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Title: Standard Handout


1
Expanding Health Coverage A CHT Forum on New,
Private Sector Health Insurance Products
February 4, 2009 Atlanta, Georgia
2
Wayne Oliver Project Director Center for Health
Transformation
3
Senator Judson Hill Senator Georgia State Senate
4
Ron Bachman Senior Fellow Center for Health
Transformation
5
Newt Gingrich Founder Center for Health
Transformation
6
Ron Bachman Senior Fellow Center for Health
Transformation
7
Chris Schubart Regional Vice President Blue
Cross Blue Shield of Georgia
8
Center for Health Transformation Conference Blue
Cross Blue Shield of Georgia Chris Schubart,
Regional Vice President Local Group
Sales February 4, 2009
9
Isnt it time for Georgia to have more control
over our healthcare costs?
  • We think so, too.

10
Discussion Topics
  • Healthcare Costs
  • Consumerism
  • Lumenos (Consumer Driven Healthcare Solution)
  • Cost Estimators

11
Rising Costs The Big 4 Risk Factors
  • The majority of the rise in private insurance
    costs is
  • due to population risk factors and their
    treatment
  • 28,000 or 24 of children in the third grade in
    Georgia are obese
  • Percentage of Adults who are obese has been
    constantly increasing since 1990 from 10.8 to
    28.7 in 2007
  • In 2007, there were 1.9 million obese adults in
    Georgia
  • In 2007, approximately 1.3 million (19.4) adults
    in Georgia smoked cigarettes
  • Average 10 of total claims costs attributable to
    tobacco
  • 60 perform no substantial activity or exercise
  • Two-thirds of all office visits to family
    physicians are due to stress-related symptoms
  • More than one in four workers have taken a
    "mental health day" off from work to cope with
    stress
  • Costs U.S. businesses 300 billion annually in
    direct indirect costs

Stress
12
Consumerism
13
Consumerism
  • Imagine having greater control over health care
    costs while improving and maintaining your health
    a win-win scenario.
  • Now you can. BCBSGa-Anthem is revolutionizing
    health care by expanding our industry-leading
    Lumenos consumer-driven health plans and making
    them available to everyone all markets, all
    segments, and all 35 million current members
    nationwide.

14
Consumers Are Becoming More Engaged in Their
Health Care
  • Survey of consumers enrolled in CDHPs
  • Value Conscious
  • 50 more likely to ask about cost
  • Prevention-Oriented
  • 25 more likely to engage in healthy behaviors
  • 30 more likely to get an annual checkup because
    they thought it would save money in the long run
  • Control Costs
  • 20 more likely to follow treatment regimens for
    chronic conditions
  • Information Needs
  • Many were dissatisfied with information available
    to them to make health decisions

Source McKinsey Company, June 2005
15
Our Solution
  • Anthems Lumenos plans give consumers the control
    and information they want while rewarding them
    for being more engaged in their health.
  • Our approach combines unique account-based plan
    designs with sound clinical strategy then tops
    it off with bold and proactive communications to
    engage consumers before and after enrollment.
  • Consumers will better understand how they can get
    more value from their health care dollars and
    will be rewarded for healthy behaviors.

16
Our Experience
Lumenos plans are super-charging
account-based solutions
  • Lumenos
  • Anthem
  • Leading healthcare company
  • Provider network advantage
  • 360? Health
  • CDHP Industry Benchmark
  • Innovative Technology
  • High Touch Proactive health improvement
  • A marriage of a fuel-efficient engine with less
    expensive gas.

17
Prescription Drug Cost Estimator
18
Prescription Drug Cost Comparison
19
ProviderFinder Treatment Costs
  • Estimate the costs of specific health care
    services or episodes of care
  • In-network and out-of-network costs based on the
    most common medical procedures
  • Connecting members to high value health care
    facilities based on the following
  • Individual Preferences
  • Quality indicators
  • Outcome measures
  • Costs

- 95010
95
20
How Do We Do It?
  • Our plan designs come with the largest national
    network of participating providers with no
    referrals necessary
  • You get a 24/7 NurseLine, health coaching
    programs, 100 coverage of nationally recommended
    preventive care services, and an online health
    site with tools and information to help you get
    the most value out of your dollars
  • Our integrated plans make it easier on everyone
  • Our turnkey communications help companies create
    a new culture around health improvement
  • Working together with our brokers/consultants we
    help customers to make better engaged employee a
    top down initiative
  • And, we can even include financial rewards for
    healthy behaviors

