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					                     Expanding Health Coverage

  Expanding Health Coverage:
A CHT Forum on New, Private Sector
    Health Insurance Products

                        February 4, 2009
                         Atlanta, Georgia
                       Expanding Health Coverage

Wayne Oliver
Project Director
Center for Health Transformation
                       Expanding Health Coverage

Senator Judson Hill
Georgia State Senate
                       Expanding Health Coverage

Ron Bachman
Senior Fellow
Center for Health Transformation
                         Expanding Health Coverage

Newt Gingrich
Center for Health Transformation
                       Expanding Health Coverage

Ron Bachman
Senior Fellow
Center for Health Transformation
                          Expanding Health Coverage

Chris Schubart
Regional Vice President
Blue Cross Blue Shield of Georgia
              Expanding Health Coverage

Center for Health
Transformation Conference

Blue Cross Blue Shield of
Georgia Chris Schubart,
Regional Vice President Local
Group Sales

February 4, 2009
                          Expanding Health Coverage

Isn‟t it time for Georgia to have
more control over our
healthcare costs?
      We think so, too.
                              Expanding Health Coverage

Discussion Topics
 o Healthcare Costs

 o Consumerism

 o Lumenos (Consumer Driven Healthcare Solution)

 o Cost Estimators
                                                        Expanding Health Coverage
Rising Costs: The “Big 4” Risk Factors

 The majority of the rise in private insurance costs is
 due to population risk factors and their treatment
                     28,000 or 24% of children in the third grade in Georgia are obese
                     Percentage of Adults who are obese has been constantly
                      increasing since 1990 from 10.8% to 28.7% in 2007
                     In 2007, there were 1.9 million obese adults in Georgia

                     In 2007, approximately 1.3 million (19.4%) adults in Georgia
                      smoked cigarettes
                     Average 10% of total claims costs attributable to tobacco

                     60% perform no substantial activity or exercise

      Stress         Two-thirds of all office visits to family physicians
                      are due to stress-related symptoms
                     More than one in four workers have taken a "mental
                      health day" off from work to cope with stress
                     Costs U.S. businesses $300 billion annually in direct
                      & indirect costs
              Expanding Health Coverage

                                Expanding Health Coverage

o Imagine having greater control over health
  care costs while improving and maintaining
  your health – a win-win scenario.

o Now you can. BCBSGa-Anthem is
  revolutionizing health care by expanding our
  industry-leading Lumenos consumer-driven
  health plans and making them available to
  everyone – all markets, all segments, and all
  35 million current members nationwide.
         Consumers Are Becoming Coverage
                        Expanding Health
      More Engaged in Their Health Care

 Survey of consumers enrolled in CDHPs:
 Value Conscious
    50% more likely to ask about cost

 Prevention-Oriented
    25% more likely to engage in healthy behaviors
    30% more likely to get an annual checkup because they thought it would
     save money in the long run

 Control Costs
    20% more likely to follow treatment regimens for chronic conditions

 Information Needs
    Many were dissatisfied with information available to them to make health
                                                                            Source: McKinsey & Company,
                                                                                    June 2005
                                         Expanding Health Coverage
                     Our Solution
 Anthem’s Lumenos plans give consumers the control and
  information they want while rewarding them for being more
  engaged in their health.
 Our approach combines unique account-based plan designs
  with sound clinical strategy; then tops it off with bold and
  proactive communications to engage consumers before and
  after enrollment.

 Consumers will better understand how they can get more
  value from their health care dollars and will be rewarded for
  healthy behaviors.
                                     Expanding Health Coverage
                  Our Experience
Lumenos plans are “super-charging” account-based

     Lumenos              +         Anthem
                                   Leading healthcare
 CDHP Industry
 Benchmark                          company
 Innovative Technology            Provider network
 High Touch Proactive                 
 health improvement                360 Health

  A marriage of a fuel-efficient engine
       with less expensive gas.
                    Expanding Health Coverage

Prescription Drug Cost Estimator
                     Expanding Health Coverage

Prescription Drug Cost Comparison
ProviderFinder:    Expanding Health Coverage
Treatment Costs
                         Estimate the costs of
                          specific health care
                          services or episodes
                          of care
         - 95010

                         In-network and out-
                          of-network costs
                          based on the most
                          medical procedures

                         Connecting members
                          to high value health
                          care facilities based
                          on the following
                              Individual Preferences
                              Quality indicators
                              Outcome measures
                              Costs
                                             Expanding Health Coverage
               How Do We Do It?

