Self-Insurance 2016 Q2 Update. Presented by Marcy Syman, Human Resources Director

Transcription

1 Self-Insurance 2016 Q2 Update Presented by Marcy Syman, Human Resources Director Management Committee

2 Dollars in Millions Self-Insured Plan Costs Q (Claims, admin fees and stop loss premium) $40.0 $35.0 $30.0 $35.7 $34.5 $25.0 $20.0 $15.0 $10.0 $5.0 $2.54 $2.45 $- Medical/Pharmacy Budget Actual Dental 1

3 Incurred Claims: Medical/Pharmacy 2

4 Dollars in Millions Total Incurred Medical Claims Per Member Per Month (PMPM) $600 $552 $562 $500 $465 $486 $508 $497 $400 $300 $200 $100 Fully Insured $- CY 2012 CY 2013 CY 2014 CY 2015 Q Q ,624 members 9,082 members 9,488 members 9,658 members 9,666 members 9,790 members 3

5 Dollars in Millions Total Incurred Medical Claims Per Member Per Month (PMPM) $600 $500 $552 $465 $486 $508 $497 13% $562 $400 $300 $200 $100 Fully Insured $- CY 2012 CY 2013 CY 2014 CY 2015 Q Q ,624 members 9,082 members 9,488 members 9,658 members 9,666 members 9,790 members 3

6 Incurred Claims: Dental

7 Health and Wellness Update

8 2015 HealthPartners Claims Data 6

9 Highest Cost Categories Cancer Psychiatry Cardiology Endocrinology 2015 PMPM 2014 PMPM 2013 PMPM Orthopedic/Arthritic $0.00 $10.00 $20.00 $30.00 $40.00 $50.00 $60.00 $70.00 $80.00 $90.00 Orthopedic conditions continue to comprise top claims Top categories continue to be lifestyle driven conditions Overall 2015 claims up 4.6% from

10 Top Disease Prevalence HP Aggregate Depression 16.8% 16.6% 15.7% 16.3% Diabetes 8.4% 8.4% 8.2% 4.7% Asthma 7.3% 7.2% 7.0% 5.3% Heart Disease 3.7% 3.3% 3.5% 2.6% COPD 1.3% 1.2% 1.2% 0.6%

11 Top 10 Pharmacy Paid 2015 Therapeutic Class Scripts Total Per Script Humira Antirheumatics 153 $565,473 $3,684 Harvoni Hepatitis 16 $477,754 $29,860 Humalog Diabetes 1037 $439,780 $424 Lantus Diabetes 1272 $386,723 $304 Enbrel Antirheumatics 1100 $348,715 $3,170 Advair Asthma 924 $292,059 $316 Victoza Diabetes 426 $231,353 $543 Adderall Stimulants 823 $216,657 $263 Sovaldi Hepatitis 7 $196,242 $28,035 Imbruvica Oncology 17 $156,994 $9,

12 Trends & Experience 4.6% increase PMPM over 2014 Primary driver was high cost cases Cost increases were most notable in cardiology, neurology and gastroenterology Top four condition categories account for 43% of the total 2015 spend Preventive care services slipped by 1% but up-to-date breast cancer screening increased by 3.9% ER Visits are 47% higher than HealthPartners aggregate 9/12/16 10

13 HealthPartners 2016 Employee Health Assessment Data

14 Health Assessment Participation 2016 participation: 48.0% - $40 incentive 2015 participation: 46.4% - $40 incentive 2014 participation: 32.0% - $20 incentive 2013 participation: 29.6% - $20 incentive

15 Health Risks Diabetes/Heart Disease 80.0% 70.0% 67.5% 67.9% 67.8% 60.0% 54.3% 50.0% 40.0% 30.0% Goal 20.0% 10.0% 11.5% 11.9% 12.3% 5.1% 0.0% Mod-High Risk Diagnosed Goal: an achievable goal based on the prevalence of diabetes/heart disease among a healthy sample population 9/12/16 13

16 Healthy Population Physical Activity: 150 min moderate or 75 min vigorous activity per week Nutrition: 5 or more servings fruit/vegetables per day Tobacco: no current tobacco use Alcohol: no more than 7 (14) drinks per week of 3(4) drinks per day for women (men) General health: excellent self-perceived health Physical health: no limitations due to physical health concerns Emotional health: no limitation due to emotional health concerns Life satisfaction: very satisfied with life

17 Modifiable Health Measures Goal Low Sleep 18.8% 41.6% 40.8% 42.4% Unhealthy Stress 1.2% 10.9% 10.4% 9.2% Overweight/Obese 50.9% 78.5% 78.7% 76.3% Low Fruit/Veg 0.0% 84.8% 86.6% 86.1% Low Physical Activity 0.0% 31.3% 32.7% 28.6% 71% high risk for overweight/obese ready to change 9/12/16 15

18 So What Improvements over last year in physical activity, nutrition, breast and cervical cancer screening, tobacco use and alcohol consumption Most risk factors experienced by our employees are modifiable Continued need to increase knowledge about nutrition and disease management Continued need to engage our workforce in improving their health which will benefit employees, their families, the Metropolitan Council and the region as a whole In absence of health/wellness support can expect a 7% net annual decline in employee health 16

19 Work Clinic 17

20 Visit Volume by Month: 7 visits per day March April May June July

21 Axis Title Top Conditions Treated Preventive Care Ear, Nose, Throat Skin Circulatory Endocrine Axis Title May June July

22 Top Medications Dispensed Allergy Antibiotics Hypertension/Cardiac Asthma Diabetes May June July

23 2017 Health and Wellness Strategy What s next 17

24 Continue to Build a Culture of Health Benefit Structure Personal Responsibility Supportive Organization

25 Focus Fit For Life Program Diabetes/Heart Disease Management Weight Management Nutrition Physical Activity Lifestyle: Screenings, Stress, Sleep,

26 Two Important Fit For Life Programs Omada Nutrition Fall 2015 launch 279 enrollees 3,663 lessons completed 2,580 lbs. lost to date 15 employees reduced their risk of developing type 2 diabetes by 85% Summer 2016 launch 173 people impacted 87 sessions completed Series of three sessions (6) 1-1 nutrition coaching sessions (72) Lunch & learn sessions (9) 16-week online program with a year of support