The power of partnership.

Transcription

1 School Board of Clay County and UnitedHealthcare. Building health ownership together. December 13, 2017 Annual Healthplan Performance Review October 1, 2016 thru September 30, 2017

2 Let s get started inspiring healthier Topics of Discussion Data Parameters Current: 10/16 09/17; no run out Prior: 10/15 09/16; no run out Engage Achieve Improve members in health care decision-making member health and productivity your financial objectives Norm*: Public School K-12 *Norm represents 12 months of data Claims experience is 90% complete Catastrophic case threshold: $50,000 UnitedHealthcare Team Carrie Setta, Strategic Account Executive Maryellen Goodwin, VP of Account Management David Harvey, Health Analytic Consultant Elizabeth Woodbury, Health Strategist Carol Mackoul, Field Account Manager Christine Laramee, Medical Director Airen Payne, Care Coordinator April Reilly, Service Account Manager 2

3 Working together to help build health ownership Clay County Initiation Awareness/Accountability Ownership Benefits Design CDHP 0% Traditional Plan Design CDHP up to 50% More HSA CDHP 50%+ Mainly HSA Network Design Limited OON Cost Share myuhc.com network directory OON Cost Share Virtual Visits Targeted Messaging Premium Tiering,higher out of network cost and cost share to promote appropriate site of care Rewards, Wellbeing Limited to no rewards (<$50) Limited Rally participation Activity-based (e.g., SimplyEngaged) Rally engagement Rewards ($50+) Outcomes-based (e.g., SimplyEngaged Plus) The Experience Plan Basics Low awareness of resources myuhc.com <30% Consumerism 101 Build awareness of decisions and impact Emerging Health Culture Framing of health care decisions and impact 3

4 Executive Summary $350 $340 $330 $320 $310 $300 $290 $280 $ PMPM, -11% below Norm Medical $303 Future Strategies: Total Paid PMPM $341 10/16-09/17 Norm Non-Catastrophic Medical Catastrophic Medical Norm Variance -11.0% -18.3% 1.6% Steerage: Plan design changes, Urgent Care, Promotion of Premium Providers Highlights $50k Wellness Budget $50k Communications Budget Real Appeal added 1/2017 Telephonic Engagement 217 members engaged Network Utilization %, 63.5% Discount, $32M in savings Premium Tier %, 0.5pts above Norm Virtual Visits 88 visits in current period, 8 visits through October 2017 ER Utilization - 11% lower than Norn Current Solutions Onsite Wellness Coordinator Simply Engaged Biometrics Screenings Onsite Flu Shots Clinical Management Real Appeal 4

5 Utilization Financials Demographics Plan Performance Norm Variance $x Diabetes Paid PMPM Tile color are based on 3% change from norm. Green indicates favorable change, Red is unfavorable, Gray is neutral 5

6 Consumer Tool Utilization Advocate4Me 58% Total Registered 50% National Average 4,761 total advocacy calls myhealthcare Cost Estimator Health4Me 683 Unique users 1,609 sessions Colonoscopy is the top area accessed 1,641 unique logins 6

7 SimplyEngaged Participation Health Assessment/Survey 823 Biometric Screening 199 Cost Estimator 401 Online Programs/Missions 398 Gym Reimbursement /2017 Telephonic Coaching 60 $72,775 earned in gift card incentives during 2016/2017 7

8 Real Appeal Enrollment Data through 12/2/ Registered 6 Pending Personalization 3%+ Loss 26.9% 5%+ Loss 14.9% Avg. Start lbs. Avg. lbs.loss Missed Personalization 258 Active 18 Disqualified 233 Enrolled 86% of enrolled are at-risk 8

9 Demographics Relationship Distribution Current Period Membership Membership by Plan 9

10 Plan Comparison 10

11 Catastrophic Claimants ( $50k) 11

12 Population Health Conditions and Cost Drivers Condition Prevalence Claimants per 1,000 Condition Cost Net Paid PMPM 12

