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Engaging Consumers to Purchase Value

Engaging Consumers to Purchase Value. Commonwealth of Virginia Department of Human Resource Management State Employee Health Benefits . Virginia Chamber of Commerce 3 rd Annual Virginia Health Care Conference Richmond Convention Center, Richmond, VA June 6, 2013.

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Engaging Consumers to Purchase Value

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  1. Engaging Consumers to Purchase Value Commonwealth of Virginia Department of Human Resource Management State Employee Health Benefits Virginia Chamber of Commerce 3rd Annual Virginia Health Care Conference Richmond Convention Center, Richmond, VA June 6, 2013

  2. $1 Billion State Employee Health PlanCost Drivers • Expensive procedures • Treatment of chronic conditions • Prescription drug therapy cost • Employee lifestyle • Smoking • Physical activity level • Overweight • Average employee age

  3. Consumer-FocusedPlan Design • Maternity • Weight Watchers • Smoking Cessation • Flu Shots • Bariatric Surgery • Diabetes • Coronary Artery Disease

  4. Maternity Consumer Action • Participate in the Maternity Program • Begin the program in the first trimester • Get extra dental cleaning Plan Incentive • Waive $300 inpatient or $125 outpatient co-pay

  5. Weight Watchers Consumer Action • Participate in 75% of the classes Plan Incentive • Receive 50% reimbursement of class fees paid

  6. Smoking Cessation Consumer Action • Participate in the program Plan Incentive • No charge for program

  7. Flu Shots Consumer Action • Get a flu shot Plan Incentive • No charge for shot

  8. Bariatric Surgery Consumer Action • Participate in the year-long coaching program • Attend a Weight Watchers or similar program Plan Incentive • Eligible for plan coverage • Receive health coaching pre-surgery and post-surgery at no charge • Eligible for Weight Watchers 50% reimbursement • Waive $300 inpatient hospital or $125 outpatient co-pay

  9. Bariatric Surgery

  10. Diabetes Consumer Action • Annual physical • Under the care of a physician for diabetes • Annual A1C test • Comply with medications Plan Incentive • Tier 1 and Tier 2 medications at no charge • Testing supplies at no charge • Receive coaching at no charge

  11. Coronary Artery Disease Consumer Action • Participate in the 6 month Health Diagnostic Lab program • Receive initial health screening • Biometric measurements • Blood draw • Share results with physician • Meet with clinical health consultant • Get follow-up health screening ~ 6 months later Plan Incentive • Receive HDL tests at no charge • Receive health coaching based on results at no charge

  12. Summary • Data driven • Value-Based Insurance Design (VBID) • Short-term cost investment for long-term health improvement resulting in lower cost • Continuous improvement

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