y ur life depend on it. - county...heart attack, stroke, amputations, surgeries, and worse…...

Y UR LIFE DEPEND ON IT.

OverviewReview TAC Health and Employee Benefits Pool’s Top Diagnostic Categories

Explore cost differences between various medical and prescription treatment options

Learn ways to save money and help achieve better health outcomes

HEBP’s Top Diagnostic Categories

1. Musculoskeletal (MSK)Back, Neck and other Joint Pain or Injuries

2. Circulatory Heart Disease, Stroke, Metabolic Syndrome (MetS)

3. NeoplasmsBreast, Colon, Lung Cancers

Musculoskeletal Disorder Prevention and Treatment Options

• Airrosti or Chiropractic Care• MRIs and Steroid Injections• Anti-Inflammatory and Pain

Medications• Back and Joint Surgeries • Lifestyle Changes (Exercise and

Weight Loss)

Unmanaged MSK can lead to decreased mobility, increaseuse of medications, and surgeries.

What is Airrosti?Treatment for MSK issuesAssessment & Diagnosis

• A thorough clinical assessment to evaluate your condition and determine the root cause of pain, while eliminating unnecessary imaging, injections, and surgeries.

Specific Manual Therapy• Soft tissue/joint mobilization through a hands on

approach to improve function and range of motion.

Active Care• Customized stretches and exercises prescribed to help

speed recovery time and prevent further injuries.

Airrosti vs. Traditional Musculoskeletal Care

Source: Airrosti reported outcomes for TAC, as of April 30, 2019

Airrosti-Surgeries Avoided & Condition Breakdown

DX Category Average Cost Surgeries Avoided

Savings

Back/Neck $11,100 9 $99,900

Shoulder $10,800 2 $21,600

Hip $19,200 0

Knee $17,800 4 $71,200

Hand/Arm $6,000 3 $18,000

Approx. Total Savings: $210,700Source: Airrosti reported outcomes for TAC, as of April 30, 2019

Airrosti vs. Steroid Injections

Airrosti

Avg. Office Visit Copay:

$40

Plan Paid: $143

avg./service

Injections

Avg. Out of Pocket Cost:

$178.05

Plan Paid: $381

avg./service

Airrosti vs. Chiropractic Care

Airrosti

Avg. Office Visit Copay: $40

No Deductible

3 Visit Avg.

Chiropractic Care

Coinsurance AFTER deductible

is met

10 Visit Avg.

Average Cost Savings per Condition: Airrosti VS Non-Airrosti Treatment

43% Lower Overall Costs

HipSavings: $2,389

Knee Savings: $1,506

Shoulder Savings: $1,093

Back/NeckSavings: $640

AirrostiSource: Airrosti Value Analysis

Circulatory Prevention and Treatment Options• Maintenance Medications

• Lifestyle Changes (Exercise and Weight Loss)

• Metabolic Syndrome (MetS) Reduction Programs

• Heart Surgery

Unmanaged can lead to Heart Attack, Stroke, Amputations, Surgeries, and Worse…

Metabolic Syndrome Financial ImpactMembers with MetS• Average 60% more annually in healthcare costs AND• Have a 700% greater likelihood of having a high-cost claim in next

three years

Neoplasms Prevention and Treatment Options

• Preventive Cancer Screenings- Covered at 100%

• Healthy Lifestyle Choices

• Chemotherapy

• Radiation

• Surgery

Early Detection Matters Breast CancerBreast Cancer Stage

Cost % Diagnosis % 5-year survival

0 $60,637 27.5 100

I/II $82,121 52.93 96.5

III $129,387 13.56 72

IV $134,682 5.99 22

Breast: Commercially Insured California PopulationColon & Lung: Medicare California Population5-Year Survival Rates From Multiple Sources

Early Detection Matters Colon Cancer

Colon Cancer Stage

Cost % Diagnosis % 5-year survival

0 $49,189 25 90

I/II $66,613 29 90

III $83,980 26 70

IV $134,682 20 12

Breast: Commercially Insured California PopulationColon & Lung: Medicare California Population5-Year Survival Rates From Multiple Sources

Early Detection Matters Lung Cancer

Lung Cancer Stage

Cost % Diagnosis

% 5-year survival non-small cell

% 5-year survival small cell

0 $60,038 20.5 1A: 921B: 68

31

I/II $73,509 4.17 2A: 602B: 53

19

III $84,980 25.18 3A:363B:26

8

IV $108,599 50.61 <1 2

Breast: Commercially Insured California PopulationColon & Lung: Medicare California Population5-Year Survival Rates From Multiple Sources

What Is One Thing That Can Help Address

All 3 Diseases?

Lifestyle

Healthy Lifestyle Resources

What is Healthy County??

Smoking

Poor StressManagement

Insufficientsleep

ExcessiveAlcohol Intake

*Poor Standard of Care

Poor Diet

PhysicalInactivity

Lack of Health Screening

Bending the Cost Curve –Prevention is KeyMeaningfully impacting as few as 3 behaviors and risks can save as much as $700 per employee/year.

These behaviors drive chronic conditions that account for 80% of total costs for all chronic illness, obesity being number one

Weight Loss BenefitsDiabetes, High Triglycerides

>3%

High Blood Pressure, Arthritis, Reflux

> 5%

Cancer, Urinary Incontinence

> 7%

Fatty Liver, Sleep Apnea

> 10%

% of Body Weight Lost

Naturally Slim

Where you go for care matters…

Options When Seeking CareRetail Health

Primary Care Physician

Telemedicine (MD Live)

Urgent Care

Hospital Emergency Room

Freestanding Emergency Room

Office Visit vs. MDLive Visit

Office Visit MDLive

1.5-2 hours away from home or

work

15-20 minutes over the phone

$40/copay

Cost to Plan: $100 avg.

$10/copay

Cost to Plan: $38 avg.

ER Visit vs. Urgent CareER Visit Urgent Care

Avg. Wait Time: 4 hours

Avg. Wait Time: 16-24 minutes

$150/copay

Avg. Cost to Plan: $1,371 avg.

$40/copay

Avg. Cost to Plan: $127

Source: www.smartERcareTexas.com

Copay Max for Specialty DrugsWhat it does: Leverages manufacturer coupons to reduce both member AND plan costs

Prescription qualifies for Copay Max program

Pharmacy submits claim to Navitus

Copay Max coinsurance is applied

Lumicera Pharmacy coordinates copay assistance for member

After copay assistance, member has a $0 copay

Key Take-Aways…Because Your Life Depends on It.

Get a yearly exam and age appropriate screenings

Consider a Virtual Visit Instead of Urgent Care

Go to Urgent Care instead of ER for non-emergent visits

Key Take-Aways…Because Your Life Depends on It.

Save money on prescriptions by using:• Tier 1 Drugs• Retail 90• Copay Max or • Mail order

Explore Airrosti as an alternative to surgery or steroid injections

Take an active approach in your healthcare decisions!

TAC Health & Benefits Services

(512)478-8753 ● (800)456-5974

www.county.org/healthycounty

Thank You!