13 Health Continuum Comparison 13

14 ER Utilization -11% lower ER utilization than Norm 7% frequent flyers ( 3 visits within 12 months) 30% of ER visits occurring on the weekend Top ER Visits per 1,000 for Primary Diagnoses 72% of ER visits associated with subscribers 54% of ER visits associated with members engaged with a PCP 50% potential redirection rate (up to a potential $94k savings) 88 virtual visits in current year Urgent care visits per % lower than Norm 14

15 Premium Tier 1 Physician Utilization Quality and efficiency care lowers utilization, risk, and cost of care Premium Provider Utilization 15

16 Telephonic Program Engagement Excludes Mailings We engaged 24% of the qualified population driving 41% of spend Of those we touched, 72% were actively engaged We were unable to reach 16% of those who qualified for nurse outreach; 53% had invalid phone numbers 16

17 Actionable Opportunities Diabetes Neoplasms Back Pain 12% of Members 26% of Spend Average paid per diabetic is 2.3 times than a nondiabetic 19 member to convert causing an additional 114k in spend 12% of Members 13% of Spend $15k in OON spend Breast Cancer was the leading condition accounting for 23% of Neoplasm spend 73% of Cancer spend is Catastrophic 9% of Members 21% of Spend Laminectomies and Spinal fusions accounting for 36% of Back Pain spend Accounts for 60% of catastrophic spend 1.9 Admissions/1000, $45k average paid per admission 17

18 Solutions: Collaborate and Take Action Consumer Education & Engagement Appropriate Care Setting Benefit Design Communications Strategy to improve engagement Tier 1 Providers via myuhc.com & Health4Me app Advocate4me Why is UHC Calling? Education on appropriate, lower-cost care settings, including urgent care, onsite clinic, and primary care physician Develop ongoing communication strategy to educate members about available resources, including onsite clinic, that will help them make informed health care decisions Steerage to Urgent Care Clinics, Virtual Visits, Premium, Providers Promotion of Choice and CDHP options Consider plan design changes 18

19 Pharmacy Executive Performance Review School Board of Clay County Current Period October 1, 2016 September 30, 2017

20 Key Performance Indicators Current Previous Change Current Previous Change Rx Count 65, % Enrolled Members 4, % Non-Specialty 65, % Utilizing Members 3, % Specialty % Utilization 81.81% 0.00% Adjusted Rx Count* 72, % Per Member Per Year % Days Supplied per Rx % Non-Specialty % Specialty % Tier 1% 78% 0.00% 0.78 Tier 2% 14% 0.00% 0.14 Tier 3% 8% 0.00% 0.08 Tier 4% 0.00% 0.00% 0.00 Single Source Brand 11.81% 0.00% 0.12 MultiSource Brand 3.09% 0.00% 0.03 Generic Dispensing Rate 85.07% 0.00% 0.85 Generic Substitution Rate 97.11% 0.00% 0.96 Mail Penetration % 20

21 Pharmacy: Top Drugs TOP 10 DRUGS RANKED BY AMOUNT PAID Drug Name HUMIRA PEN 002 INFLAMMATORY CONDITIONS Days Supplied Rank by Amount Paid Rx Count Rank Rx Count Patient Count Per Rx Current % Total Current % Total Current Current Current % % ORKAMBI 002 CYSTIC FIBROSIS % % INVOKANA 002 DIABETES % % VICTOZA 003 DIABETES % % HUMALOG KWIKPEN 002 DIABETES % % LATUDA 003 ANTIPSYCHOTICS % % TECFIDERA 002 Adjudicated Client Cost Tier Disease State MULTIPLE SCLEROSIS % % IBRANCE 002 ONCOLOGY % % POMALYST 003 ONCOLOGY % % ENBREL SURECLICK 003 TOP 10 DRUGS RANGED BY RX COUNT INFLAMMATORY CONDITIONS % % Drug Name Rx Count Patient Count Days Supplied Per Rx Current % Total Current % Total Current Current Current LISINOPRIL 001 CARDIOVASCULAR % % 1, ATORVASTATIN CHOLESTEROL 001 CALCIUM LOWERING % LEVOTHYROXINE THYROID 001 SODIUM REPLACEMENT % % 1, SIMVASTATIN 001 CHOLESTEROL LOWERING % AMLODIPINE BESYLATE 001 CARDIOVASCULAR % % 1, SERTRALINE HCL 001 DEPRESSION % LOSARTAN POTASSIUM 001 CARDIOVASCULAR % HYDROCODONE/ ACETAMINOPHE 001 NARCOTIC ANALGESICS % % 1, METFORMIN HCL 001 DIABETES % MONTELUKAST SODIUM Adjudicated Client Cost Tier Disease State Rank by Amount Paid Rx Count Rank 001 ASTHMA / COPD %

