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© 2009 Regence. Private and Confidential. 1 Activate SM – Healthy Living Rewarded Rewards employees for healthy choices Employees pay their doctors online Encourages healthy competition Supports loyalty through growing rewards Simple to administer Key Attributes:
© 2009 Regence. Private and Confidential. 2 1 2 Regence Activate SM Coverage Health Plan Simple benefit design Affordable coverage Options to choose from Member Choice Account $ rewards for healthy choices Pays deductible & coinsurance Provides up-front coverage Funds roll over each year Activate brings together a simple health plan with financial incentives for making healthy lifestyle choices
© 2009 Regence. Private and Confidential. 3 Member Choice Account Save! Use MCA to pay deductible & coinsurance Pay providers directly online Unused funds roll over each year 3 Log On Sign up on myRegence.com Health assessment activates MCA $200 goes into MCA 1 Get Moving 5,000 points = $10 Earn up to $100 each quarter Members can earn $600 per year 2 Activate Home Page
© 2009 Regence. Private and Confidential. 4 Reward Points Examples Activity Stress Management Physical Activities Preventive Health Nutrition & Weight Loss Online Activities Activities Designed To Fit Any Lifestyle 250 points each Go biking or walking; participate in team sports, take an exercise class 5000 points per year 500 points per year Get an annual womens or mens exam; Get a flu shot 500 points each Increase fiber intake; Eat fruits and vegetables 600 points per year 500 points per month Get help with child care; get a massage 100 points each 500 points per use Read health-related articles Use the Health Cost Estimator Tool Over 100 activities available to choose from!
© 2009 Regence. Private and Confidential. 5 Typical Copay Plan Activate Healthy Living Rewarded Member Choice Account Up-front Benefits Activate offers a unique option for pre-deductible benefits $600 Member Choice Account$20 copay / Upfront Lab & X-ray 100%coverage – no copays Benefits are members choice Accumulates toward deductible Funds roll over each year to build equity over time Pay your doctor online Advantages Provides cost predictability Full benefit is available day one Doesnt require engagement Considerations Full benefit is achieved throughout the year Requires engagement Considerations Always have to pay cost share Benefits are specified Does not accumulate toward deductible Use it or lose it benefits
© 2009 Regence. Private and Confidential. 6 Member Choice Account Whats it Worth? Nearly ½ of insured consumers spend less than $600 on medical expenses each year Common ServicesMCA Benefit A $600 MCA will pay for… 1 wellness exam, a mammogram, 2 doctor visits, a cholesterol screening and an allergy shot or… 1 wellness exam, a doctor visit, a specialist visit and two x-rays or… 5 doctor visits …it is all up to the member And it all counts toward the deductible! Adult wellness exam$150 - $190 Well-child/baby exam$100 - $135 Doctor visit$100 - $120 Specialist visit$215 - $280 Immunizations$10 - $15 Cholesterol screening$20 - $50 X-ray$25 - $80 Mammogram$85 - $150 PSA Test$30 - $60 Allergy injection$50 - $60 Source: RBS 2008-2009 network discount costs Why $600? ] [
© 2009 Regence. Private and Confidential. 7 Member Choice Account The Employee Perspective Lets look at the spending habits of 100 typical consumers. See how a $600 MCA creates value for all employees. Source: Regence 2007-2008 claims data Member Claims These members will have no costs, so all funds are retained (15%) Covers most costs (20%) Buys down deductible by $600 (35%) Covers all costs (30%) $5,000+ $0 $600 $1,500
© 2009 Regence. Private and Confidential. 8 Couple Family of 4 Year 1Year 2Year 3 and Beyond Single Building Loyalty Through Rewards Earned Account RolloverTotal Rollover Deductible is max. amount $600 $1,200 $2,400 $1,200 $2,400 $4,800 $1,800 $4,800 $7,200 Each family member's MCA remains separate Total sum value is displayed
© 2009 Regence. Private and Confidential. 9 Keeping Employees Engaged Keeping Employers Informed Supporting Program Success Online scorecard to track and improve participation Communications triggered by low activity levels Superior interactive reporting Employee activity participation MCA earnings, expenditures, and rollover Elizabeth Heather Richard Account OverviewActivity Graph Activated Members 50% 35% 85%
© 2009 Regence. Private and Confidential. 10 A Solution That Strikes at Health Care Dysfunction Creates a direct connection between behavior and cost at the employee level Encourages loyalty through growing rewards Gets the entire family involved Offers a seamless web-based experience Regence Activate…
© 2009 Regence. Private and Confidential. 11 You Choose From Three Categories of Providers Employees can select the Provider(s) they want, depending on the portion of the cost they wish to pay - providers fall into one of three categories: Category 1 90% of doctors Lowest patient cost Category 2 3% of doctors Moderate patient cost Category 3 7% of doctors Highest patient cost
© 2009 Regence. Private and Confidential. 12 Activate SM Snapshot *Deductible *Coinsurance Coinsurance Maximum Lifetime Maximum Member Choice Account Riders $1,500, $2,000, $3,000 80/60/60 $3,000 $4,000 $6,000 $2 million Up to $600 per member 4 options - Vision, EAP, Spinal Manipulations, Complementary Care Medical * Can be paid with MCA funds
© 2009 Regence. Private and Confidential. 13 Activate SM Snapshot Generics Brand Formulary Brand Non-Formulary Deductible Options Annual OOP Max (Per member) $5$7$1010% 75%70%$3570% 50%50%$7550% $250, $500, $1,000 NA Rx
© 2009 Regence. Private and Confidential. 14 What is a Value-Based Benefit Design? Value in healthcare depends on Improving health Reducing financial barriers to effective treatments Future treatment costs tend to be more manageable for those actively involved in their own health Financial incentives drive improved health status: Reduced financial barriers for medication therapies of higher clinical value Goal is to improve medication adherence
© 2009 Regence. Private and Confidential. 15 Providing Value to Everyone Employer Employee Incentives to take personal responsibility to improve/maintain health Aligns preventive benefits with better access to high value medications Decreases financial barriers to medication adherence Employees who are healthier, engaged and productive Drive reduced absenteeism Better medication adherence may reduce treatment costs Example Untreated high cholesterol can lead to atherosclerosis, causing restricted blood flow that could lead to heart attack or stroke. ER costs or other medical care could potentially be avoided by following a medication regimen.
© 2009 Regence. Private and Confidential. 16 Activate Rx: Transformational Pharmacy Product Integration of wellness and prevention Not subject to deductible are Generics and Formulary Brands frequently used for: High cholesterol High blood pressure Asthma Diabetes Diabetic patients can receive a generic medication for high cholesterol for $0 copay Smoking cessation
© 2009 Regence. Private and Confidential. 17 [Insert Customer Name Here] Helping You Plan for a Healthier Future Thank you for your time! Questions?
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