美世 - Consumer Driven Health Care Pricing and Design

Mercer Human Resource Consulting
10
CDHP Designs Get More Complex Multiple Designs
?
Multiple Plans for Employee Choice
Economics & Change
“Nobody spends somebody else’s money as carefully as they spend their own.”
- Milton Friedman


“We always over estimate the change that will happen in two years and under estimate the change that will happen in ten.” - Bill Gates “Healthcare is a failed marketplace today because the person paying the bill isn’t the one choosing the service.” - Howard Wizig, Vivius “I am convinced that if the rate of change within an organization is less than the rate of change outside, the end of the company is in sight.” - Jack Welch
Medica
Mutual of Omaha Assurant Vested Health Others (Blues, TPAs): Totals
1,775
6,390 113,869 7,500 75,000+ 1,282,534+
25
3
150 300,000+ 2-3M+
Source: 9/24/2004 Inside Consumer-Directed Care and Mercer
$5k 80% in-network 60% out-of-network 80% in-network 60% out-of-network
Current Industry Standard HRA
80% in-network 60% out-of-network
$4k $3k $2k
Insurance: 90% In-net 70% out-net




Mercer Human Resource Consulting
4
CDHP

Basic coverage for routine and preventive services Support services for people with chronic illnesses Accounts for discretionary medical spending (HRA/HSA) Coverage for catastrophic coverage Member cost sharing features
7
Account-Based Plans Accelerating
Mid 2004 Members Definity Lumenos Aetna Uniprise Humana Great West CIGNA First Health HealthMarket Destiny Health PacifiCare 320,000+ 165,000 191,000 100,000 14,000 46,000 6,000 96,000 40,000 40,000 60,000+ 370 10 5 2,600 1,500 50 Groups 80+ 80+ 238 40 300,000 2005 (Projected) Members 500,000+ Groups
Mercer Human Resource Consulting
8
CDHP Designs Evolving Account Amounts & Incentives
Early Industry Standard HRA
$5k Insurance: 90% In-net 70% out-net Insurance: 90% In-net 70% out-net

Well-educated, self-sufficient employees Existing meaningful employee contribution to health care costs High overall employer health care cost Low union membership Corporate culture and support of independent employee choice Employee dissatisfaction with current options
$4k
$3k
$1,000 $750 $500 $1k $1,000 Accoun0 $2k $1,125 Gap $750 Gap $750 HRA Single $1,125 HRA Two-Party
$1,500 Gap
$1,500 Account
Health Care FSA
Member Responsibility
Health Reimbursement Account
(employer funded)
Annual Insurance Deductible
Mercer Human Resource Consulting
6
Consumer Directed Health Plans Multi-year Results-driven Program Design







A sustainable market based solution for containing costs and improving quality
3
Mercer Human Resource Consulting
Employer Characteristics
What employer characteristics make adoption of consumer strategies easier?
Mercer Human Resource Consulting
5
CDHP One Approach to Consumerist Design
100% After Out-of-Pocket Maximum In-Network Insurance Preventive Care
(100%)
Out-of-Network Insurance
$700 Account $0 Single Family
Mercer Human Resource Consulting
9
CDHP Designs Get More Complex Cost Sharing
?
Coinsurance Along Side HRA
$5k Insurance: 90% In-net 70% out-net Insurance: 90% In-net 70% out-net
?
Reinserting the Upfront Deductible
$5k Insurance: 90% In-net 70% out-net Insurance: 90% In-net 70% out-net
$4k $3k $2k
Insurance: 90% In-net 70% out-net
October 20, 2004
Consumer Driven Health Care Pricing and Design Session 51 The Conference and Academy 2004 Annual Meeting
Tom Tomczyk Sander Domaszewicz Eric Blumberg
Family

Mostly smaller employers exploring innovative cost-sharing designs that include account Many administrators and insurers can’t handle this complexity If offered along side traditional plans, very tough to “sell” advantages of CDH Communication becomes more involved As CDH full replacements expand, so will a variety of cost-sharing designs
$2,000 Account
$1k
$1,500 HRA Family
Adding Behavior Incentives
$5k Insurance: 80% In-net 60% out-net Insurance: 80% In-net 60% out-net
Expanding Behavior Incentives

$4k Insurance: 80% In-net 60% out-net
$3k
$1,400 Gap $2k $700 Gap
$100 risk assessment
$1,050 Gap