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