Presentation on theme: "State & School Employees’ Life & Health Insurance Plan Presented to the John D. Bower, M.D. School Health Network April 18, 2007."— Presentation transcript:
State & School Employees’ Life & Health Insurance Plan Presented to the John D. Bower, M.D. School Health Network April 18, 2007
1 State and School Employees’ Health Insurance Plan Consists of Active and Retired employees (and their covered dependents) of agencies, school districts, community/junior colleges, public libraries, and universities of the State of Mississippi Self-insured CY2006 - Health premiums collected $624.9 (million) CY2006 - Health claims incurred $533.6 (million) 189,167 Total Covered Lives (December 2006)
2 Enrollment as of December 31, 2006 119,396 Active and COBRA employees + 44,555 dependents 19,980 Retirees + 5,236 dependents 189,167 Total Covered Lives
3 FactsFacts Chronic diseases are the most prevalent, costly and preventable of all health problems. Seven out of ten Americans who die each year die of a chronic disease. Smoking, obesity and physical inactivity are three risk factors that are modifiable through behavior change. Source: National Center for Chronic Disease Prevention and Health Promotion – “Chronic Diseases: The Leading Causes of Death”, Center for Disease Control and Prevention, November 2005
4 State of Mississippi Facts Cardiovascular Disease (CVD) Mississippi’s CVD mortality rate is the highest rate in the nation CVD is the leading cause of death in Mississippi, accounting for 45% of all deaths in 2001 Obesity Mississippi has the highest rate of adult obesity in the nation Mississippi has the highest combined level of obese plus overweight adults at 67.3% Diabetes Diabetes contributes to the deaths of 1,600 Mississippians each year Main cause of death in persons with diabetes is heart disease Sources: MS Department of Health – “Chronic Disease Fact Sheet”; “Trust For America’s Health, How Obesity Policies are Failing in America, August 2006”, “American Heart Association-Mississippi State Fact Sheet”
5 How have diabetes and cardiovascular disease impacted the Plan? Plan Payments Plan Participants Calendar Year 2005 Diabetes $18,300,000 13,325 Cardiovascular Disease $45,500,000 13,993 Total $63,800,000 27,318 Calendar Year 2006 (Jan-Nov) Diabetes $15,350,000 13,968 Cardiovascular Disease $40,000,000 13,170 Total $55,350,000 27,138 Source: MEDSTAT, Incurred Medical and Pharmacy Claims, includes Medicare
6 2006 Wellness/Preventive Benefit First-dollar coverage up to $250; no deductible 100% coverage for office visits and certain diagnostic tests Must use AHS State Network provider
7 Motivating Mississippi - Keys to Living Healthy The Plan has contracted with APS Healthcare to provide a wellness and health promotion program designed to help participants live a healthy lifestyle Available at no cost to all Plan participants, age 18 or older. Web based at www.healthytogether.net/mississippi or call 1-877-289-9109 Increased wellness benefit of additional $50 (total of $300) for participants completing a Succeed Health Risk Assessment (HRA)
8 Components of the Program Succeed Health Risk Assessment 4 Lifestyle Management Programs On-line tools and education Access to personal wellness coaches
9 Succeed Health Risk Assessment Takes about 30 minutes to complete questionnaire Completely confidential-individual information is not provided to Plan or the school district Find out how social, environmental, and family history may affect health Learn more about preventive care Receive individualized action plan
11 BalanceBalance Six-week program that helps participants work toward achieving successful weight loss. Looks at health and medical history, body image, prior weight loss experiences, and much more. Teaches each participant how to make their own smart decisions about managing weight.
12 NourishNourish Eight-week nutrition program that helps participants make healthy eating decisions and change unhealthy eating behaviors by exploring eating patterns and providing tips for dealing with obstacles. Explains different aspects of nutrition, such as appropriate serving sizes based on a participant’s health needs and how to prepare healthy meals.
13 BreatheBreathe Provides each participant customized strategies for overcoming barriers and effective steps for managing withdrawal. Designed specifically to help participants stop smoking based on their chosen quit date. Teaches the participant about the seven key characteristics that predict success, such as ability to cope with stress, prior quitting experiences, and support from family and friends.
14 RelaxRelax Five-week program that can help reduce stress and anxiety. Helps participants identify their sources of stress. Teaches different techniques to manage stress and stress-related symptoms like headaches, irritability, and sleep problems.
15 Other Tools On-line medical library On-line exercise and stretching videos On-line cookbook and recipes Access to personal wellness coaches to provide guidance and support with the programs and tools Access to APS staff located in Mississippi
16 How to Benefit Complete Health Risk Assessment http://knowyourbenefits.dfa.state.ms.us click on link to Health Risk Assessment Use AHS State Network providers for annual visit Take list of allowable wellness/preventive services to physician Remind physician to code with a wellness visit diagnosis
17 School Site Champions Requesting that your school’s Wellness Coordinator also serve as the Site Champion for this program Site Champions will receive email communications including posters, informational materials, and newsletter articles
18 How can APS help your Site Champions? Provide “lunch and learn” presentations Provide information on how to plan a health fair and a list of resource organizations Attend large staff meetings and/or organizational meetings Serve as a resource for ideas and activities that promote wellness within your school
20 What do we hope to accomplish? Improve the health of Plan participants, thereby preventing chronic disease. Reduce the complications for those already diagnosed with chronic disease. Reduce the healthcare costs for participants as well as the Plan.
21 ContactContact Teresa Planch State Insurance Administrator Department of Finance and Administration Office of Insurance P. O. Box 24208 Jackson, MS 39225-4208 Phone: 601-359-3411 Email: firstname.lastname@example.org