1. Case Study: Six Straight Years of Declining Healthcare Costs
--Presentation and Case Study--
#kyshrmconf
Dr. Rick Cartor, Custom Healthcare Designs / BB&T 1
rickcartor.wordpress.com

2. Dr. Rick Cartor, Custom Healthcare Designs / BB&T
AGENDA
1. Our Purpose Today
2. The Company
3. The Summary Statement
4. The Timeline & Results
5. Why it works & Advice
#kyshrmconf
Dr. Rick Cartor, Custom Healthcare Designs / BB&T
rickcartor.wordpress.com

3. Dr. Rick Cartor, ChD / BB&T
Our Purpose Today
The purpose of this session is generate ideas that may enhance the value1 of the healthcare benefits your company provides its employees, by sharing the details of one company’s very successful2 health care benefit system.
1. Value: low cost, high quality, accessible care
2. Success: decreasing PEPY spending, improved health, positive reactions, accessible quality care
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
rickcartor.wordpress.com

4. Dr. Rick Cartor, ChD / BB&T
About the company
Description
History & Purpose
The Mary Byron Foundation
Products/Services
Awards
VP, 150
Healthcare experience and vision
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 4
rickcartor.wordpress.com

5. Dr. Rick Cartor, ChD / BB&T
The Summary Statement
A long term incremental introduction of an integrated system that engaged employees in primary care by creating a collaborative culture of health awareness by:
aligning incentives,
analyzing and sharing data (information)
contracting for convenient primary care
establishing and steering to a narrow network
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 5
rickcartor.wordpress.com

6. The “integrated system”
Health assessment and promotion
“Wellness” with incentives / disincentives
Continuum of coaching
Contracted accessible care
Fixed rate (lower and more predictable)
On-site or near site x Solo or shared
Data acquisition and analysis
Analytics, information and transparency
Narrow network and steerage
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 6
rickcartor.wordpress.com

7. Biometrics (Eddington)
Timeline
START:
Existing
Care plan
HDHP/HSA
Jan. 1 $1 !?
You are here (09/27)
Biometrics (Eddington)
Drawing: F2T
Renewal $
Stop HRA
Add Sr+
Committee
HRA
Coaching
2008
2010
2012 1 2 3 4
2006
2007
2009
2011
2013
Coaching & DM
ONSITE CARE
Healthcare to HR
WELLNESS
SELF-FUND
ChD
BHN EXCLUSIVE NETWORK
Incentives (+PCC) for partners
Rewards: Participation to ZT to results
Free e-cigs
Nicotine test to attest
Non-smoker reward to smoker fees
½ fitness fees +
Steerage
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
rickcartor.wordpress.com

8. Dr. Rick Cartor, ChD / BB&T
Data  Actions
PMPM data
Recidivists (biometrics)
Targeting repeat high risk factor employees
Effects (biometric scores  healthcare costs)
Focus wellness programs, activities
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 8
rickcartor.wordpress.com

9. Wellness Self Fund On Site PCC 2006 2007 2008 2009 2010 2011 2012 2013
BACK
Wellness
Self Fund
On Site PCC
$210
2006
2007
2008
2009
2010
2011
2012
2013 1 2 3 4

10. Dr. Rick Cartor, ChD / BB&T
Data  Actions
PMPM data
Recidivists (biometrics)
Targeting repeat high risk factor employees
Effects (biometric scores  healthcare costs)
Focus wellness programs, activities
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 10
rickcartor.wordpress.com

11. Dr. Rick Cartor, ChD / BB&T
Why it Works (1-5 of 11)
01. Primary and preventive care
Dr. Barbara Starfield, Johns Hopkins, etc.
02. Transaction costs:
doctor visits / meds & pharmacy / lab work
03. Coaching & disease management
04. ER, ICC use
05. Procedures, Inpatient care, Meds
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 11
rickcartor.wordpress.com

12. Dr. Rick Cartor, ChD / BB&T
Why it Works (6-11 of 11)
06. In Network + Transparency = Lower costs
07. Self-funding: incentive management, steerage
08. Unbundled: transparency, competition, value.
09. Data driven decisions
10. Zero Trend basis (P’MaintainImprove)
11. Integration: system design
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 12
rickcartor.wordpress.com

13. Unsolicited Advice (…or free consulting!)
01. Believe.
02. Emphasize primary care, prevention.
03. Stop Idea Whack-a-Mole.
04. Think small / act locally.
05. Use a formal PSDM process.
06. Agree on goals, objectives, criteria.
07. Think > 12 month (Plan & ROI).
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 13
rickcartor.wordpress.com

14. Unsolicited Advice (…or free consulting!)
08. Follow up with chronic conditions.
09. Consider exclusive (“narrow”) networks.
10. Insist on acquiring / analyzing data.
11. Align on healthiness.
12. Integrate the system…
13. Stay vigilant: “No victory is final or complete.”
#kyshrmconf
Dr. Rick Cartor, ChD / BB&T
(502)
Page 14
rickcartor.wordpress.com