21
Does It Work?
  • 53 of Lumenos consumers report increased
    knowledge in managing their healthcare
  • 62 switched to a generic prescription drug
  • Preventive care services doubled - 5.4 compared
    to industry average of 2-3
  • And, Lumenos consumers tell us that theyre
    happy, more engaged and healthier
  • 93 consumer satisfaction, 92 would renew, and
    93 would recommend
  • 95 cite greater flexibility and control in
    managing their health
  • 93 cite that our Lumenos plan was the best value
    for their money

Source Results from Lumenos book of business 2005
22
Thank you!
23
Todd Slawter Senior Vice President, Aetna, Inc.
24
Health Care Reform Understanding Aetnas
Perspective
Expanding Health Coverage A CHT
Forum February 2009
  • Todd Slawter
  • Sr. VP, Southeast Regional Head of Sales

25
Presentation Roadmap
Health Care Reform Understanding Aetnas
Perspective
  • Aetnas Position on Health Care System
    Transformation To Your Health!
  • Enable the Consumer
  • Plans and Products

26
To Your Health! Aetnas Proposal for Health Care
System Transformation
Health Care Reform Understanding Aetnas
Perspective
  • Get and keep everyone covered
  • (1) Transform health insurance into a civic
    responsibility
  • (2) Strengthen public programs and the safety
    net for those most in need
  • Maintain the employer-based system and export its
    strengths to make the individual market function
    better
  • (3) Leverage the strengths of the current
    health care system to advance the goal of
    universal coverage
  • (4) Use the tax system to expand access and
    increase affordability
  • (5) Promote greater portability of health
    insurance
  • Reorient the system toward prevention, value and
    quality of care
  • (6) Promote preventive care and wellness
  • (7) Improve health care quality and patient
    safety
  • Use market incentives to improve coverage, drive
    down costs and make the system more
    consumer-oriented
  • (8) Create a legislative and regulatory
    environment conducive to affordable insurance
    options
  • (9) Make the health care system more
    transparent and consumer-friendly
  • (10) Harness the power of health information
    technology to reduce costs and improve quality

27
Do consumers really understand the cost of health
care?
Health Care Reform Understanding Aetnas
Perspective
  • Price of a Honda Accord
  • within 300
  • Cost of a 4-day Hospital Stay
  • off by 8,100!!

Gap between guess and actual cost
28
Our health care transparency availability (as
of January 2009)
29
Products with Purpose
Health Care Reform Understanding Aetnas
Perspective
  • Aetna Affordable Health Choices (SRC)
  • Limited benefits plans
  • Targets part-time, seasonal and temporary workers
  • Available in 47 states
  • Middle Med Plans
  • Niche product piloted
  • Could fill a gap between Limited Benefit plans
    and Traditional comprehensive benefits
  • Aetna Student Health
  • 450,000 Undergraduate and Graduate students
  • more than 170 institutions

30
The Issue
Health Care Reform Understanding Aetnas
Perspective
  • 47 million uninsured in the US
  • 1.7 million uninsured in Georgia
  • 380,000 work for Small Businesses
  • 800,000 Small Businesses in Georgia
  • 62,000 without Insurance

31
Value Pick Program
Health Care Reform Understanding Aetnas
Perspective
  • Targeted to Small Businesses with Working
    Uninsured
  • 4 or more minimum enrolled employees
  • Open Access HMO (plan 709)
  • Open Access POS (plan 708)
  • HDHP Open Access POS (713)
  • Dual Triple Option available depending on
    case size
  • Lowered Employer Contrib. level (25)
  • Lowered Participation Requirement (50)

32
Finally
Health Care Reform Understanding Aetnas
Perspective
  • Thank you!
  • Center for Health Transformation
  • Speaker Gingrich
  • Mr. Ron Bachman
  • Mr. Wayne Oliver
  • Sen. Judson Hill

33
Joe Ochipinti Regional Vice President UnitedHealt
h Care
34
UnitedHealth Premium, UnitedHealthcare EDGESM
Health Savings Account A Quality Path to
Affordability
35
Improving care variation
Cost Variation
Care Variation
Studies show that quality and efficiency of care
designated physicians have lower costs per
episode, on average, compared to non-designated
physicians
The New England Journal of Medicine reports that
adults are receiving recommended treatments only
55 of the time
Evidence-based Care
Lower Costs
Procedure Re-dos 2x the re-do rate of designated
physicians for CVS
Complications 70 higher than expected compared
to designated physicians for CVS
Orthopedics 31.2 lower than non- QE designated
physicians
Cardiovascular Surgery 20.4 lower than non- QE
designated physicians
Endocrinology 32.4 lower than non- QE
designated physicians
SOURCE UnitedHealthcare claims analysis,
November 2007
36
UnitedHealth Premium Designation
  • Leverages transparency to improve quality and
    lower costs
  • Physicians are first assessed on quality we
    identify specialists who meet or exceed quality
    standards established by third party professional
    societies such as the American College of
    Cardiology and the American Academy of Orthopedic
    Surgeons
  • Only if they meet quality standards, are they
    assessed on efficiency of care, based on peer
    comparison and third party evaluations, i.e. most
    appropriate treatment, less complications and
    re-dos
  • With UnitedHealthcare EDGE, employees who use
    specialists designated for both quality and
    efficiency receive increased coverage in the form
    of lower copays and coinsurance
  • Here is a small listing of the collaborators used
    to establish quality criteria
  • - American College of Cardiology (ACC)
  • - American Board of Internal Medicine (ABIM)
  • - National Committee for Quality Assurance
    (NCQA)
  • - Society of Thoracic Surgeons (STS)
  • - Virtually every other State Society

