2013 Healthcare Program Trustees Finance & Audit Committee, April 2012 Current Status – April 2012 17,300 FT Employees; 16,150 enrolled in medical 37,000 plus covered lives 4 medical plans: PPO networks, with member cost sharing Salary-based premiums, with credit for non-use of tobacco HDHP & HSA with 8,100 employee enrollments PPACA compliant No post-65 Retiree Healthcare liability FY 2011/12 IU Budget for Healthcare = $186.6 m FY 2012/13 IU Budget = $197.8 m or $11,433 per eligible employee Assumptions for CY 2013 (as of April 2012) Same or lower number of covered employees Same medical plan options as 2012 increase enrollment in the HDHP & HSA plan Moderate increase in total premiums small or no increase in HDHP plan premiums PPACA: new “Summary of Benefits and Coverage” annual limit of $2,500 for health FSA contribution, starting 2013 Form W-2 reporting for 2012 health coverage Cost Increases: 1) provider fees and 2) medical utilization Medical Utilization – The Top 10 “Disease and Injury” Classifications (by $s paid for 2011) % Difference w/2010 Supplemental Classifications (e.g. pregnancy, dialysis) - .6% Musculoskeletal system & connective tissue + 29.4% Neoplasms + 22.9% Circulatory system + 4.7% Symptoms, signs and ill-defined conditions (e.g. ER) + .4% Digestive system - 10.3% Genitourinary system + 5.9% Nervous system & sense organs + 30.0% Injury & poisoning - 9.5% Complications of pregnancy and childbirth + 11.6% Prescription Drug Utilization – The Top 10 Therapeutic Class (by $s paid for 2011) % of Total # Rxs Miscellaneous (e.g. transplant, MS) 2.5% Anti-depressants 9.8% Lipotropics 7.8% Diabetic therapy 4.1% Anti-arthritics 2.7% Bronchial dilators 3.2% Anti-ulcer 3.7% Antivirals 0.9% Anti-neoplastics (cancer) 0.5% Other hypotensives (blood pressure) 7.4% IU’s Employee Medical Plans Relationship Between Members and Plan Costs 1% 15% 12% 29% 43% 8% of members = 58% of costs 28% of members = 87% of costs 37% 71% of members = <14% of costs 14% of members with no costs 20% 21% 7% 1% Members Plan Costs IU’s Employee Medical Plans Relationship Between Members and Plan Costs for 2011 $ Per Member 1% 14% 5,180 mbrs $ 0.0 15% 5,550 mbrs $ 1.9 m --- $ 342 /yr 43% 15,910 mbrs $ 22.8 m --- $ 1,433 / yr 20% 7,400 mbrs $ 55.1 m --- $ 7,446 / yr 7% 2,590 mbrs 370 mbrs $ 70.3 m --- $27,143 / yr Members --- $ 0 / yr 29% $ 39.9 m --- $107,838 / yr Major Medical Program Initiatives Initiatives that Are applicable across all medical plan options Complement or supplement provider and member activities Integrated Clinical Care Services -- details to follow Personal Health Record (PHR) Personal web-based access to medical records, such as: contact info, medications, immunizations, illnesses, medical history, allergies, biometric tracking, legal documents, etc. Data integration with Medco, Anthem, and IU Health/HealthSmart Support for Clinical Care Services program (clinical portal) Transparency Member web-based access to: location of PPO providers; “price” for services by provider; “cost” for episodes of care by provider group/healthcare system; and quality measures & patient satisfaction Major Medical Program Initiatives Integrated Clinical Care Services Improve access to primary care providers, for routine and urgent care Dedicated care management team, for patients with chronic and/or complex medical conditions Connectivity of medical records Integrated Clinical Care Services Virtual patient centered medical home Essential components: 1. Primary care provider group(s) 2. Dedicated team of nurse care-managers 3. Electronic medical records system (EMR) 4. IU-based resources Promotion to plan members Expansion opportunities Integrated Clinical Care Services 1. Primary Care Provider Groups Physicians, nurse practitioners, physician assistants Walk in care, same day appointments After hours access: telephone, e-visits Electronic Medical Records (EMR) system Quality Health First program measures Participate in care management activities Integrated Clinical Care Services 1. Primary Care Provider Groups Proposed initial rollout in Bloomington East of the IU Bloomington campus Sare Rd. – Premier Healthcare Clarizz Blvd. – IU Health Southern IN Physicians West of the IU Bloomington campus Landmark Ave. – Premier Healthcare Rogers St. – IU Health Southern IN Physicians Integrated Clinical Care Services Primary Care Provider Groups -- Proposed Integrated Clinical Care Services 2. Nurse Care-Managers (including pt pharmacist) Care transitions: hospital home, p-care specialty care Medication management for chronic conditions Registries for diabetes, high blood pressure, high cholesterol, asthma, heart failure, COPD Outreach to patients with a chronic condition Support self-management by patients Triage agent Integrated Clinical Care Services 3. Electronic Medical Records (EMR) System Connectivity across all providers Meet NCQA medical home standards Includes e-prescriptions Additional features: Order & retrieval of lab and imaging tests Patient portal for medical records, scheduling appointments, prescription refills, referrals Connected with IU Health and IU Health Physicians Integrated Clinical Care Services 4. IU-based Resources Membership data: employees, retirees, graduate assistants and their families, who are covered by IU medical plans Coordinate with existing care-management programs Anthem, Aetna, Medco Interface with existing programs: 24-hour nurse line, tobacco cessation, nutrition & weight management, Employee Assistance Written and website communications Integrated Clinical Care Services Promotion to Employee/Retirees/Graduate Assistants Greater access to primary care Nurse care-manager for consultation Enhanced medical plan coverage Enhanced dental plan coverage Electronic connectivity Electronic Medical Record (EMR) Personal Health Record (PHR) Integrated Clinical Care Services Expansion Considerations Pediatrics in Bloomington Adults in Ellettsville Bedford Spencer Nashville Adults and pediatrics at other Indiana regions, especially where meaningful numbers of plan members reside Clinical Care Services Provider Locations IU Health Southern Indiana Pediatrics Clarizz Blvd. IU Health Southern Indiana Pediatrics Landmark Ave. IU Health Southern Indiana Pediatrics Arlington Rd. IU Health Southern Indiana Physicians Clarizz Blvd IU Health Southern Indiana Physicians Rogers Rd. IU Health Urgent Care East Woodcrest Dr. IU Health Urgent Care West Third St. Premier Healthcare Medical Center Landmark Ave. Premier Healthcare Family Practice Landmark Ave. Premier Healthcare Family Practice Sare Rd.