Wellness on the Run Show Me the Money- Help your employees lower their cost of care
Agenda 3 Keys to helping employees be better health care consumers Tools and Tips for saving money Health plan programs that help lower costs Q&A (15 minutes) 2
Reducing Cost of Care Reducing cost of care starts with building a more aware health care consumer. In order to encourage employees to be better consumers you need four things 1. Wellness Culture/ Wellness Programs: Users understand that healthy lifestyle changes will result in less health spending 2. Benefit Structure/ Incentives: Plan design and incentives help users feel the impact of their choices 3. Access to Tools and Information: Help users understand the costs of services and give them tools and information to make better choices 4. Provider Collaboration: Provider programs that share gap in care information and reward quality care 3
One out of every five visits to the emergency room is avoidable, yet trips to the ER are on the rise. Avoidable ER visits: Second highest outpatient cost driver $1.2 million in unnecessary expenses each day 1 in 3 visits to the ER are during physician normal business hours 4 4
Where to go when it s not a real emergency Faster, less expensive, more convenient Retail health clinic: good for basic medical services, usually found in a major pharmacy or retail store Walk-in doctor s office: doesn t require an appointment, handles routine care and common family illness Urgent care center: when someone needs to be looked at right away but isn t experiencing a severe emergency, most can do X-rays, lab tests and stitches LiveHealth Online: Connect with a doctor right away online, using a webcam, without appointments, waiting rooms or high costs. Issues that usually don t require the ER Sprains Animal bites Stitches Mild asthma Cold and flu Strep throat Rashes Eye irritations Ear irritations Headaches Nausea 5 5
Web experience Educating our members Learn more about ER alternatives Fliers with decisionmaking grid Members Issues can also that search for usually urgent don t care using the require mobile the app ER Take a fun quiz Search for providers Enhanced provider finder includes: Special search query for ER alternatives Maps, hours of operation and x-ray capabilities for each listing Links back to educational page above 6
24/7 NurseLine: Telephonic access to trained, registered nurses Provides around the clock, toll-free access to a registered nurse for accurate and important information about any health issue Speak to an RN or listen to audiotape library Helps members access the right level of care in the right setting 7 7
SpecialOffers Exclusively for our members DISCOUNTS ON: Family & home Fitness & health Vision, hearing & dental Medicine & treatment 8
IT S FREE. IT S EXCLUSIVE. IT S EASY. Visit and register on healthplan website Click Discounts Save money Live healthier 9
Your employees can save money on their pharmacy benefits! Choose a generic drug over a brand-name drug. Use over-the-counter (OTC) medicines, if available. Do research. Log in to the health plan website or use our mobile app to see if a generic is available and find out the cost. Use medications on the drug list. Tier 1 drugs have the lowest copay. Use home delivery, if available. 10 10
Other Money Saving Tips for Members Find a primary care doctor. Schedule physical exams. Get the screenings you need. Keep up with vaccinations. Stay on top of your prescriptions. Saving money on Medications: Ask about generic drugs. Use a preferred drug. Look for over-the-counter options. Use home delivery pharmacy services. Generic drugs typically cost up to 85 percent less than brand-name drugs. 11 11
Giving Care Teams more points of data, and a big picture view of member health Using analytics to identify, and close, gaps in care Gaps in Care Analytics are run on 100% of our members. These opportunities to improve health: Are run continually, and will appear in the care management system even if employers do not purchase the MyHealth Advantage program. Are completely accessible to nurses who use them to develop a better picture of members health and develop health coaching plans. Are displayed in our care management system, helping staff provide timely, personalized communication to both members and providers, and improving health outcomes. 12 12
Imaging Cost & Quality: Program alerting members to lower-cost, better-quality service providers Designed to lower member and employer costs Current includes imaging and sleep study facilities Touchpoints via phone, communication materials, videos Results: average per-image savings of $177 for member; $747 for employer 1 Buy up for Self Funded Buy up program for Self Funded clients Not available in VA Compass Smart Shopper program in NH 1 Internal pilot study, 2011 13 13
Why focus on imaging studies? The Opportunity Imaging study usage continues to grow at substantial rates Hospital imaging unit costs are almost double that of freestanding sites ($1150 vs. $570) 80% of high-tech imaging spend is for CT/MRI there are often choices of CT/MRI sites the member can use. Members are willing to choose an alternate if a saving opportunity exists Through prior authorization, health plans know 85% of the time who is getting the test, before the actual exam is performed MEMBER SURVEY How willing would you be to go to a select set of doctors, hospitals or clinics determined by your health insurance company if you could save 10% - 15%? 65% answered that they would likely make a change specific to an MRI or other high-level scan*. * 2011 internal study by AIM, Inc. 14 14
Why focus on sleep studies? The Opportunity Sleep study usage continues to grow at substantial rates Hospital Sleep Labs costs are more than double that of freestanding sites ($3,000 vs. $1,000) Members are willing to choose an alternate if a saving opportunity exists Depending on benefit design, savings for an account could reach 40% of current sleep study spending. Members are not compliant with treatment, with less than 50% compliance rate Studies estimate that more than 5% of sleep studies are inappropriate and are often performed at an average cost of $1,500 per study * 2011 internal study by AIM, Inc. 15 15
Enhanced Personal Health Care Reinforcing relationships and driving savings PCPs have the opportunity and trust needed to engage members in their health and Enhanced Personal Health Care provides them with the tools and resources that will help them deliver value-based health care, moving away from the volume-based model that s become prevalent. Sign up for our September 24 th webinar to learn more These strong relationships help connect members with: Multidisciplinary Care Teams Clinical teams share information with PCP, driving quality care and lowering costs Primary Care Nurses Help members understand resources and courses of action throughout health events Provider Clinical Liaisons Ensure that data transparency and updated patient information are available to the entire team 16 16
Our strategy of building on the primary care relationship works. Improvements in quality and efficiency Positive clinical outcomes 23% FEWER HOSPITAL ADMISSIONS 18% FEWER AVOIDABLE ER VISITS 9% LOWER READMISSION RATE 15% MORE IMPROVEMENT IN ALL DIABETES MEASURES 1 7 17
WE RE COMMITTED TO LEAD. Better tools Smarter choices Healthier decisions 18 18
Promoting Programs in the Workplace Visit the Webinar Archive on Time Well Spent to access materials on the programs mentioned today! Share them with your employees! 19
Q&A Visit Time Well Spent to access the presentation, health communication resources, event recordings, and to sign up for future webinar events: CA: http://timewellspent-ca.anthem.com NY: http://timewellspent.empireblue.com GA: http://timewellspent.bcbsga.com/ All other states: http://timewellspent.anthem.com/ Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Blue Cross and Blue Shield of Georgia, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. 20