Presentation on theme: "Trustees Finance & Audit Committee, April 2012 2013 Healthcare Program."— Presentation transcript:
Trustees Finance & Audit Committee, April Healthcare Program
Current Status – April ,300 FT Employees; 16,150 enrolled in medical 37,000 plus covered lives 4 medical plans: PPO networks, with member cost sharing Salary-based premiums, with credit for non-use of tobacco HDHP & HSA with 8,100 employee enrollments PPACA compliant No post-65 Retiree Healthcare liability FY 2011/12 IU Budget for Healthcare = $186.6 m FY 2012/13 IU Budget = $197.8 m or $11,433 per eligible employee
Assumptions for CY 2013 (as of April 2012) Same or lower number of covered employees Same medical plan options as 2012 increase enrollment in the HDHP & HSA plan Moderate increase in total premiums small or no increase in HDHP plan premiums PPACA: new “Summary of Benefits and Coverage” annual limit of $2,500 for health FSA contribution, starting 2013 Form W-2 reporting for 2012 health coverage Cost Increases: 1) provider fees and 2) medical utilization
Medical Utilization – The Top 10 “Disease and Injury” Classifications (by $s paid for 2011) % Difference w/2010 Supplemental Classifications (e.g. pregnancy, dialysis)-.6% Musculoskeletal system & connective tissue+ 29.4% Neoplasms+ 22.9% Circulatory system+ 4.7% Symptoms, signs and ill-defined conditions (e.g. ER)+.4% Digestive system- 10.3% Genitourinary system+ 5.9% Nervous system & sense organs+ 30.0% Injury & poisoning- 9.5% Complications of pregnancy and childbirth+ 11.6%
Prescription Drug Utilization – The Top 10 Therapeutic Class (by $s paid for 2011)% of Total # Rxs Miscellaneous (e.g. transplant, MS)2.5% Anti-depressants9.8% Lipotropics7.8% Diabetic therapy4.1% Anti-arthritics2.7% Bronchial dilators3.2% Anti-ulcer3.7% Antivirals0.9% Anti-neoplastics (cancer)0.5% Other hypotensives (blood pressure)7.4%
Relationship Between Members and Plan Costs IU’s Employee Medical Plans 21% 12% 37% 29% 7% 20% 43% 15% 1% 8% of members = 58% of costs 28% of members = 87% of costs 71% of members = <14% of costs 14% of members with no costs
Relationship Between Members and Plan Costs for 2011 IU’s Employee Medical Plans 29% 7% 20% 43% 15% 1% 14% 5,180 mbrs 15,910 mbrs 7,400 mbrs 2,590 mbrs 370 mbrs 5,550 mbrs $ $ 0 / yr $ 1.9 m --- $ 342 /yr $ 22.8 m --- $ 1,433 / yr $ 55.1 m --- $ 7,446 / yr $ 70.3 m --- $27,143 / yr $ 39.9 m --- $107,838 / yr $ Per Member
Major Medical Program Initiatives Initiatives that Are applicable across all medical plan options Complement or supplement provider and member activities Integrated Clinical Care Services -- details to follow Personal Health Record (PHR) Personal web-based access to medical records, such as: contact info, medications, immunizations, illnesses, medical history, allergies, biometric tracking, legal documents, etc. Data integration with Medco, Anthem, and IU Health/HealthSmart Support for Clinical Care Services program (clinical portal) Transparency Member web-based access to: location of PPO providers; “price” for services by provider; “cost” for episodes of care by provider group/healthcare system; and quality measures & patient satisfaction
Major Medical Program Initiatives Integrated Clinical Care Services Improve access to primary care providers, for routine and urgent care Dedicated care management team, for patients with chronic and/or complex medical conditions Connectivity of medical records
Integrated Clinical Care Services Virtual patient centered medical home Essential components: Primary care provider group(s) Dedicated team of nurse care-managers Electronic medical records system (EMR) IU-based resources Promotion to plan members Expansion opportunities
Integrated Clinical Care Services Primary Care Provider Groups Physicians, nurse practitioners, physician assistants Walk in care, same day appointments After hours access: telephone, e-visits Electronic Medical Records (EMR) system Quality Health First program measures Participate in care management activities
Integrated Clinical Care Services Primary Care Provider Groups Proposed initial rollout in Bloomington East of the IU Bloomington campus Sare Rd. – Premier Healthcare Clarizz Blvd. – IU Health Southern IN Physicians West of the IU Bloomington campus Landmark Ave. – Premier Healthcare Rogers St. – IU Health Southern IN Physicians
Integrated Clinical Care Services Primary Care Provider Groups -- Proposed
Integrated Clinical Care Services Nurse Care-Managers (including pt pharmacist) Care transitions: hospital home, p-care specialty care Medication management for chronic conditions Registries for diabetes, high blood pressure, high cholesterol, asthma, heart failure, COPD Outreach to patients with a chronic condition Support self-management by patients Triage agent
Integrated Clinical Care Services Electronic Medical Records (EMR) System Connectivity across all providers Meet NCQA medical home standards Includes e-prescriptions Additional features: Order & retrieval of lab and imaging tests Patient portal for medical records, scheduling appointments, prescription refills, referrals Connected with IU Health and IU Health Physicians
Integrated Clinical Care Services IU-based Resources Membership data: employees, retirees, graduate assistants and their families, who are covered by IU medical plans Coordinate with existing care-management programs Anthem, Aetna, Medco Interface with existing programs: 24-hour nurse line, tobacco cessation, nutrition & weight management, Employee Assistance Written and website communications
Integrated Clinical Care Services Promotion to Employee/Retirees/Graduate Assistants Greater access to primary care Nurse care-manager for consultation Enhanced medical plan coverage Enhanced dental plan coverage Electronic connectivity Electronic Medical Record (EMR) Personal Health Record (PHR)
Integrated Clinical Care Services Expansion Considerations Pediatrics in Bloomington Adults in Ellettsville Bedford Spencer Nashville Adults and pediatrics at other Indiana regions, especially where meaningful numbers of plan members reside
Clinical Care Services Provider Locations
IU Health Southern Indiana Pediatrics Clarizz Blvd.
IU Health Southern Indiana Pediatrics Landmark Ave.
IU Health Southern Indiana Pediatrics Arlington Rd.
IU Health Southern Indiana Physicians Clarizz Blvd
IU Health Southern Indiana Physicians Rogers Rd.
IU Health Urgent Care East Woodcrest Dr.
IU Health Urgent Care West Third St.
Premier Healthcare Medical Center Landmark Ave.
Premier Healthcare Family Practice Landmark Ave.