Shannon Trowbridge, CLF Becoming an Engaged Health Care Consumer Dad of the Year Candidate, Insurance Big Brother President-Elect of South Carolina Association of Health Underwriters Becoming an Engaged Health Care Consumer 15 Ways Employers Can Reduce Health Care Spending That Aren’t Cost Sharing 03/27/2019

Business Owner- Healthcare User

“Insurance is expensive because healthcare is expensive”

“I DON’T UNDERSTAND HEALTH BENEFITS. I DON’T WANT TO!”

According to Forbes, 26% of Employees would rather clean these toilets than deal with the complexity of a health plan. 

By the Numbers 3.6 Trillion Health Care Spend 2019 5.2% ↑ 30% of 3.6 Trillion deemed wasteful * 180 Million Workers receive Healthcare through Employer 2019 Average Cost Family: $19,610- 5% ↑ Individual: $6,896- 3% ↑ MORE GOOD NEWS- Expect 5% ↑ 2020

Let’s Talk ACA By the Numbers 2010- 10 Million 2015- 17 Million 2018- 14.4 Million 31.3% ↑ 2019 – 5.3% ↑- No Penalty ”Kinda” still in Courts- Texas Lawsuit Metal Plans 60/30/5- Silver, Bronze, Gold Trump declares ACA should be repealed

By the Numbers- Businesses 2-50 ACA Metallic Plans- 47.1 Gold/ 46.9 Silver Grandfather Plans-Effect prior 2010 Grandmother Plans-Effective 2010-2014 Self Funded Reference Based Pricing Religious Affiliation Products Short Term Plans Association Health Plans- Charleston Chamber Members?

TOP 5 PRACTICES TO SAVE ON HEALTH CARE COST Average Saving of $3,548 less per year per employee by implementing these strategies.

1. Focus on quality care through value based plan designs. Model Aligns Patient Care Provider Incentive towards Efficient Care- PAID FOR PERFORMANCE Shift from Fee of Service to Outcomes Model Using Centers of Excellence- Outcomes based Reduce Complications & Reoccurrences https://one.walmart.com/content/uswire/en_us/me/health/health-programs/centers-of-excellence.html Bundled Payment- Pre and Post Operative for one price. HSA ACCOUNTS 1. Focus on quality care through value based plan designs.

2. Educate Employees on Pharmacy Cost Pharmacy cost use to be 8% to 10% of total cost. Today, we are seeing up to 30% of total health spend contributed to pharmacy alone. Cost Driver= Biologics- Drugs made from complex molecules using Microorganisms - Humira- $5,410 for a supply of 2. - Enbrel- $5,560 for a carton of 4 slicks-Arthritis - Remicade-$1,300 to $2,500 per dose. 2. Educate Employees on Pharmacy Cost

Tier 0- Maintenance Drugs- $168 Tier 1- Generic- $48 Tier 2- $437 Tier 3-$1862 Tier 4- $9067 Help Employee Navigate RX Options WWW.GOODRX.COM 2. Provide Educational Resources on Pharmacy Cost- Carrier Pays Example

3. Offer Integrated Well-Being Program Multi-Generational Workforce wants Employers to encourage a Healthy, Physical, Emotional , Social and Financial Lifestyle. Create programs to help Employees meet both short term and long term financial goals. Wellness, TeleMedicine, and EAP Programs- 3. Offer Integrated Well-Being Program

4. Empower Employees to make informed Benefit Decisions Multi-generational Workforce Understand each employee has unique needs Offer voluntary and ancillary programs to round benefits portfolio Provide Tools and Resources- Online Benefit Administrative Platforms Face to face Benefit Counselors Onsite Quarterly lunch and learns 4. Empower Employees to make informed Benefit Decisions

5. Mine Workforce Data To Ensure HealthCare Strategy Works Use data to analyze benefit results EXAMPLE: Conduct multiyear evaluations of claims( depending on number of employees) and employee feedback Help your Employees lower Risk Factors such as: Smoking Recreational Drug Use Alcohol Intake 5. Mine Workforce Data To Ensure HealthCare Strategy Works

The Wellness Challenge

OTHER RECOMMENDATIONS 6. Telemedicine- Allows Healthcare Professional to evaluate, diagnose, and treat patients over the phone. Copay vs. No Copay 7. Provide Case Management Services to identify barriers that may prevent people from getting the best care. Ambassacare here in Charleston. 8.Provide Nurse Advice Lines- Gives employees 24 hour access to their health related questions

OTHER RECOMMENDATIONS 9. Health Claims utilization analysis- If the data is available- use data to pinpoint top health concerns 10. Provide Price Transparency Tools- December 31, 2018 - Starting January 1, 2019, hospitals will be required to post their price lists online in an effort to increase price transparency and empower consumers to make informed choices about their care.

OTHER RECOMMENDATIONS 11. Self Fund and take control. Self funding increases Employers Financial control and plan management options. Option for companies as few as 10 Employees Total Group is underwritten Composite Ratings available 12.Join another STOP LOSS CAPTIVE

OTHER RECOMMENDATIONS 13.Carve out drug coverage from Medical Insurance. Evaluate Pharmacy spend yearly. Cap Cost with Reference Base Pricing- NC Example -Capping reimbursement at a percentage of Medicare’s Standard Pricing Schedule. Helps avoid Doctors and Hospitals that charge above average prices. Strong TPA to handle balance billing

OTHER RECOMMENDATIONS 15. Offer Clinical Care Management for Chronic Illnesses -Conditions such as diabetes, musculoskeletal pain, and heart disease- Largest cost drivers -Disease Management programs can help Employees control their conditions

Key Federal Legislative Issues affecting Health Care Premiums Balance Billing HIT Tax & Cadillac Tax RX Cost Transparency Employer Tax Exclusion Updating HSA/HRA Rules 90 Day Rule on ACA Plans

Become an Engaged Healthcare Consumer YOUR DUTY TO YOUR EMPLOYEES AND YOUR BUSINESS IS TO ENCOURAGE ENGAGED HEALTHCARE CONSUMERS BEHAVIORS. Become an Engaged Healthcare Consumer

THANK YOU! Shannon Trowbridge, CLF Shannon@vbwork.com 843-452-0260