• Our plan designs come with the largest national network of
  participating providers with no referrals necessary
• You get a 24/7 NurseLine, health coaching programs, 100% coverage of
  nationally recommended preventive care services, and an online health
  site with tools and information to help you get the most value out of
  your dollars
• Our integrated plans make it easier on everyone
• Our turnkey communications help companies create a new culture
  around health improvement
• Working together with our brokers/consultants we help customers to
  make better engaged employee a top down initiative
• And, we can even include financial rewards for healthy behaviors
                                                          Expanding Health Coverage

                                                Does It Work?
• 53% of Lumenos consumers report increased knowledge in managing
  their healthcare
• 62% switched to a generic prescription drug
• Preventive care services doubled - 5.4% compared to industry average
  of 2-3%

• And, Lumenos consumers tell us that they’re happy, more engaged and
• 93% consumer satisfaction, 92% would renew, and 93% would
• 95% cite greater flexibility and control in managing their health
• 93% cite that our Lumenos plan was the best value for their money
    Source: Results from Lumenos book of business 2005
             Expanding Health Coverage

Thank you!
                         Expanding Health Coverage

Todd Slawter
Senior Vice President,
Aetna, Inc.
                         Expanding Health Coverage

           Health Care Reform:
Expanding Health Coverage:
     Understanding Aetna’s Perspective
A CHT Forum
February 2009

                Todd Slawter
                Sr. VP, Southeast Regional
                Head of Sales
                       Expanding Health Coverage
 Presentation Roadmap
             Health Care Reform:
Aetna’s Position on Health Care
    Understanding Aetna’s Perspective
     System Transformation – To
     Your Health!
Enable the Consumer
Plans and Products
                        Proposal Coverage
To Your Health! Aetna’sExpanding Health for
Health Care System Transformation
                         Health Care Reform:
Get and keep everyone covered
 (1) Transform health insurance into a civic responsibility
                                       Aetna’s Perspective
              Understanding export its strengths to make the
  (2) Strengthen public programs and the safety net for those most in need
Maintain the employer-based system and
individual market function better
  (3) Leverage the strengths of the current health care system to advance the goal of   universal
   (4) Use the tax system to expand access and increase affordability
   (5) Promote greater portability of health insurance
Reorient the system toward prevention, value and quality of care
 (6) Promote preventive care and wellness
  (7) Improve health care quality and patient safety
Use market incentives to improve coverage, drive down costs and make the
system more consumer-oriented
 (8) Create a legislative and regulatory environment conducive to affordable insurance options
  (9) Make the health care system more transparent and consumer-friendly
  (10) Harness the power of health information technology to reduce costs and improve
                           Expanding Health Coverage
     Do consumers really understand
               Health Care Reform:
         the cost of health care?
          Understanding Aetna’s Perspective
Gap           •Price of a Honda Accord
guess              •within $300
actual     •Cost of a 4-day Hospital Stay
                   •off by $8,100!!
Our health care transparency availability Health Coverage
(as of January 2009)
                                 Expanding Health Coverage
Products with Purpose
             Health Care Reform:
  Aetna Affordable Health Choices (SRC)
 Understanding Aetna’s Perspective
    •Limited benefits plans
   •Targets part-time, seasonal and temporary workers
   •Available in 47 states
  “Middle Med” Plans
   •Niche product piloted
   •Could fill a gap between Limited Benefit plans and
   Traditional comprehensive benefits
  Aetna Student Health
   •450,000 Undergraduate and Graduate students
   •more than 170 institutions
                     Expanding Health Coverage
       The Issue
         Health Care Reform:
 47 million uninsured in the US
Understanding Aetna’s Perspective
 1.7 million uninsured in Georgia
   • 380,000 work for Small
 800,000 Small Businesses in
   • 62,000 without Insurance
                               Expanding Health Coverage
    Value Pick Program
               Health Care Reform:
 Targeted to Small Businesses with “Working
    Understanding Aetna’s Perspective
 4 or more minimum enrolled employees
    • Open Access HMO (plan 709)
    • Open Access POS (plan 708)
    • HDHP Open Access POS (713)
 Dual & Triple Option available depending on case
 Lowered Employer Contrib. level (25%)
 Lowered Participation Requirement (50%)
                      Expanding Health Coverage
      Health Care Reform:
 Thank you! Aetna’s Perspective
  •Center for Health Transformation
  •Speaker Gingrich
  •Mr. Ron Bachman
  •Mr. Wayne Oliver
Sen. Judson Hill
                          Expanding Health Coverage

