Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 2 280548 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 3 280548 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+ 4 280548 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 5 280548 • 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 6 280548 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 7 280548 • 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 8 280548 • 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 9 280548 • 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 10 280548 • 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 11 280548 • 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 12 280548 • 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 13 280548 Successes CDHPs appear to be successfully aligning incentives and engaging consumers around cost and health decisions Non-CDHP HSA-eligible Engaged Consumer 14 280548 • 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 15 280548 • 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 16 280548 • 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 17 280548 • 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 18 280548 • 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 19 280548 Consumer Engagement HSA users are more savvy shoppers, and HSA learnings can be leveraged to better engage all consumers HSA-eligible Engaged Consumer 20 280548