翰威特-HealthCareConsumerism.ppt

Health Care Consumerism: The Broad View Hewitt Annual Health Care Research Results and Insights,Presented by: Jack E. Bruner, FSA Global Health Care Practice Leader Hewitt Associates LLC,To protect the confidential and proprietary information included in this material, it may not be disclosed or provided to any third parties without the approval of Hewitt Associates LLC.,Health Care Survey Participant Profile,524 companies 6+ million employees Average company: 12,611 employees Primarily HR and Benefit Leaders,Consumer products,12%,Pharmaceuticals,4%,Manufacturing,13%,Financial,7%,Technology,4%,Health care,9%,Retail,9%,Entertainment/hospitality,4%,Insurance,7%,Professional,services,8%,Energy production/,Transmission,2%,Other,2%,Printing, Publishing &,Communication,2%,Utilities,4%,Government/ Education,8%,Telecommunications,3%,Chemicals,3%,Transportation,2%,Expected Average Cost Increase,Overall cost increase from 2004 to 2005 will average 12%, but 8% is the maximum affordable increase,Strategic Direction,Employee contributions for dependent coverage,Provider networks,Employee contributions for single coverage,Disease management incentives,Benefit design and out-of-pocket cost sharing,Prescription drug plan alternatives,Your Organizations Approach Toward Change,Strategic Direction,Your Organizations Approach Toward Change,Advanced procurement strategies,Incentives to use efficient providers,Strategic outsourcing,Consumer driven health plans,Exiting retiree medical,13%,27%,27%,25%,19%,19%,13%,9%,8%,8%,How Will We Influence Consumers?,+,Employee Choosing and Using Behaviors,Choosing Health Plans,+,Designing Incentives for Behavioral Change,Copays $20,Coinsurance 20%,Carrots + Sticks $2 Generics 30% Brands,“Build Your Own” Health Plan,Health Savings Accounts,Mandates/ Closed Networks,+,Health Savings Account-Based Consumer Driven Health Plans,Health Plan Coverage $2,000/year deductible 90%/70% Coinsurance,Health Savings Account $1,000,Gap $1,000,Employer deposits $1,000 into an employees HSA,Employer provides PPO coverage above the gap,Employee is responsible for $1,000 gap,Used by employees for routine care; unused amounts roll over year-to-year,Coverage takes effect when expenses exceed HSA contribution plus the gap,Health Plan Choice Consumer Driven Health Plans,+,Health Plan Choice Build Your Own Health Plan,+,Risk Exposure,Risk Sharing,Network, No deductible Traditional deductible ($300) Catastrophic deductible ($1,500) Catastrophic deductible ($2,000) with Health Savings Account ($1,000), $25 copay 80% $10 copay/$50 specialist,At Point of CarePhysician, Broad network (PPO) Select network (PPO) HMO network,At the Pharmacy, $10 generic/$20 formulary brand/ $35 nonformulary brand $5 generic/70% brand 50% coinsurance,Health & Condition Management, Will participate in Health Risk Assessment and follow-up protocol Will participate in Disease Management Program Will not participate in either program,Your MONTHLY contribution $ varies by selection,Your ANNUAL contribution $ varies by selection,D e c i s i o n P o i n t s,Opportunities in Health Improvement,Reduced or waived mail order prescription copays,Reduced cost for maintenance drugs to treat targeted conditions,Upfront incentives for high-risk employees,Out-of-pocket limits for participants reduced,Reduced or waived physician office copays if related to identified condition,Lower annual premium to participants,Prevalent Incentives for Condition Management,Health Improvement,Incentives for wellness,Health and productivity impact measurement,Incentives for condition management programs,Access to condition management programs,Interest in Ways to Improve Outcomes and Lower Costs,Profiling chronic conditions,+,Physician Selection,Strategies to Influence the Choice of Physicians,PCP gatekeeper,Coinsurance-based coverage,Multi-tier network,Select, or narrow, network,Variable copays,+,Hospital Selection,Strategies to Encourage Employees to Use Cost-efficient Hospitals,Leapfrog quality data,Hospital cost data,Select network,Multi-tier network,Hospital quality data,+,Prescription Drug Coverage,Design Incentives,Use a coinsurance approach,Step therapy,Mandatory generics,Mandatory mail order,Use a three-tier design,Use a two-tier design with generous generic coverage,Therapeutic MAC/reverse copays,+,How Can We Get There?,81% want to be active employers 91% believe consumer education is important or critical to achieve cost goals Fewer than 5% believe employees are ready and able to be active coinsurers Under 20% are fully prepared to have the procurement expertise, consumer health expertise, and technology platform for the emergi