Transcript C.M. Smith Agency, Inc. Employee Benefits Department

Health Care:
Employer Issues to Address in 2005
John F. O’Connell, Jr. CEBS, CLU
C.M. Smith Agency, Inc.
100 Western Blvd.
Glastonbury, CT. 06033
(860) 633-3611
www.cmsmith.com
January 12, 2005
S:/Users/John/Jan.12-2005-HealthCare-Employer Issues to Address in 2005
Medicare Part D
Health Savings Accounts
(“Account Based” Health Care)
Progressive Care Management Programs
Medicare Part D
 Effective 1/06
 Provides prescription drug coverage to Medicare
enrollees
 Employers currently offering Medicare Supplement Plans
with drug coverage must choose:
Terminate the existing plan
Continue the existing plan and accept federal subsidies
Redesign the existing plan to coordinate with Medicare
 Information can be found at:
www.cms.hhs.gov/opendoor/retireewhitepaper.pdf
Health Savings Accounts
(“Account Based” Health Care)
 HSA’s were part of 2003 Medicare Modernization Act
 Require use of a high deductible health plan
 Various surveys suggest 25-35% of large employers will
offer by 1/06
 Dramatic growth in “Account Based Health Plans” –
topped 3.1 mm by the end of 2004
 Include HSA’s in broader discussion of account-based
health care, including FSA’s, HRA’s, Retiree Health
Accounts, etc.
 Does the concept fit employer health care strategy?
A Shift in Focus? A Trend?
 The ownership society?
 Will employers see “Account Based” Health Care
as a step to a new future?
 Is this a move from “Employer Sponsored” to an
“Employer Subsidy”?
 Will employees (claimants) figure out the new
deal?
 Will the provider community expand efforts
regarding cost transparency and quality reporting?
Progressive Care Management Programs
Predictive Modeling – find the patients who need
additional health care resources
#
Claimants
2%
24%
74%
100%
% of Total Annual Claims
36%
42%
22%
100%
Progressive Care Management Programs (contd.)
“Now offer or will
Program
implement in 2005”
24 hour nurse line
82%
Disease/demand management interventions
75%
Wellness Programs
60%
Centers of Excellence
54%
Offer health risk assessment
50%
Offer a health portal
35%
Source: Towers Perrin 2005 Health Care Cost Survey
2005 Objectives
 Examine your strategy, especially regarding
Account-Based Health Care
 Demand top performance from your vendors – or
find new ones
 Figure out Medicare Part D
 Expand your care management portfolio
Thank You
and
Best Wishes for a
Happy New Year