1. 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

2. Business Owner- Healthcare User

4. “Insurance is expensive because healthcare is expensive”

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

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

8. 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

9. Let’s Talk ACA By the Numbers
Million
Million
Million % ↑
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Trump declares ACA should be repealed

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

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

13. 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
Bundled Payment- Pre and Post Operative for one price.
HSA ACCOUNTS
1. Focus on quality care through value based plan designs.

14. 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

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

16. 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

17. 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

18. 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

19. The Wellness Challenge

20. 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

21. 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, 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.

22. 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

24. 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

25. 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

26. 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

27. 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

29. THANK YOU!
Shannon Trowbridge, CLF