37
2009 EDGE Plan Overview
  • EDGE Plans Overview
  • Access to entire UnitedHealthcare Choice Plus
    Network
  • Open Access POS Plans
  • Significantly lower priced than our base plans
  • Can be paired with an HSA
  • Current EDGE plans in good alignment with market
    preferences
  • Employers want EDGE deductibles between 1.5K and
    2K, so fits with HDHP plan
  • Excluding primary plan design elements of PCP
    Copay and Deductible, 100 preventive care is the
    most important feature, so we included it in all
    new EDGE plan designs
  • Employers prefer to see lower OOP Maximums, so we
    developed plans that lowered OOP Max down to 3K,
    4K and 5K without significant PMPM impact
  • Employers want EDGE plans to be paired with an
    HSA, so we are offering five national HSA plans
  • EDGE Plans Benefit Differences
  • Provides members with lower copays and higher
    coinsurance when using specialty physicians
    receiving quality and efficiency UnitedHealth
    Premium designation
  • Per occurrence deductibles apply to inpatient
    hospitalization and outpatient surgery
    (Calculated to go toward out-of-pocket maximum)
  • Lab and X-ray applies to deductible coinsurance
    except for Preventive Care when plan covers
    preventive benefits at 100
  • Covers MH/SA Chiropractic at state mandate
    levels

38
Georgia Broker Feedback
  • Platinum Broker
  • United HealthCares EDGE program effectively
    delivers differentiated value at lower cost for
    our clients. Offering an EDGE HSA provides even
    more savings for the Employer. United
    HealthCares EDGE plans are making a positive
    difference for the healthcare consumers market
    place.

39
Georgia Customer Feedback
  • Small Business Employer
  • Smaller businesses such as ours are eager to
    provide benefit packages in order to attract and
    retain valuable employees. UnitedHealthcares
    EDGE enables us to offer comprehensive,
    affordable health care benefits increased tax
    advantages for our employees. We believe our
    employees will have peace of mind knowing they
    have access to Premium-designated physicians who
    deliver quality, cost-effective care.

40
Robert Wolfkiel Market Vice President Humana
41
Working Well Health Promotion and Workplace
Wellness Strategies
Bob Wolfkiel Market Vice President February 4,
2009
42
Wellness The Good
43
Wellness The Bad
44
Wellness The Ugly
45
Just the Facts, Maam
46
Georgia The Peach State or the Couch Potato
State?
47
Georgia An Expanding Population
48
The Evolution of Man
49
Obesity trends among U.S. adults
BRFSS, 1985-2006
(BMI 30, or 30 lbs overweight for 5 4
person)
50
Obesity a costly disease
53.2
51.6
Direct Cost of Chronic Diseases in the United
States
38.7
Direct Cost ( Billions)
18.4
18.1
Type 2 Diabetes
Obesity
Coronary Heart Disease
Hyper-tension
Stroke
Wolf AM, Colditz GA. Obes Res. 1998697-106. Hodg
son TA, Cohen AJ. Med Care. 199937994-1012.
Adjusted to 1995 dollars.
51
Current Status of Wellness Strategies
Information from 2007 survey of 555 organizations
with an average of 12,500 employees
52
Top Strategic Objectives for Wellness Programs
  • Reducing Health Care Costs
  • Improving Worker Productivity
  • Reducing Employee Absences
  • Improving Workforce Morale
  • Attracting and Retaining Employees
  • Employers spend an average of 135 per employee
  • per year on Wellness programs, and an additional
  • 100 per employee on incentive rewards

53
Panel Questions Answers
Panelists Ron Bachman, Senior Fellow
Center for Health Transformation Chris
Schubart, Regional Vice President Blue Cross
Blue Shield of Georgia Todd Slawter, Senior Vice
President Aetna Joe Ochipinti, Regional Vice
President United Healthcare Robert Wolfkiel,
Market Vice President Humana
54
Expanding Health Coverage A CHT Forum on New,
Private Sector Health Insurance Products
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