Download Non-CDHP HSA-eligible Engaged Consumer

A Blue Cross and Blue Shield Association Presentation
Health Plan Initiatives, Trends and
Research in Consumer-Driven Care
National Consumer Driven
Health Summit
October 20, 2008
Maureen E. Sullivan
Senior Vice President
Market Enrollment in CDHPs
Launched as a way to increase consumer engagement,
CDHP enrollment is up more than 25% in the last year
Members Enrolled in Millions
12.5
10.0
7.5
7.0
3.0
HSA-eligible
• Blues serve approximately 4.4
million CDHP enrollees, up more
than 50% from a year ago
– 2.9 million covered by HSAqualified plans
5.0
2006
Blue CDHP Profile
– 1.5 million members in HRAbased products
2007
HRA
Sources: American Association of Preferred Provider Organizations, Blue Cross and Blue Shield Association
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CDHP Offer and Uptake Rates
Growth is being driven by increased employer and
health plan offerings of CDHP products
Percentage of Consumers
Offered a CDHP Option
75%
CDHP Uptake for Consumers
with a Choice of a CDHP Product
75%
69%
60%
60%
49%
45%
39%
39%
45%
34%
30%
30%
21%
17%
18%
15%
15%
0%
0%
2005
2007
Sources: 2005, 2007 and 2008 BCBSA CDHP Member Experience Surveys
25%
12%
2005
2008
HSA-eligible
25%23%
2007
2008
HRA
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CDHP Demographics
CDHP members increasingly mirror non-CDHP population
Age Distribution
HSA-eligible
7%
32%
10%
25%
Income Distribution
Non-CDHP
14%
26%
HSA-eligible
Non-CDHP
21%
20%
21%
22%
24%
26%
20%
19%
23%
26%
27%
21%
25%
27%
10%
8%
5%
9%
2005
2007
2008
2008
18%
16%
27%
35%
26%
2005
18-29
41%
24%
2007
30-44
42%
18%
2008
45-54
38%
17%
2008
55-64
Sources: 2005, 2007 and 2008 BCBSA CDHP Member Experience Surveys
Less than 25K
25K-50K
50K-75K
30%
75K-100K
100K+
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CDHP & Consumer Engagement
Are we creating a more savvy shopper?
• Offer Incentives
• Encourage Value
Purchasing
Engaged Consumer
Non-CDHP
HSA-eligible
• Motivate Healthy
Behavior
• Educate and Support
Decision Making
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• Offer Incentives
Rewards and Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA-eligible enrollees are offered more incentives
Consumers Receiving Incentives or Rewards
for Health and Wellness Participation
Examples of
Rewards/Incentives
40%
Percentage of Enrollees
33%*
30%*
1. Cash
30%
2. Contributions to account
20%
17%
3. Lower premiums, copays
and deductibles
10%
4. Points redeemable for
merchandise
0%
HSA-eligible w/
Account
HSA-eligible w/o
Account
Non-CDHP
* Statistically different from non-CDHP results at a 95% confidence level
Sources: 2008 BCBSA CDHP Member Experience Survey
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Opening Rates of
Health Savings Accounts
• Offer Incentives
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
More employees open HSAs when offered incentives
Percentage of Enrollees
HSA-eligible Consumers Opening Accounts
29% *
52%
16%
12%
55% *
36%
With Contribution
Have already opened
Without Contribution
Plan to open
* Statistically different from ‘Without Contribution’ results at a 95% confidence level
Sources: 2008 BCBSA CDHP Member Experience Survey
Do not plan to open
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• Offer Incentives
Consumer Attitudes
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA-eligible enrollees want more control over costs, utilization
Consumer Attitudes
37%*
31%*
Percentage of Enrollees
32%*
27%
24%*
19%
"I would utilize healthcare more
carefully if I got to share in the
savings of using lower cost
providers"
HSA-eligible w/ Account
"I would use my health benefits
more carefully if I were directly
responsible for more of the costs"
HSA-eligible w/o Account
* Statistically different from non-CDHP results at a 95% confidence level
Sources: 2008 BCBSA CDHP Member Experience Surveys
Non-CDHP
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• Offer Incentives
Cost-Sensitive Behaviors
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA-eligible consumers more cost-conscious and cost-driven
Behaviors Considered Because of Cost
60%
Percentage of Enrollees
52%*
43%*
40%
38%*
36%*
38%*
33%
30%*
30%
23%
21%*
17%
20%
15%
0%
Choose lower cost treatment
option
Ask doctor about cost of
treatments
HSA-eligible w/ Account
Use mail order Rx
HSA-eligible w/o Account
* Statistically different from non-CDHP without Account results at a 95% confidence level
Sources: 2008 BCBSA CDHP Member Experience Survey
Search Internet for a lowerpriced Rx
Non-CDHP
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• Offer Incentives
Healthcare Financial Behaviors
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA-eligible enrollees are more actively engaged in
tracking and estimating their healthcare costs
Healthcare Financial Behavior
Percentage of Enrollees
80%
72%*
60%
48%*
40%
38%*
40%
24%*
31%
27%*
27%
22%
20%
0%
Tracked Healthcare Expenses
Estimated Future Health Expenses
HSA-eligible w/ Account
HSA-eligible w/o Account
* Statistically different from non-CDHP results at a 95% confidence level
Sources: 2008 BCBSA CDHP Member Experience Survey
Discussed Health Expenses with
Physician
Non-CDHP
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• Offer Incentives
Health and Wellness
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA-eligible enrollees more engaged in health and wellness
Participation in Health or Wellness Programs
Percentage of Enrollees
50%
43%*
40%
37%*
30%
30%
25%*
21%*
19%*
20%
18%
14%
15%
13%*
11%*
10%
7%
0%
Health Screening
Exercise
HSA-eligible w/ Account
