1 / 33

FY17 Risk Management Report on Health Care

FY17 Risk Management Report on Health Care. Summary. Total Claims Paid decreased by $525,858 RX Claims increased by $639,632 Emergency Room Claims increased by $115,904 Urgent Care Claim Paid decreased by $2,970 Primary Care Claims decreased by $163,018 Specialty Care decreased by $65,620

dfischer
Download Presentation

FY17 Risk Management Report on Health Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FY17 Risk Management Report on Health Care

  2. Summary • Total Claims Paid decreased by $525,858 • RX Claims increased by $639,632 • Emergency Room Claims increased by $115,904 • Urgent Care Claim Paid decreased by $2,970 • Primary Care Claims decreased by $163,018 • Specialty Care decreased by $65,620 • Inpatient claims decreased by$480,344 • Outpatient claims decreased $569,813

  3. RX Factors • 35% of the membership used their RX benefit. • Brand Drugs were responsible for 78% ($3,684,206) of the plan spend for this period while accounting for 15% of the utilization. • Specialty Drugs accounted for 23.3% ($1,097,743) of plan spend but only accounted for .04% utilization. • The trend for specialty drug cost increased 39% and utilization was up 20.4%. • Generic Drugs were responsible for 22% ($1,018,392) of the plan spend and 85% of the utilization.

  4. Emergency Room Factors • Utilization of emergency room increased by 50 visits. • 14.8% of the member population visited the Emergency Room without admission to the hospital. • 35.8% of the ER visits were divertible – could have been handled by Urgent Care or Primary Care (dizziness, nausea, vomiting or headache)

  5. Urgent Care Factors • Urgent Care claims cost were down by $2,970 and utilization was down by 105 visits. • The average spend per visit for a Urgent Care Claim was up from $129 to $146. • Compared to the cost is significantly lower than the average spend per visit for a Emergency Room Claim of $1,838

  6. High Cost Claims >100K • High Cost Claims expenditures were down by $465,956 and utilization was down by 13%. • These claims accounted for 0.50% of the member population and 18% of the total cost. • Retirees accounted for 16% of the High Cost Spend. • The average age of the High Cost Members was 52.2 years of age.

  7. A Look Back FY 16/17 Employee Health & Wellness Center

  8. Status of the Center • Demographics of Visits • Total Visits in FY16/17 8922 Visits 1945 Unique Patients

  9. Prevalent Conditions Found

  10. Impact on FL Blue Utilization Based on # of visits- • Primary Care-  15.0% (FY16 -12.2% ) • Emergency Room-  6.7% (FY16 -10.8%) • Urgent Care Centers-  14.4% (FY16 -32.6%) • Specialty Care-  4% (FY16 -37%) • Pharmacy-  9.5% (FY16 -12.5%)

  11. Cost Avoidance vs Clinic Expenses

  12. High Deductible Plan Health Insurance

  13. High Deductible Plan • Offer as an Option – Not Mandatory. • Premiums for Employee will be lower. • Higher Deductible equates to more risk for employee. • Will be coupled with a Health Reimbursement Account. • Expect a 5% migration to this plan. • Premiums are set to be revenue neutral.

  14. Premiums - All Rates Are Monthly

  15. Plan Design – Deductibles and Co-Insurance • Deductibles are as follows: • Single Coverage - $1,500 Annually in Network $3,000 Annually Out-of-Network • Employee + 1/Family - $3,000 Annually $6,000 Annually Out-of-Network

  16. Plan Design – Deductibles and Co-Insurance • After the Deductible is met the coverage is 80/20 in Network and 50/50 Out of network co-insurance with one exception – Prescription Drugs • The same co –pay structure as in the current plan applies once deductible is met. • Generic - $10 per 30 day supply • Preferred Brand - $50 per 30 day supply • Non-Preferred Brand - $80 per 30 day supply

