Transcript presentation to Trustees - Indiana University Bloomington

2013 Healthcare Program
Trustees Finance & Audit Committee, April 2012
Current Status – April 2012
17,300 FT Employees; 16,150 enrolled in medical
37,000 plus covered lives
4 medical plans: PPO networks, with member cost sharing
Salary-based premiums, with credit for non-use of tobacco
HDHP & HSA with 8,100 employee enrollments
PPACA compliant
No post-65 Retiree Healthcare liability
FY 2011/12 IU Budget for Healthcare = $186.6 m
FY 2012/13 IU Budget = $197.8 m
or $11,433 per eligible employee
Assumptions for CY 2013
(as of April 2012)
Same or lower number of covered employees
Same medical plan options as 2012
increase enrollment in the HDHP & HSA plan
Moderate increase in total premiums
small or no increase in HDHP plan premiums
PPACA:
new “Summary of Benefits and Coverage”
annual limit of $2,500 for health FSA contribution, starting 2013
Form W-2 reporting for 2012 health coverage
Cost Increases: 1) provider fees and 2) medical utilization
Medical Utilization – The Top 10
“Disease and Injury” Classifications
(by $s paid for 2011)
% Difference w/2010
Supplemental Classifications (e.g. pregnancy, dialysis)
-
.6%
Musculoskeletal system & connective tissue
+ 29.4%
Neoplasms
+ 22.9%
Circulatory system
+ 4.7%
Symptoms, signs and ill-defined conditions (e.g. ER)
+ .4%
Digestive system
- 10.3%
Genitourinary system
+ 5.9%
Nervous system & sense organs
+ 30.0%
Injury & poisoning
- 9.5%
Complications of pregnancy and childbirth
+ 11.6%
Prescription Drug Utilization – The Top 10
Therapeutic Class (by $s paid for 2011)
% of Total # Rxs
Miscellaneous (e.g. transplant, MS)
2.5%
Anti-depressants
9.8%
Lipotropics
7.8%
Diabetic therapy
4.1%
Anti-arthritics
2.7%
Bronchial dilators
3.2%
Anti-ulcer
3.7%
Antivirals
0.9%
Anti-neoplastics (cancer)
0.5%
Other hypotensives (blood pressure)
7.4%
IU’s Employee Medical Plans
Relationship Between Members and Plan Costs
1%
15%
12%
29%
43%
8% of members = 58% of costs
28% of members = 87% of costs
37%
71% of members = <14% of costs
14% of members with no costs
20%
21%
7%
1%
Members
Plan Costs
IU’s Employee Medical Plans
Relationship Between Members and Plan Costs for 2011
$ Per Member
1%
14%
5,180 mbrs
$ 0.0
15%
5,550 mbrs
$ 1.9 m --- $ 342 /yr
43%
15,910 mbrs
$ 22.8 m --- $ 1,433 / yr
20%
7,400 mbrs
$ 55.1 m --- $ 7,446 / yr
7%
2,590 mbrs
370 mbrs
$ 70.3 m --- $27,143 / yr
Members
--- $
0 / yr
29%
$ 39.9 m --- $107,838 / yr
Major Medical Program Initiatives
Initiatives that
Are applicable across all medical plan options
Complement or supplement provider and member activities
Integrated Clinical Care Services -- details to follow
Personal Health Record (PHR)
Personal web-based access to medical records, such as: contact info,
medications, immunizations, illnesses, medical history, allergies,
biometric tracking, legal documents, etc.
Data integration with Medco, Anthem, and IU Health/HealthSmart
Support for Clinical Care Services program (clinical portal)
Transparency
Member web-based access to: location of PPO providers; “price” for
services by provider; “cost” for episodes of care by provider
group/healthcare system; and quality measures & patient satisfaction
Major Medical Program Initiatives
Integrated Clinical Care Services
Improve access to primary care providers, for routine and
urgent care
Dedicated care management team, for patients with
chronic and/or complex medical conditions
Connectivity of medical records
Integrated Clinical Care Services
Virtual patient centered medical home
Essential components:
1.
Primary care provider group(s)
2.
Dedicated team of nurse care-managers
3.
Electronic medical records system (EMR)
4.
IU-based resources
Promotion to plan members
Expansion opportunities
Integrated Clinical Care Services
1.
Primary Care Provider Groups
Physicians, nurse practitioners, physician assistants
Walk in care, same day appointments
After hours access: telephone, e-visits
Electronic Medical Records (EMR) system
Quality Health First program measures
Participate in care management activities
Integrated Clinical Care Services
1.
Primary Care Provider Groups
Proposed initial rollout in Bloomington
East of the IU Bloomington campus
Sare Rd. – Premier Healthcare
Clarizz Blvd. – IU Health Southern IN Physicians
West of the IU Bloomington campus
Landmark Ave. – Premier Healthcare
Rogers St. – IU Health Southern IN Physicians
Integrated Clinical Care Services
Primary Care Provider Groups -- Proposed
Integrated Clinical Care Services
2.
Nurse Care-Managers (including pt pharmacist)
Care transitions: hospital
home, p-care
specialty care
Medication management for chronic conditions
Registries for diabetes, high blood pressure, high
cholesterol, asthma, heart failure, COPD
Outreach to patients with a chronic condition
Support self-management by patients
Triage agent
Integrated Clinical Care Services
3.
Electronic Medical Records (EMR) System
Connectivity across all providers
Meet NCQA medical home standards
Includes e-prescriptions
Additional features:
Order & retrieval of lab and imaging tests
Patient portal for medical records, scheduling
appointments, prescription refills, referrals
Connected with IU Health and IU Health Physicians
Integrated Clinical Care Services
4.
IU-based Resources
Membership data: employees, retirees, graduate assistants
and their families, who are covered by IU medical plans
Coordinate with existing care-management programs
Anthem, Aetna, Medco
Interface with existing programs: 24-hour nurse line, tobacco
cessation, nutrition & weight management, Employee
Assistance
Written and website communications
Integrated Clinical Care Services
Promotion to Employee/Retirees/Graduate Assistants
Greater access to primary care
Nurse care-manager for consultation
Enhanced medical plan coverage
Enhanced dental plan coverage
Electronic connectivity
Electronic Medical Record (EMR)
Personal Health Record (PHR)
Integrated Clinical Care Services
Expansion Considerations
Pediatrics in Bloomington
Adults in
Ellettsville
Bedford
Spencer
Nashville
Adults and pediatrics at other Indiana regions, especially
where meaningful numbers of plan members reside
Clinical Care Services
Provider Locations
IU Health Southern Indiana Pediatrics Clarizz
Blvd.
IU Health Southern Indiana Pediatrics
Landmark Ave.
IU Health Southern Indiana Pediatrics
Arlington Rd.
IU Health Southern Indiana Physicians
Clarizz Blvd
IU Health Southern Indiana Physicians
Rogers Rd.
IU Health Urgent Care East
Woodcrest Dr.
IU Health Urgent Care West
Third St.
Premier Healthcare Medical Center
Landmark Ave.
Premier Healthcare Family Practice
Landmark Ave.
Premier Healthcare Family Practice
Sare Rd.