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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
Senator
Georgia State Senate
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Ron Bachman
Senior Fellow
Center for Health Transformation
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Newt Gingrich
Founder
Center for Health Transformation
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Ron Bachman
Senior Fellow
Center for Health Transformation
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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
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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
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Consumerism
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Consumerism
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
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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
decisions
Source: McKinsey & Company,
June 2005
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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.
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Our Experience
Lumenos plans are “super-charging” account-based
solutions
Lumenos + Anthem
Leading healthcare
CDHP Industry
Benchmark company
Innovative Technology Provider network
advantage
High Touch Proactive
health improvement 360 Health
A marriage of a fuel-efficient engine
with less expensive gas.
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Prescription Drug Cost Estimator
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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
common
medical procedures
95
Connecting members
to high value health
care facilities based
on the following
Individual Preferences
Quality indicators
Outcome measures
Costs
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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
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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
healthier:
• 93% consumer satisfaction, 92% would renew, and 93% would
recommend
• 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
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Thank you!
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Todd Slawter
Senior Vice President,
Aetna, Inc.
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Health Care Reform:
Expanding Health Coverage:
Understanding Aetna’s Perspective
A CHT Forum
February 2009
Todd Slawter
Sr. VP, Southeast Regional
Head of Sales
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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
coverage
(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
quality
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Do consumers really understand
Health Care Reform:
the cost of health care?
Understanding Aetna’s Perspective
Gap •Price of a Honda Accord
between
guess •within $300
and
actual •Cost of a 4-day Hospital Stay
cost
•off by $8,100!!
Expanding
Our health care transparency availability Health Coverage
(as of January 2009)
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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
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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
Businesses
800,000 Small Businesses in
Georgia
• 62,000 without Insurance
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Value Pick Program
Health Care Reform:
Targeted to Small Businesses with “Working
Understanding Aetna’s Perspective
Uninsured”
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
size
Lowered Employer Contrib. level (25%)
Lowered Participation Requirement (50%)
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Finally
Health Care Reform:
Thank you! Aetna’s Perspective
Understanding
•Center for Health Transformation
•Speaker Gingrich
•Mr. Ron Bachman
•Mr. Wayne Oliver
Sen. Judson Hill
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Joe Ochipinti
Regional Vice President
UnitedHealth Care
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UnitedHealth Premium®,
UnitedHealthcare EDGESM & Health
Savings Account
A Quality Path to Affordability
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Improving
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
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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
coinsurance
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
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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
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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.”
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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.”
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Robert Wolfkiel
Market Vice President
Humana
Expanding
Working Well: Health Promotion and Health Coverage
Workplace Wellness Strategies
Bob Wolfkiel
Market Vice President
February 4, 2009
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Wellness: The Good
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Wellness: The Bad
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Wellness:
The Ugly
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“Just the Facts, Ma‟am”
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Georgia: The Peach State or the Couch
Potato State?
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Georgia: An Expanding Population
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The „Evolution‟ of Man
Obesity trends among U.S. Coverage
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adults
BRFSS, 1985-2006
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
2005
2004
2006
1988
2003
1990
1994
1993
1986
1996
1991
2000
1995
1997
1992
1989
1998
1987
1999
2001
2002
1985
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
„disease‟
Obesity – a costly Expanding Health Coverage
$53.2 $51.6
Direct Cost * of Chronic
Diseases in the United
Direct Cost ($ Billions)
$38.7
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
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Strategies
Information from 2007 survey of 555 organizations with an average of 12,500
employees
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Top Strategic Objectives for Wellness
Programs
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
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Panel Questions & Answers
Panelists:
Ron Bachman, Senior Fellow
Center for Health Transformation
Chris Schubart, Regional Vice President
Blue Cross Blue Shield of Georgia
Todd Slawter, Senior Vice President
Aetna
Joe Ochipinti, Regional Vice President
United Healthcare
Robert Wolfkiel, Market Vice President
Humana
Expanding Health Coverage
Expanding Health Coverage:
A CHT Forum on New, Private Sector
Health Insurance Products
