention

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How does MyChoice work?

• Participating employees and covered spouses must
• Be willing to take responsibility for their
  health
• Use a secure web-based Personal Health Record to
  monitor their progress towards achieving health
  goals.

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3 Steps of Participation Personal Health Record

• Step One MyChoice Eligibility Questionnaire
• Step Two My Plan for Health
• Step Three Health Risk Assessment

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Eligibility Questionnaire

• The employee and spouse must take and pass the
  eligibility questionnaire by agreeing to follow
  certain lifestyle behaviors.
• The questionnaire is taken yearly during the
  MyChoice open enrollment period.
• Question topics include
• Seat Belt Usage
• Tobacco Usage
• Obesity
• Blood Pressure
• Cholesterol
• Diabetes
• Preventive Screenings

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My Plan for Health

• A personal plan for health will be generated from
  your answers to the eligibility questionnaire.
• Examples of health activities include cholesterol
  test, colon cancer screening, tobacco cessation
  program, and mammography.
• Throughout the year, the employee and spouse will
  login to a secure website and enter the date that
  the health activity was completed.
• Participating employees and spouses will be
  required to complete these health activities in
  order to be eligible for the MyChoice benefit
  plan the following year.

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Health Risk Assessment (HRA)

• The HRA is a health and lifestyle questionnaire.
  
• The answers to these questions form a
  personalized Health Analysis Report, which
  includes a good habit score.
• Recommendations from the Health Analysis can be
  used to develop health and wellness goals for the
  upcoming year.

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Healthwise Knowledgebase Highlights
Access to thousands of topics including - Health
conditions - Medical tests and procedures -
Medications and - Everyday health and wellness
issues.
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Whats in it for the employees?

• Healthier, more productive lives
• A sense of mutual responsibility in their
  healthcare
• Increased benefits
• Decreased premiums and copayments

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MyChoice Benefit Options
Option A Selection based on benefit levels
Option B Selection based on contribution levels
Option C Selection based on both benefit and
contribution levels
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The correlation between incentives and adoption

• The optimal reward amount should be just enough
  to tip the balance.
• Employees must perceive the difference in either
  benefit or contribution levels to be significant.

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Results what is the outcome of using MyChoice?

• When members are given the opportunity with
  incentives and the appropriate tools to take
  responsibility for improving their personal
  health, they embrace it.
• This enables employers to foster a culture that
  focuses on wellness and rewards employees who get
  and stay healthy.
• Ultimately, healthier employees spend less on
  healthcare services.

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MyChoice Results
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Keys to your Success

• Employer support and accountability
• Employee education and responsibility
• Incentives in the form of richer benefits and
  reduced copays

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Why you cant afford not to use MyChoice

• Shifting costs to employees can hurt employee
  morale and commitment and will not solve the cost
  problem.
• Poor lifestyles lead to ill health.
• Indirect costs of poor health incidental
  absence, disability, and presenteeism can be
  more costly than medical and drug costs.
• Healthy employees (and dependents) consume fewer
  services and cost the least.

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The Bottom Line
Healthy employees mean more productive employees,
a result every employer wants.
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A Final Thought
Employers invest large amounts of money in
training, computers, and pay-for-performance to
maximize employee output Shouldnt employers
also invest in the health of their employees to
improve both the quality and value of the goods
and services they produce?