Transcript Mary Bradley

Pitney Bowes’ Value Based Purchasing
Mary Bradley
Director of Health Care Planning
Overview
 Who we Are – Our Workforce
 Health Care Strategy
− Objectives
− Communications
− Results – Good and Bad
− Continuing Evolution
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About Pitney Bowes
 80-plus year legacy
 Fortune 500 company
 $6.4 billion global provider of integrated
mail and document management
solutions
 Global team of more than 35,000
employees
 Presence in more than 130 countries
worldwide
 More than 2 million customers
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Pitney Bowes - The U.S. Workgroup
 Products
−Engineers, Software Developers, Sales and Service,
Call Centers
−Average age: 45
−Average tenure: 10
 Document Management
−Diverse, hourly workforce
−Average age: 41
−Average tenure: 6
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Health Care Objectives
 Maintain and Improve Employee Health
 Encourage Appropriate Utilization of Health
Care Services
 Choice of Health Plans
 Affordable for PB and the Employee
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Evolving Strategies
 Launch of key programs in 2003
− Value-based health plan purchasing/management
− Restructure benefit design
• Emphasis on preventive care
• Launched CDH option
• Value-based pharmacy design
− Broad-based health improvement/wellness programs
− Launch disease management programs with Health
Plans
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Value Based Purchasing
National Business Coalition on Health’s Quality Metrics
 Adopted eValue8 as our standard RFI on quality
−Mandatory for competitive bidding
 Continuous quality improvement discussions with
Health Plans
 Set HMO contributions based upon cost and
quality (eValue8 scores)
 Share data with employees
−Annual enrollment meetings
−Plan comparison charts
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Value Based Purchasing
Percentage of Available Points
Fairfield County Health Plans
80%
70%
60%
50%
2005
40%
2006
30%
20%
10%
0%
Plan A
Plan B
Plan C
Plan D
Plan E
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Value Based Purchasing - Employees
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Restructure Medical Design
Saver – HSA
In-network
PPO
In-network
HMO/ EPO
Preventive
No cost
No to low cost
No to low cost
Routine
$2,000/$4,000
Co-pay
HPN Incentive
Major
deductible
Then 100%
Co-pay or %
HPN incentive
$500 deductible
plus 20%
coinsurance
Co-pay
RX
Tier 1
Tier 2
Tier 3
Preventive: 10%
Non-Preventive:
100% after deductible
10%*
30%
55%
*includes certain
chronic medication
Varies
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Communication – Annual Enrollment
Medical:
How your choice affects costs
High
Potential
Out-of-Pocket
Saver
PPO 500
HMOs/EPOs
Low
Payroll Deductions
High
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Your Change in Payroll Deductions
Current
New
EE
EE+Child EE+Spouse Family
HMO
PPO
$(300)
$(600)
$(750)
$(1000)
HMO
Saver
$(900)
$(2000)
$(2300)
$(3500)
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Communication – Cost Comparison
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Measuring Results – Enrollment
2009
HMO – 34%
PPO – 50%
Saver – 16%
Combined high/low PPO
into one plan
2008
HMO – 33%
PPO – 54%
Saver – 13%
2007
HMO – 33%
PPO – 55%
Saver – 12%
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Measuring Results – Costs and Utilization
2008 and 2007 Saver Option VS PPO
What works:
PMPY allowed amounts are 25% lower
Outpatient services are 35% lower
−ER Visits are 20% lower
Allowed amount per script is 17% lower
−12% higher % generic scripts
In patient admits are 20% lower
Preventive care averages 10% higher
What we’re working on:
DM participation is lower by 5 points
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Restructure RX Design
Key predicators for migration from normal spend to high
cost spend
 Individuals with chronic conditions and low medication
compliance rates
− Asthma
• More than 1 fill of Albuterol in a 30 day period
− Diabetes
• Less than 9, 30-day fills in a 12 month period
− Hypertension
• Less than 9, 30-day fills in a 12 month period
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Change in Drug Tiering - Effective January 2002
“Traditional” Rx Benefit
Tier 1
New Rx Access Benefit
Tier 1
Most generic drugs
Most generic drugs and
and all brand name drugs
for:
10% Coinsurance
Tier 2
Most preferred brand
name drugs, including
those for:
• Asthma
• Diabetes
• Hypertension
30% Coinsurance
Tier 3
Non-preferred brand
name drugs, including
those for:
• Asthma
• Diabetes
• Hypertension
• Asthma
• Diabetes
• Hypertension
10% Coinsurance
Tier 2
Most preferred brand
name drugs
30% Coinsurance
Tier 3
Non-preferred brand
name drugs
55% Coinsurance
55% Coinsurance
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Measuring Results – Rx Design
Adherence Score*
Seven Year Change in Medication Adherence
90
80
70
60
50
40
30
20
10
0
75
79
76
80
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Asthma
Diabetes
2001
Hypertension
2008
*Caremark proprietary scoring system
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Measuring Results – Rx Design
Changes in Asthma Drug Utilization
Percent of Target Population Possessing Medication
2001
2008
Albuterol Only
51%
33%
Long Acting Controllers
49%
66%
-Exclusively or Combined with Albuterol
Increased possession rate of long acting controllers inversely correlates with an
observed 22% decline in ER use and a 59% decline in hospital admissions
over the same time periods.
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Measuring Results – Rx Design
Key Chronic Condition Results
Six Years Post Implementation
Cost of Care
0%
Estimated 2007 cost offset
against expected costs
 17% lower for asthma
 14% lower for diabetes
 20% lower for
-5%
Costs (%)

-10%
-15%
-14%
hypertension
-17%
-20%

-20%
17% for all three conditions
combined
-25%
Asthma
Diabetes
Hypertension
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Measuring Results – Rx Design
Impact on Pharmacy Utilization Metrics
2001-2008
CAGR
Generic Utilization
38 – 62
7%
Generic Substitution
90 – 97
1%
Scripts per Member
8 – 11
4%
Net PMPY
$320 - $741
13%
Employee Cost Share
20% - 16%
-4%
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Updating the Rx Strategy for 2007
Additional Drug Classes Moved to Tier 1
Osteoporosis treatment
Anti-clotting
Anti-seizure
Smoking cessation
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Updating the RX Strategy for 2007
Gaps in Evidence Based Treatment
 Evidence clearly shows need for statins or
statin combination as secondary prevention in
diabetics and also for post cardiac patients
 Only 60% of PB-covered diabetics received a
statin in 2006
 52% of PB-covered people with a previous
cardiac event were on a statin
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Updating the PB Strategy for 2007
 No coinsurance on all statins and statin fixed-dose

combinations for:
− Diabetics
− Post cardiac event
• MI
• Angioplasty
• Stent
Observed impact – 2007 vs 2006
− 7% increase in targeted members on statins
− 6% increase in days supply (279 – 295)
− Sub-Optimal users decreased from 28% to 23%
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Evolve to Measuring Outcomes
35%
5%
20%
 Manage and Stabilize

40%
Non Users
$1,000 to $10,000
population
Address gaps in care
 ? Plan Design
 ? Disease
Management
Less than $1,000
More than $10,000
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Measuring Recommended Treatment
HgA1c Testing Diabetes
Plan A
50%
Plan B
49%
Plan C
24%
Plan D
34%
Plan E
24%
% of population
who received no
services
% of population who received
% of population whose care
some services, but did not meet met recommended clinical
recommended clinical guidelines
guidelines
Analysis Courtesy Thomson Reuters
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Incentives for Recommended Treatment
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Incentives for Recommended Treatment
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