Joe Ochipinti
Regional Vice President
UnitedHealth Care
                           Expanding Health Coverage

UnitedHealth Premium®,
UnitedHealthcare EDGESM & Health
Savings Account

     A Quality Path to Affordability
                                                                                    Expanding Health Coverage

                                                          care variation

                            Care Variation                                                    Cost Variation

               The New England Journal of                                 Studies show that quality and efficiency of care
              Medicine reports that adults are                             designated physicians have lower costs per
            receiving recommended treatments                                 episode, on average, compared to non-
                    only 55% of the time                                             designated physicians

                        Evidence-based Care                                                    Lower Costs

        Complications                          Procedure Re-do’s           Cardiovascular        Orthopedics       Endocrinology
    70% higher than expected                     2x the re-do rate of         Surgery           31.2% lower than   32.4% lower than
     compared to designated                   designated physicians for    20.4% lower than         non- Q&E           non- Q&E
       physicians for CVS                                CVS                   non- Q&E            designated         designated
                                                                              designated           physicians         physicians
SOURCE: UnitedHealthcare claims analysis, November 2007                       physicians
                                                         Expanding Health Coverage

UnitedHealth Premium Designation
     Leverages transparency to improve quality and lower costs
        Physicians are first assessed on quality: we identify specialists who meet or exceed
         quality standards established by third party professional societies such as the American
         College of Cardiology and the American Academy of Orthopedic Surgeons
        Only if they meet quality standards, are they assessed on efficiency of care, based on
         peer comparison and third party evaluations, i.e. most appropriate treatment, less
         complications and re-do’s
     With UnitedHealthcare EDGE, employees who use specialists designated for both
      quality and efficiency receive increased coverage in the form of lower copays and
     Here is a small listing of the collaborators used to establish quality criteria:
            - American College of Cardiology (ACC)
            - American Board of Internal Medicine (ABIM)
            - National Committee for Quality Assurance (NCQA)
            - Society of Thoracic Surgeons (STS)
            - Virtually every other State Society
                                                                  Expanding Health Coverage

2009 EDGE Plan Overview
EDGE Plans Overview
•   Access to entire UnitedHealthcare Choice Plus Network
•   Open Access POS Plans
•   Significantly lower priced than our base plans
•   Can be paired with an HSA
       • Current EDGE plans in good alignment with market preferences
       • Employers want EDGE deductibles between $1.5K and $2K, so fits with HDHP plan
       • Excluding primary plan design elements of PCP Copay and Deductible, 100% preventive care is the
          most important feature, so we included it in all new EDGE plan designs
       • Employers prefer to see lower OOP Maximums, so we developed plans that lowered OOP Max
          down to $3K, $4K and $5K without significant PMPM impact
       • Employers want EDGE plans to be paired with an HSA, so we are offering five national HSA plans