*Statistically different from HSA-eligible results at a 95% confidence level
Note: Participation among those offered health or wellness program
Sources: 2008 BCBSA CDHP Member Experience Survey
Nutrition/Diet
HSA-eligible w/o Account
Health Coaching
Non-CDHP
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• Offer Incentives
Healthcare Utilization
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA-eligible enrollees use more preventive services, and
their use of necessary care mirrors non-CDHP population
Healthcare Utilization
Percentage of Enrollees
80%
69%*
64% 62%
60%
40%
30% 30% 31%
20%
15% 13% 15%
14% 15% 14%
6% 4%* 6%
0%
Had regular checkup,
physical or preventive
health screening
Had diagnostic
imaging
HSA-eligible w/ Account
* Statistically different from non-CDHP results at a 95% confidence level
Sources: 2008 BCBSA CDHP Member Experience Survey
Had Oupatient
Procedure
Visited ER
HSA-eligible w/o Account
Had Inpatient
Procedure
Non-CDHP
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• Offer Incentives
Healthcare Utilization: Study
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
Savings due to reduced utilization are observed in CDHPs,
however, CDHP enrollees are not foregoing needed care
Savings Due to
Reduced Utilization
Member Healthcare Compliance
Preventive Compliance
$1,500
Chronic Compliance
70%
$1,074+
$1,200
60%
50%
$900
44%
45%
45%
CDHP
PPO
CDHP
58%
57%
CDHP
PPO
60%
61%
CDHP
PPO
41%
40%
$615*
30%
$600
20%
$300
10%
0%
$0
CDHP - Choice
CDHP - Full
Replacement
Choice
PPO
Full
Replacement
Choice
Full
Replacement
*Statistically different from Traditional PPO - Choice results at a 95% confidence level
+ Statistically different from Traditional PPO – Full Replacement results at a 95% confidence level
Note: CDHC study population restricted to a subset of 1,364 members from an original CDHC enrollment base of 57,365 members in 2006
Sources: Blue Cross Blue Shield of Tennessee, CDHC Impact on Utilization, Costs, & Quality, June 2008
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Successes
CDHPs appear to be successfully aligning incentives and
engaging consumers around cost and health decisions
Non-CDHP
HSA-eligible
Engaged Consumer
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• Offer Incentives
Information Needs
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA users want more cost information, and their interest
in quality information is on par with non-CDHP enrollees
Information Useful When Making Healthcare Decisions
Percentage of Enrollees
80%
64% *
60%
57% *
51%
40%
58%
52%
47% *
44% *
38%
56%
48% 49%
46% *
43% *
45%
35%
20%
0%
Cost Information
on Treatment
Cost Information
on Doctors
Cost Information
on Hospitals
HSA-eligible w/Account
* Statistically different from non-CDHP results at a 95% confidence level
Sources: 2008 BCBSA CDHP Member Experience Survey
Quality Information
on Doctors
HSA-eligible w/o Account
Quality Information
on Hospitals
Non-CDHP
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• Offer Incentives
Quality Information Key
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
National Blue Distinction program created to educate
consumers and engage them based on quality
•
Blue Distinction Centers for
Cardiac Care®
WA
VT
ND
MT
MI
WY
IA
NE
NV
UT
CA
NY
WI
SD
ID
Blue Distinction Centers for
Bariatric Surgery®
NH
MN
OR
•
CO
IL
KS
PA
OH
IN
WV VA
Blue Distinction Centers
for Transplants®
AZ
OK
NM
MO
NC
Source: BCBSA
AL
GA
LA
FL
AK
Blue Distinction Centers for
Complex and Rare
CancersSM
SC
AR
MS
TX
•
MA
RI
CT
NJ
DE
MD
KY
TN
•
ME
HI
PR
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• Offer Incentives
Quality Information Key
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
Percentage of Patients
Readmitted in 90 Days
Blue Distinction facilities delivering better quality results
20%
32%
18.7%
15%
14.2%
10%
5%
n = 1741
3584
0%
Acute Myocardial Infarction (AMI)
BDC
Other
Note: All cardiac and cardiac related readmissions during the initial admission through 90 days, 90 day eligibility required for patient cohort
Source: HealthCore Analysis of WellPoint Data, July 2008
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• Offer Incentives
Likelihood to Recommend
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
Member recommendations starting to reflect the increased
maturity of the product
Likelihood to Recommend Coverage
Percentage of Enrollees
80%
62%*
60%
46%
47%*
45%
38%
40%
38%*
20%
0%
2005
2007
HSA-eligible
2008
Non-CDHP
*Statistically different from non-CDHP results and HRA results for 2008 at a 95% confidence level
Note: 2005 and 2007 non-CDHP results include 4 largest carriers only
Sources: 2005, 2007 and 2008 BCBSA CDHP Member Experience Surveys
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• Offer Incentives
Drivers of Recommendation
• Encourage Value Purchasing
• Motivate Healthy Behavior
• Educate and Support Decision Making
HSA-eligible enrollees require more health plan support
Drivers of Recommendation
HSA-eligible Enrollees
Primary
Drivers
Secondary
Drivers
Out-of-pocket cost
Out-of-pocket cost
Claims payment
Access to preventive care
Information on health plan
benefits
Information on health plan
benefits
Network
Network
Tertiary
Drivers
Non-CDHP Enrollees
Claims payment
Help to manage healthcare
costs
Service
Website
Sources: 2008 BCBSA Member Experience Survey
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Consumer Engagement
HSA users are more savvy shoppers, and HSA learnings
can be leveraged to better engage all consumers
HSA-eligible
Engaged Consumer
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