L O C K T O N C O M P A N I E S
University of Alaska & JHCC FY 18 Strategy Meeting November 18, 2016
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Table of Contents
O B J E C T I V E S
S E C T I O N 1 Vendor Programs
S E C T I O N 2 Wellness
S E C T I O N 3 Healthcare Reform Update & FY 18 Plan Ideas
A P P E N D I X
Vendor Programs
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Best Doctors (July 2015 – June 2016)
3,640 Eligible Employees (8,164 total members) for cost of $101,775
95 Member Contacts (Below target of 120 Contacts)
Diagnosis Change: 38% (Above BOB of 34%)
Treatment Change: 67% (Above BOB of 64%)
InterConsultation (24 contacts): An in-depth medical review by a leading physician to confirm a diagnosis or treatment, or suggest a recommended change.
University’s top specialty utilization is Orthopaedic Surgery, Neurology and Gastroenterology (in line with Best Doctors Book of Business)
Estimated Cost Avoidance: $267,907
$50k for reduced ER and inpatient admissions for Celiac Disease & Irritable Bowel Syndrome
$139k for averting surgery for Chiari malformation causing migraines
Ask The Expert (5 contacts): Best Doctors offers personalized answers to medical questions from leading physicians based on a member’s specific situation.
Estimated Cost Avoidance: $3,250
FindBestDoc (44 contacts)
eSummary (4 contacts)
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Best Doctors Financial Impact (July 2011 to June 2016)
Total program cost of $602,958
2011 – 2013: $291,656
2013 – 2014: $114,920
2014 – 2015: $103,511
2015 – 2016: $92,871
Total Best Doctor’s estimated savings of $529,148
2011 – 2013: $69,143
2013 – 2014: $157,529
2014 – 2015: $145,862
2015 – 2016: $288,757
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Patient Care Utilization – July 2015 to June 2016
July 2015 – June 2016: 96% of the services requested were resolved
Top service requests: Benefit Questions and Education, Choosing a Health Plan, Claims/Billing Issues, Cost Transparency and Network Questions
Within the Claims/Billing Issues, most utilized for General Claims payment and Payor Errors (both categories above PatientCare benchmark)
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Patient Care Return on Investment – July 2015 to June 2016
Additional Employer Savings
202 hours spent by Advocates
278 Service Requests since inception
23% of members surveyed would have worked on health issues at work
15% of members surveyed would have given their issues to Human Resources
Estimated annual FY 16 cost of $102,000
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Patient Care – Rewards Program
Offers financial incentive for members to choose the lowest cost/highest quality care for elective health care procedures
Member calls Patient Care to compare costs before scheduling ANY elective procedure
Cost is provided by Patient Care to member within 7 days
Member chooses lower cost provider based on 3 facilities compared
Member submits their EOB and Reward form to Patient Care within 180 days
Member receives 20% of the savings, up to $1,000 (could cap at $500)
Rewards will be paid once per test or procedure per year
Employees will receive the reward in their paycheck (taxed)
Additional PEPM of $1.00 (University of Alaska paying $2.32 PEPM)
Additional pepm cost of $40,836
Family members enrolled on the Medical Plan are eligible
Patient Care estimated average ROI of 239% after rewards are paid
Estimated number of payouts would be ~375 at an average payout of $230
Estimated cost of $86,250
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Retrofit Overview – 8 Months
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Outcomes
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2015 Graduate Group Remains Engaged
Wellness
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FY 17 Incentive Program (FY 2018 Contributions)
July 1, 2016 – April 30, 2017
Activity Points
Personal Health Assessment (PHA) Required
Biometric Screening* Required
Earn at least 5 points by completing any combination of the following activities
Points
Activity Utilizing Connected! 1 point max per month / 4 points max
Tobacco Attestation 1 point / 1 point max
Worksite Health Challenge 1 point each / 2 points max
Education Opportunities 4 points max
Online Classes 1 point per 8 classes / 2 points max
On-Site Education Sessions 1 point per class / 4 points max Lifestyle Coaching 2 points per 4 sessions / 4 point max
Routine Wellness Opportunities 4 points max
Annual Wellness Visit 1 point / 1 point max
Adult Immunization Attestation 1 point / 1 point max
Dental Exam 1 point / 1 point max
Vision Exam 1 point / 1 point max
Participants must complete a PHA, a Biometric Screening and 5 points by April 30, 2017, to be eligible for the rebate on their health care contributions in FY18. Employees can earn up to $600 per year for their participation and up to $600 back for their spouse/FIP participation.
