The Trust and MiPCT Partnerships in Health Care Innovation Devorah E. Rich, PhD Senior Program Director UAW Retiree Medical Benefits Trust

The mission of the Trust is to serve as a source for retiree health care coverage for its members: Creating a new model of health care for retirees Partnering with members, health plans, and providers to improve the health and quality of life for retirees Prudent purchaser of health benefits focused on providing the best value for its members Responsible steward of the fund’s assets

The Trust … Manages health care benefits for 820,000 members Uses data to identify opportunities Actively engages in partnerships that test and spreads innovations in health care delivery Must live within its means, now and in the future Trust has created a data warehouse We have continuous data on our retirees over their lives to support research and measure impact of interventions

Who We Serve

Membership Demographics Trust Population by State WI 2.6% MI 40.4% NY 4.5% IL 2.3% OH 11.8% CA 1.3% IN 8.7% NJ 1.3% MO 4.0% KY 1.9% TN 2.3% There are UAW VEBA members in every state. The picture below shows the states with significant numbers of our members. AL 1.5% GA 2.5% TX 1.6% Top 10 states (yellow + gold) – 83% of population Top 15 states (yellow + blue) – 90% of population FL 3.7% 1% is approximately 8,300 covered lives

Multi-Generational Trust Also called Traditional or Veterans Membership Also called Traditional or Veterans Baby Boomers Born 1946-1964 X Y Z Silent Generation Born 1925-1945 Children of the Great Depression G.I Generation Born 1901-1924 WWII Veterans Pre-65 Post-65 Current Dependents Future Retirees 104,000 145,000 149,000 Membership facts: Trust members make up more than 521,000 households - Single people represent 48% of all households, there are 40,700 dependent children Age of the population ranges from zero to 112 - 58% of all members are 65 or older - 25% are 75 or older - Approximately 20,000 members (2.4%) are 90 or older (71% women) Approximately 2,000 members die each month 64% of members are covered by Medicare and 36% are pre-Medicare Members covered by Medicare will steadily increase with the aging of the population (approximately 34,500 will turn 65 in 2012, 30,000 in 2013) 117,000 101,000 87,000 55,000 64,000 48,000 58,000 Figures rounded to nearest thousand as of December 2011 Member Age Buckets

Trust Demographics Over 521,000 households Age ranges from zero to 112 Single people represent 48% of all households 40,700 dependent children Age ranges from zero to 112 58% of members are 65 or older 25% are 75 or older Approximately 20,000 members (2.4%) are 90 or older (71% women) - 46,304 of the 519,537 Medicare members are under 65 (8.9%) - These 46,304 represent 5.6% of the total Trust population.

Future Demographics Approximately 2,000 members die each month 64% of members covered by Medicare Future retirees: Potentially 104,000 Medicare Members will increase with aging of population 34,500 turn 65 in 2012 30,000 turn 65 in in 2013

Trust Membership in Major Michigan Metropolitan Service Areas Total Membership Count by MSA Groupings MSA Groupings Total Member Count Michigan - Detroit MSA 86,111 Michigan - Northern Oakland MSA 82,908 Michigan - Flint MSA 72,306 Michigan - Lansing MSA 27,987 Michigan - Grand Rapids MSA 12,445 Total MSA Group Count in Michigan 281,757 Trust Population in MiPCT practices 15,296 Population is concentrated in a small set of metropolitan areas

Estimated Yearly Health Care Spend ______________ $4.4 Billion Medical Pharmacy Health care spend was $4.6 billion in 2010. This was all we knew about the population at the time of the Trust initiation – no claims data 10

Annual Medical Spend Medical spend: 68% of Trust’s total health care spend Approximately 168,000 admissions Over 262,000 emergency room visits Variation in care and quality evident across markets and care providers

Trust Annual Pharmacy Spend Pharmacy spend: 32% of Trust’s total health care spend 14 million prescriptions filled in 2011 Increased generic utilization rate from 68% to 80% 47% of Trust Medicare members take 10 or more prescriptions Confirmed that 12% are not receiving prescriptions through the Trust pharmacy benefit, probably driven by the younger portions of the population served by the Trust Source: Medco 2011

Patient Stratification Utilizing Pharmacy Data Patient Care Needs Constipation/ Hemorrhoids, Contraception/ Hormone Therapy, Skin Conditions Well Provides specialized patient-centric care for members with chronic or complex conditions. 76.2% of the population are Chronic or Complex patients Chronic and Complex represent 99.5% of Plan Cost Colds & Flu, Strep Throat, Ear Infection, Headache, Sprains Acute Heart Disease, Diabetes, Arthritis, High Blood Pressure, High Cholesterol, Dementia, Back Pain Chronic Multiple Chronic Conditions such as Heart Failure & Diabetes, Cancer, AIDS, Multiple Sclerosis, Metabolic Syndrome Complex Source: Medco Q2- 2011 13

MiPCT Matters to the Trust 75% of members have chronic disease Trust provides member coverage over their lifetime Trust manages its resources to provide coverage for many years into the future Need innovative models that engage patients in managing chronic disease As members age into Medicare, Medicare picks up a portion of the cost but the Trust is responsible for pharmaceutical costs. Source: Medco 2011

Trust Active MiPCT Supporter Steering Committee Data and Evaluation Committee Incentive Working Group Patient Advisory Council—Co-Chair Confirmed that 12% are not receiving prescriptions through the Trust pharmacy benefit, probably driven by the younger portions of the population served by the Trust Source: Medco 2011

Measurable Results Paramount Trust has a wealth of data Trust uses data to show variation and opportunities Key improvement areas: Radiology Avoidable Admissions ER Utilization Cancer Diabetes Advance Illness management Confirmed that 12% are not receiving prescriptions through the Trust pharmacy benefit, probably driven by the younger portions of the population served by the Trust Source: Medco 2011

Road to Best Value for Members A new model of health care Driving innovations in care Providing measurable value based upon the Triple Aim: Superior Quality Superior Customer Experience Affordable Care MiPCT affords opportunity to manage patients with chronic disease A new model requires engaging patients and families to help them maintain health, and address health issues that are specific to this population MiPCT affords opportunity to manage patients with chronic disease Manage complex chronic members Keep moderate chronically ill members from deteriorating

Impact of Chronic Disease Management Reduced Emergency Room visits Reduced avoidable hospitalizations Reduced readmissions Healthier retirement Sustainability of Trust funding over time

The Golden Years Source: Medco 2011