22 Pharmacy: Top Disease States TOP 10 DISEASE STATES BY AMOUNT PAID Days Supplied Rank by Amount Paid Rx Count Rank Rx Count Patient Count Disease State Per Rx Current % Total Current % Total Current Current Current DIABETES % % INFLAMMATORY CONDITIONS % % ONCOLOGY % % ASTHMA / COPD % % CYSTIC FIBROSIS % % CARDIOVASCULAR % % 12,089 1, SEIZURE DISORDERS MULTIPLE SCLEROSIS CHOLESTEROL LOWERING % % % % % % ADHD % %

23 Pharmacy: Member Type Employee Employee Employee Spouse or Domestic Partner Spouse or Domestic Partner Spouse or Domestic Partner Child or Dependent Child or Dependent Child or Dependent Top 3 Disease States by Plan Paid DIABETES INFLAMMATORY CONDITIONS ONCOLOGY DIABETES ASTHMA / COPD HEPATITIS CYSTIC FIBROSIS SEIZURE DISORDERS GROWTH HORMONE DEFICIENCY 100% 90% Employee Rx Per Member Per Year % 70% 60% 50% 73% 81% Spouse or Domestic Partner Rx Per Member Per Year Child or Dependent Rx Per Member Per Year % 30% 20% 10% 0% 12% 14% 15% 5% % Paid Total % Rx Cnt Child or Dependent Spouse or Domestic Partner Employee 23

24 Pharmacy: Age Statistics Age Band Rx per Member per Year Plan Paid % Total % Total Utilizers % 0.80% % 2.52% % 4.80% % 11.09% % 20.55% % 32.75% % 22.28% % 5.21% Top 3 Disease States by Plan Paid SEIZURE DISORDERS ADHD ASTHMA / COPD CYSTIC FIBROSIS GROWTH HORMONE DEFICIENCY ADHD SEIZURE DISORDERS DIABETES ANTIPSYCHOTICS DIABETES ASTHMA / COPD MULTIPLE SCLEROSIS DIABETES INFLAMMATORY CONDITIONS BLOOD CELL STIMULATORS INFLAMMATORY CONDITIONS ONCOLOGY DIABETES DIABETES HEPATITIS INFLAMMATORY CONDITIONS DIABETES ASTHMA / COPD NARCOTIC ANALGESICS 24

25 Appendix 25

26 Motivating Health Ownership Phases Initiation Awareness Accountability Ownership Plan design solutions do not encourage members to engage. Members are passive as there are no consequences for action or inaction. Typically, the only member financial impact is the co pay. This is the most expensive phase along the continuum for plan sponsor In this phase, the member becomes more aware of cost and quality differences. Communication focuses on enrollment and provider choices, and making good health decisions; incentives are voluntary in nature. In this phase, the member experiences financial impact through the decisions they make, e.g. enrollment, provider selection and ongoing care decisions. Wellness is more outcomes based and incentives balance both a carrot and stick approach This is the ideal state where the member has both the motivation and the ability to take ownership of their health choices and outcomes. This phase puts greater emphasis on the member experience as well as plan sponsor culture to maximize engagement and lead to lower costs Trailblazer = Individual clients that are furthest along towards ownership, excluding UnitedHealth Group 26

27 Aligning your health benefits strategy with your objectives and culture. It s all about helping people achieve better health by making more informed health care decisions, which over time, can lead to lower cost and better business performance. 27