*If 3 out of 5 biometrics are met, member will also earn rebate for FY19, and only have to complete PHA in FY18
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Proposed FY 2018 Incentive Program (FY 2019 Contributions)
July 1, 2017 – April 30, 2018 Activity Points
Personal Health Assessment (PHA) Required
Biometric Screening Required if member did not meet 3 out of
5 measurements in FY17 If 3 out of 5 measurements were not met in FY17 - Earn at least 5 points by completing any combination of the following activities
Points
Activity Utilizing Connected! 1 point max per month / 4 points max
Tobacco Attestation 1 point / 1 point max
Worksite Health Challenge 1 point each / 2 points max
Education Opportunities 4 points max
Online Classes 1 point per 8 classes / 2 points max
On-Site Education Sessions 1 point per class / 4 points max Lifestyle Coaching 2 points per 4 sessions / 4 point max
Routine Wellness Opportunities 4 points max
Annual Wellness Visit 1 point / 1 point max
Adult Immunization Attestation 1 point / 1 point max
Dental Exam 1 point / 1 point max
Vision Exam 1 point / 1 point max
Participants must complete a PHA and if a participate did not meet 3 out of 5 measurements in FY17, then they must also complete biometrics and earn 5 activity points by April 30, 2018, to be eligible for the rebate on their health care contributions in FY19. Employees can earn up to $600 per year for their participation and up to $600 back for their spouse/FIP participation.
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FY17/FY18 Outcomes Based Wellness (FY 2019 Contributions)
WOMEN
HDL Cholesterol ≥ 50
Triglycerides < 150
Waist Circumference < 35 inches (not pants size)
Blood Pressure < 130/85
Fasting glucose < 100
MEN
HDL Cholesterol ≥ 40
Triglycerides < 150
Waist Circumference < 40 inches (not pants size)
Blood Pressure < 130/85
Fasting glucose < 100
Employee and Spouse must achieve 3 out of the 5 measures Can add Tobacco in the future
Healthcare Reform Update & FY 18 Plan Ideas
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Health Care Strategy: Path to 2020
Upcoming Fees
2017 Fees
$2.08 pmpy PCORI fee paid by the University – July 31, 2016
$2.16 pmpy PCORI fee paid by the University – July 31, 2017
$27.00 pmpy Reinsurance fee paid by University (built into plan costs) – December 2016
Challenges and Opportunities
2020 Excise (Cadillac) taxes are on the horizon
At this time, FSA and HSA payroll deductions will be included in tax and employers will likely terminate these options
Incidence and severity of large claims projected to continue to increase
Increased scrutiny from stop-loss carriers
Leave administration & COBRA
ACA employer-mandated reporting
1094C (to IRS) and 1095-C (to Employees)
University of Alaska aggregates data from Banner & submits data to IRS
1095 Notice to Employees by January 31, 2017
1094 and copy of 1095 notices to IRS by March 31, 2017
$7,150 Individual OOP Maximum in 2017
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Cadillac Tax
What is the Cadillac Tax? Beginning in 2020, a 40 percent excise tax will be imposed on the value of health insurance
benefits exceeding a certain threshold. Based on Calendar Year not Plan Year Plan value is budget/funding rates
The annual thresholds are $10,200 for individual coverage and $27,500 for family coverage (indexed to inflation).
