RE Sutton and Associates

Transcription

1 RE Sutton and Associates It has been our pleasure to work with Carmel Clay Schools for the last 25 + year as your Benefit Advisor. RE Sutton and Associates is a benefit consulting firm that specializes in working with Indiana School Corporations. We currently work with over 180 Indiana School Corporations in the State, either as individual corporations or as a participant in one of our school Consortiums or Trusts. RE Sutton and Associates established one of the first school clinics over 10 years ago and now have approximately 75 clinics statewide. Non-Direct

2 RE Sutton and Associates I remember my first conversation with Roger McMichael many years ago about the idea of establishing a clinic / wellness center for Carmel Schools and his comment was..." I like the idea, particularly the wellness aspects, and I want our clinic to be the very best in the State. Mission accomplished! Since the time the Carmel Clay Wellness Center opened it's door in hundreds of employees and dependents have experienced: Improved health Insurance premiums have remained flat for over 6 years (no rate increases) where medical trend has run from 8% -11% annually. Even more impressive, the no rate increases happened without benefit reductions and with significant increase in the self funded reserve account. Truly amazing and a remarkable achievement. Congratulations!

3 RE Sutton and Associates Thank you for allowing us to be a part of your success. It is now my pleasure to introduce Mary Delaney from Vital Incite.

4 Carmel Clay Schools School Board Program Overview 9/10/2018

5 PEPM Plan Paid Amount Financial Trend $1,500 $1,400 Financial Trend $1,300 $1,200 $1,100 $1,000 $900 $800 $700 $ Year PEPM Actual Trended PEPM 2

6 Member Count RUB Distribution Total Population Avg. Plan Spend (Med & Rx) per Member No Information Healthy User Low Risk Moderate Risk High Risk Very High Risk Carmel Clay Schools $2.79 $ $ $4, $18, $59, Midwest Benchmark $36.52 $ $ $3, $17, $63, Vital Incite Benchmark $36.45 $ $ $3, $16, $56, Data represents the number of members in each RUB category Includes the cost of the onsite clinic Risk Period: 6/1/2017-5/31/2018 Avg. plan spend in the last 12 months (6/1/2017-5/31/2018) 3

7 RUB Migration Carmel Clay Schools Total Population Healthy and Low Risk 5% 5% 7% Moderate Risk 6% 1% High and Very High Risk 4% 0% 12% 13% 28% 14% 35% 70% 60% 79% 61% 28% of healthy/low risk members increased risk comparing higher than benchmark at 27%. 93% of moderate risk members maintained or improved risk comparing higher than benchmark at 91%. 35% of high/very high risk members improved risk comparing higher than benchmark at 32%. Vital Incite Benchmark Total Population Healthy and Low Risk 12% 8% 7% 8% Moderate Risk 8% 1% High and Very High Risk 5% 0% 12% 27% 13% 32% 68% 58% 78% 63% Data represents the risk migration of individuals on the plan in 2017 and the current risk period (6/1/2017-5/31/2018). Showing only those still on the plan as of May

8 Engagement in Onsite Clinic Employee & Spouse 50% Engagement Total No Healthy Low High Moderate Risk Information User Risk Risk Very High Risk Clinic Participant- Count 1, Clinic NonParticipant- Count 1, Clinic Participant- Avg. Plan Paid (Med, Rx, Onsite Clinic) $6,373 $487 $983 $3,800 $21,550 $44,682 Clinic NonParticipant- Avg Plan Paid (Med & Rx) $6,845 $4 $269 $995 $7,439 $18,758 $81,808 Risk Period: 6/1/2017-5/31/2018 Paid Dates: 6/1/2017-5/31/2018 Participation Dates: 6/1/2017-5/31/2018 5

9 Impact of Onsite Clinic Moderate Risk 0% High and Very High-Risk 0% Engaged in Onsite Clinic 14% 86% 72% 24% 4% Moderate Risk 3% High and Very High-Risk 1% Not engaged in Onsite Clinic 15% 82% 67% 27% 5% 6