EDGE Plans – Benefit Differences
•   Provides members with lower copays and higher coinsurance when using specialty physicians receiving
    quality and efficiency UnitedHealth Premium designation
•   Per occurrence deductibles apply to inpatient hospitalization and outpatient surgery (Calculated to go
    toward out-of-pocket maximum)
•   Lab and X-ray applies to deductible & coinsurance except for Preventive Care when plan covers
    preventive benefits at 100%
•   Covers MH/SA & Chiropractic at state mandate levels
                                 Expanding Health Coverage

Georgia Broker Feedback
Platinum Broker
  “United HealthCare’s EDGE program effectively
  delivers differentiated value at lower cost for our
  clients. Offering an EDGE HSA provides even more
  savings for the Employer. United HealthCare’s
  EDGE plans are making a positive difference for the
  healthcare consumer’s market place.”
                                     Expanding Health Coverage

Georgia Customer Feedback
Small Business Employer
 “Smaller businesses such as ours are eager to provide
  benefit packages in order to attract and retain valuable
  employees. UnitedHealthcare’s EDGE enables us to
  offer comprehensive, affordable health care benefits &
  increased tax advantages for our employees. We
  believe our employees will have peace of mind knowing
  they have access to Premium-designated physicians who
  deliver quality, cost-effective care.”
                        Expanding Health Coverage

Robert Wolfkiel
Market Vice President
   Working Well: Health Promotion and Health Coverage
      Workplace Wellness Strategies

Bob Wolfkiel
Market Vice President
February 4, 2009
                 Expanding Health Coverage

Wellness: The Good
                    Expanding Health Coverage

Wellness: The Bad
            Expanding Health Coverage

The Ugly
                    Expanding Health Coverage

“Just the Facts, Ma‟am”
                       Expanding Health Coverage

Georgia: The Peach State or the Couch
Potato State?
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Georgia: An Expanding Population
                    Expanding Health Coverage

The „Evolution‟ of Man
          Obesity trends among U.S. Coverage
                              Expanding Health
                BRFSS, 1985-2006
                 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data   <10%      10%–14%   15%–19%    20%–24%     25%–29%   ≥30%
                                           Obesity – a costly Expanding Health Coverage

                                      60      $53.2      $51.6
                                      50                                                  Direct Cost * of Chronic
                                                                                           Diseases in the United
           Direct Cost ($ Billions)

                                      40                                                          States
                                                                                             $18.4    $18.1


                                              Type 2    Obesity        Coronary              Hyper-   Stroke
                                             Diabetes                Heart Disease          tension

Wolf AM, Colditz GA. Obes Res. 1998;6:97-106.
                                                             *Adjusted to 1995 dollars.
Hodgson TA, Cohen AJ. Med Care. 1999;37:994-1012.
Current Status of Wellness Health Coverage
                         Current Status of Wellness Strategy

                                       7%                 15%



                                 14%                5%

                  Fully Implemented
                  Partially Implemented
                  Have Strategy, Not Implemented
                  No Current Strategy, Plan to Develop
                  Numerous Wellness Initiatives but no Comprehensive Strategy
                  No Plans for Wellness Strategy

    Information from 2007 survey of 555 organizations with an average of 12,500
                                         Expanding Health Coverage

Top Strategic Objectives for Wellness
   Reducing Health Care Costs
   Improving Worker Productivity
   Reducing Employee Absences
   Improving Workforce Morale
   Attracting and Retaining Employees

• Employers spend an average of $135 per employee
  per year on Wellness programs, and an additional
  $100 per employee on incentive rewards
                                    Expanding Health Coverage

      Panel Questions & Answers
Ron Bachman, Senior Fellow
       Center for Health Transformation
Chris Schubart, Regional Vice President
       Blue Cross Blue Shield of Georgia
Todd Slawter, Senior Vice President
Joe Ochipinti, Regional Vice President
       United Healthcare
Robert Wolfkiel, Market Vice President
                     Expanding Health Coverage

  Expanding Health Coverage:
A CHT Forum on New, Private Sector
    Health Insurance Products

Description: Ga Small Business Health Insurance document sample