Transcript Slide 1
Total Care Plan Joint development of a new and effective vehicle for delivering health benefits Tim Cappel, President, Humana of Ohio William Banks – VP, Revenue Cycle, St. Elizabeth Project Selection & Purpose • Project Selection • The development of the Total Care Plan was selected as a unique opportunity to solve the problem of rising medical cost trends in a way that increases quality and preserves patient choice • Alignment • • Both Humana and SEH stood to gain market share by developing a unique product in the market. Both also stand to ‘re-develop’ an understanding about how to manage and market a limited network health plan. • Stakeholders • • Humana and SEH are both major stakeholders Every employer in No. KY is also a stakeholder, since they stand to gain as we learn to better manage medical trend. Current Situation • Identifying the Root Causes or Improvement Opportunities • • Medical cost trend statistics (Gr. Cincinnati/ No. KY market) Key drivers – unit cost/ utilization/ mix change/ duplication • Identifying Final Root Causes • • Utilization as THE actionable driver St. E internal trend as proof that keeping care internal can help trend • Stakeholder Involvement • • • Humana as the keeper of data and actuaries who analyze St. E as the keeper of local market knowledge and willing partner Chamber of Commerce as catalyst to encourage local businesses to consider this option. Solution Development • Method for Selecting Possible Solution(s) • To lower costs, we had three options to choose from: 1. 2. 3. More aggressive price negotiation, Lowered benefit levels, Design a system that reduced utilization of services • Final Solution Selection • • • Only option #3 above offered the promise of long term price and trend reduction Offered a more limited access product alongside more traditional benefit plans Shared expected savings with employees by lowering their payroll contribution • Benefits to Final Solution • Allowed those who didn’t want to switch the ability to stay with their current plan Project Results • Results • • • • • • The new product attracted 5,420 St. E members (49%) year 1 – now our largest offering Humana estimates 7,500 members from all employers by 1/1/12 Effectiveness • St. E overall medical trend (excluding highcost cases 2011 vs. 2010 is -2.4%) Admits (-5.8%), ER(-2.8%), OP svcs (-2.1%) all down Within St. E, the HMO population showed significantly lower utilization rates in all areas – IP(-44%), OP(-31%), MD visits(-20%), Rx (-25%) Validation • • 54,830 member months of data (5,420 members in the HMO) Sustainability • • • Applicability and Use By Other Organizations • • • SEH has made a long-term commitment to this concept To continue to attract buyers, the product must show approximately 10% savings vs. larger network offerings. The product was designed from the start to be available to any employer, fully insured or self funded. It requires no customization Total Care Plan is a valuable precursor to ACO development. Innovation • Previous efforts at trend management have failed because the care providers haven’t had incentive to reduce costs. The Total Care product represents a new approach to managing health care benefits in which each player brings their unique strengths and both are aligned around the common goal of medical cost trend reduction.