10 Control Chronic Conditions Controlled A1c Carmel Clay- 78% Benchmark- 59% 29% of pre-diabetics in 2017 have lowered their A1c below the prediabetic range in 2018 and none of the pre-diabetics became diabetic 11% of those with a BMI >=30 in 2017 have decreased their BMI category in Controlled BP Carmel Clay- 76% Benchmark- 74% 76% of those with an uncontrolled BP in 2017 have decreased their BP into a controlled range in

11 Care Coordination Adults 21 and Older Carmel Clay Schools Vital Incite Benchmark Jun May Jun May 2018 Act Ingredients >=12 6% 7% 6% 11% 11% 10% ER Visits >=1 11% 10% 9% 14% 14% 13% ER Visits >=2 2% 2% 2% 4% 4% 3% No Generalist Seen % 20% 21% 23% 34% 32% 34% Prospective Risk Clinic Participants Clinic Nonparticipants Jun Jun May 2018 May 2018 Adults > = 21 1,037 1,060 1,083 1,173 1,155 1,184 Act Ingredients >=12 5% 5% 5% 7% 8% 7% ER Visits >=1 12% 10% 10% 9% 9% 9% ER Visits >=2 2% 2% 2% 2% 2% 2% No Generalist Seen % 0% 0% 0% 38% 41% 44% Prospective Risk Clinic participation includes members with one or more primary care visits. 8

12 Carmel Clay Schools Employee Wellness Center

13 Carmel Clay Schools Employee Wellness Center The CCS Employee Wellness Center Through its dedication to employee health and wellness and its partnership with St. Vincent, Carmel Clay Schools (CCS) established the CCS Employee Wellness Center an exclusive worksite clinic for its employees and their families. The CCS Employee Wellness Center is staffed by healthcare professionals who can provide a wide range of no-cost wellness services including acute care, routine exams, lab work, chronic disease management and pharmacy services. The clinic also offers an innovative approach that has been shown to improve employee health and wellness while reducing healthcare costs for both the employee and Carmel Clay Schools. 2

14 Carmel Clay Schools Employee Wellness Center Person-Centered Healthcare Clinical Nurse Primary Care Physician Pharm.D. Registered Dietitian Behavioral Health Specialists Wellness Coordinator Physical Therapy Care Navigator Person Exercise Phys. 3

15 Carmel Clay Schools Employee Wellness Center Scope of Services Patient-Centered Model Same or Next Day Visits Expanded Hours Preventive Care Care Coordination Immunizations Specialty Referrals Chronic Disease Management Lab Point of Care Testing On Site Limited Pharmacy Medication Management Behavioral Health Management Physical Therapy Education and Navigation Tele-Consults Screening & Education Asthma Smoking Cessation Diabetes Weight Loss Sleep Apnea Osteoporosis Skin Cancer Stress Management Nutrition Education/Consultation Fitness Education 4

16 Carmel Clay Schools Employee Wellness Center Hours of Operation and Staffing Hours of Operation (34 hours per week) Monday, Tuesday and Thursday: 11 a.m. 6:00 p.m. Wednesday and Friday: 6:30 a.m. 1 p.m. Staffing Primary Care MDs Physical Therapist RNs & LPN Medical Assistants Patient Health Advocate Wellness Coordinator Pharmacist Chronic Disease Navigator Dietitian Exercise Physiologist Licensed Behavioral Health Specialist 5

17 Carmel Clay Schools Employee Wellness Center Benefits of Near-Site Health Clinics The benefits of establishing a near-site health care facility are improved member health, which will translates into lower costs. Better Member Care by: Improved access to care with a more personalized and distinct healthcare experience Connecting members with a primary care physician (many do not have one) Redirect care from sub-optimal and expensive venues like the emergency room Convenient appointments with a doctor who spends 20 to 60 minutes per patient. Provides perfect venue for management of chronic medical conditions A holistic approach to health across lifestyle, fitness, and medical integrations 6

18 Carmel Clay Schools Employee Wellness Center Benefits of Near-Site Health Clinics (cont d) The benefits of establishing a near-site health care facility are improved member health, which will translates into lower costs. Lower Costs by: Reduction in emergency room and urgent care utilization Appropriate referrals / visits to costly specialists Fewer and shorter hospital stays Avoidance of future high cost claims by addressing chronic conditions earlier Due to fixed cost model, price stability ensured 7

19 Carmel Clay Schools Employee Wellness Center Thank you Questions? 8