Possible Solutions Reduce plan values (Plan Design Changes) Eliminate FSA / Limited Use FSA HSA contributions as post-tax Utilize wellness plan to drive healthier outcomes
Plan Trend Rate
(7/2016 to 7/2018) Over Threshold 2020 Estimated 2020 Excise Tax*
750 8% Yes
EE, EE+SP+1, 2 & 3 $1,320,400
HDHP 8% Yes
EE, EE+SP+2 & 3 $1,091,200
CDHP 8% Yes
EE, EE+SP+2 & 3 $250,900
Total $2,662,500
*Does not include FSA or HSA contributions or biometric costs
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FY 18 Plan Design Possibilities
Plan Design Estimated Cost Savings
CDHP w/ HSA
Increase family in-network out-of-pocket maximum from $6,850 to $7,150
($40,000)
Increase deductible from $1,500/$3,000 to $1,800,$3,600 ($138,000)
HDHP
Increase deductible from $1,250 to $1,500 ($263,000)
HDHP & 750
Increase Rx copays from $10/$30/$60/$100 to $10/$40/$70/$125 ($77,000)
Eliminate 2 fills at retail for Specialty drugs TBD
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FY 18 (July 1, 2017) Plan Design Ideas Under Consideration
Specialty Rx - No Fills at Retail (2 fills)
Reduce waste at Point of Sale
Provide education to the member of side effects
University is investigating the feasibility of a Limited FSA
2 Types
Limited FSA can only pay for dental and vision – Recommended
Most common Limited FSA
Reduced employee confusion on when and where it can used
Limited FSA can pay for HSA expenses once the deductible has been met
Employee must manage money and not use until deductible is met
Employee confusion on when to use funds
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FY 2018 Communication Plan
Proposed FY 2018 Communication Campaign Open Enrollment Campaign
BenefitLink Launch Campaign
Text Messaging Opt-In Campaign
Typical Campaign Elements: Email
Intranet article
Poster
Postcard
Contest/Game
Flier, etc.
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Communication Campaign – BenefitLink (App) Standard
App is Active Today
Estimated Budget: $0
Branding Company logo
Content Services Standard Newsfeed Articles
Benefit Contact Information
Standard Newsfeed Images/Tiles
Documents Library including Benefits Guide
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Communication Campaign – BenefitLink (App) Enhanced
Implementation Timeline:
1 week setup 1 week testing 2 weeks collateral development 2 weeks launch/contest
Estimated Budget: $15k-$20k/year
Customization of site HRIS data integration # of push notifications Custom newsfeed
Branding Company logo
Company color
Implementation & Utilization Support
Account Management
Annual Strategy Meeting
Customized Launch/Utilization Campaign
Utilization Contest
Content Services Newsfeed Articles
Push Notifications
Custom Newsfeed Images/Tiles
Analytics Monthly Login Report
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BenefitLink App Uses
Replace an employee newsletter
Distribute informal CEO iPhone video series
Recognize an outstanding employee each month
Request employee input on key topics
Measure the impact of communications on HSA participation
Run a wellness photo contest
Promote open positions
Share safety alerts
Push biometric screening reminders
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Communications Campaign – Trumpia (Text)
Demo: Link Text ldbdemo to 99000
Implementation Timeline: 1 week setup 1 week testing 3 weeks collateral development 2 weeks opt-in campaign
Services:
Platform setup & licensing Text messages (assumes 24/year) Writing Publishing Opt-in campaign Platform/Database management
Estimated Budget: $14,000-18,000/year
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Communications Campaign – FLIMP (Video)
Demo: Link Implementation Timeline:
1-2 weeks PowerPoint/script 3 weeks VO/storyboard 2 weeks animation
Services: Estimate coordination Script development Visual development Voiceover Animations Proofing/review
Estimated Budget: $5,500-$8,000/video
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Communications Campaign – Jellyvision (Interactive Video)
Demo Implementation Timeline:
Minimum of 3 weeks production
Services: Interactive design support videos
Estimated Budget: Average of $15 PEPY for DIY
model, which involves the Lockton communications team entering data into Jellyvision portal vs client working directly with Jellyvision
Appendix
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2016 Incentive Program Overview (FY 17 Contributions)
Participants must complete a PHA, a Biometric Screening and 5 activity points by April 30, 2016, to be eligible for the rebate on their health care contributions in FY17. Employees can earn up to $600 per year for their participation and up to $600 back for their spouse/FIP participation.
July 1, 2015 – April 30, 2016
Activity Points
Personal Health Assessment (PHA) Required
Biometric Screening Required
Earn at least 5 points by completing any combination of the following activities
Points
Physical Activity: 120,000 points per one calendar month 1 point per max/month / 4 points max
Tobacco Attestation 1 point / 1 point max
Worksite Health Challenge 1 point each / 2 points max
Education Opportunities 4 points max
Online Classes 1 point per 8 classes / 4 points max
On-Site Education Sessions 1 point per class / 4 points max Lifestyle Coaching 2 points per 4 sessions / 4 point max
Routine Wellness Opportunities 4 points max
Annual Wellness Visit 1 point / 1 point max
Adult Immunization Attestation 1 point / 1 point max
Dental Exam 1 point / 1 point max
Vision Exam 1 point / 1 point max