  17. Plan Design - Health Reimbursement Accounts and Maximum Out of Pocket Limits • The County will fund a Health Reimbursement Account (HRA) as follows: • Single Coverage - $750 Annually • Employee +1/Family Coverage - $1,500 Annually • The Maximum Out of Pockets Limits are as follows: • Single Coverage - $4,000 network/$8,000 out of network • Employee + 1/ Family Coverage - $8,000 in network/$16,000 out of network

  18. Here Is How It Works - Single Coverage

  19. Here is how it Works - Employee +1/Family Coverage

  20. Fourth QTR and HRA Rollover Feature • The County will do a one time fourth quarter Rollover for October, November, and December of 2018. • The deductible for the last three months of 2018 will be the full $1,500/$3,000. Any money you spend against your deductible during this period will be credited against the new calendar year. • The County will fund the HRA for the last three months of 2018 at $500/$1,000. • Any unused HRA, up to an amount equal to the annual contribution, can be rolled over to the next calendar year.

  21. New Supplemental Insurance Offerings • Short Term Disability • Long Term Disability • Critical Illness • Accident • Employee Identity Theft and Legal Protection Plans

  22. New Supplemental Insurance Offerings • The four insurance policies will be offered by Standard Insurance and the Legal Services will be through Legal Shield. • Participation is voluntary. • All premiums are 100% paid by the employee.

  23. Short Term Disability • Will cover up to 60% of their weekly salary (tax free). • Maximum benefit is $1,000 weekly. • There is a 7 day waiting period before benefits begin. (illness or accident). • Only good for off-duty injuries or illnesses. • Maximum coverage period is 13 weeks. • No pre-existing condition exclusions. • 20% participation is required for coverage to be effective.

  24. Long Term Disability • Will cover up to 60% of their monthly salary (tax free). • Maximum benefit is $5,000 per month. • There is a 90 day qualifying period before benefits begin. • The maximum benefit period is up to Normal Social Security Retirement age. • There is a 3/12 pre-existing condition limitation. • 20% participation is required for coverage to be effective.

  25. Critical Illness • Covers a wide variety of illnesses including heart attack, stroke and cancer. • Premiums are based non-tobacco versus tobacco user, amount of coverage desired and age • Spouse can be covered for an additional premium (based on factors listed above) • Children are covered at no additional charge • Coverage is portable.

  26. Critical Illness • Coverage amounts are: • Employee - $5,000 to $50,000 in $5,000 increments • Spouse - $5,000 to $30,000 in $5,000 increments • Child – 25% of the employee amount • Guarantee issue up to $20,000 for employees and $10,000 for spouses. • Guarantee issue up to $20,000 for employees and $10,000 for spouses. • Plan includes a $50 wellness benefit. • Coverage is portable. • There is a pre existing condition clause of 6/12.

  27. Accident Policy • Only covers on/off duty accidents. • 4 levels of premiums (All premiums listed are monthly) • Employee - $18.24 • Employee and Spouse - $27.28 • Employee and Children - $31.70 • Employee and Family - $48.84

  28. Accident Policy • Covers numerous injuries at varying benefit levels. • Has an Accidental Death Benefit. • Employee - $50,000 • Spouse - $25,000 • Children - $12,500 • Plan includes a $50 wellness benefit. • Policy is portable.

  29. Identity Theft Protection • Includes • Privacy Monitoring • Security Monitoring • Social Media Monitoring • Credit Monitoring • Monthly Credit Score Tracker • Consultation • Full Service Restoration

  30. Employee Legal Protection Plans • Provided by LegalShield Closed Panel Network of Attorneys • Legal Protection Covers: • Legal Advice and Consultation – Including Attorney Letters and Phone Calls • 24/7 Emergency Assistance • Family Law Matters • Contract and Document Review • Attorney Prepared Estate Planning (Will, Living Will, Health Care POA, Durable POA) • Traffic Violations and Accident Protection • IRS Audit Assistance • 25% member discount with network attorneys

  31. Premiums • Legal Shield Plan (All premiums monthly) • Employee Only – $23.95 • Family - $23.95 • ID Shield Plan • Employee Only - $8.95 • Family - $18.95 • Combined Plans • Employee Only - $32.90 • Family $38.90

More Related