1. Epic Insurance Solutions
Bend Healthcare Trend
Donald B. Thompson
President
Epic Insurance Solutions

2. AGENDA How Insurance Carriers Develop Premiums
Implementing a Successful Long Term Wellness Strategy
Utilizing Data Analytics to support your Wellness Plan
Empowering and Educating Employees

3. Health Insurance Premium
Health Insurance Premiums are a reflection of the underlying cost of care. When the cost of medical services such as doctors visits, hospital stays, and medical devices increase, these cost drive a corresponding increase in premiums
Federal data shows that over the past 20 years health cost have increased by an average of 7.2% annually and premium increases have averaged 7.1% annually
Calculating health insurance premiums is a process driven by three main factors
Cost of medical benefits (claims / expected future claims) %
Administrative cost (selling expense, administering the plan, profit) 15%
Premium Tax (including new ACA taxes) %

4. What Drives Premium?
Increased Utilization and Higher Prices for Medical Services
Accounts for approximately 70% of the increase each year
Demand for New Technologies
One of our nation’s strengths lies in our ability to bring forth innovation. The newest treatments are typically much more expensive than current ones
Provider Consolidation
Providers are banding together which typically reduces competition. In addition, these providers demand higher reimbursements driving up the premium cost
Cost Shifting
From Public Programs such as Medicaid and Medicare to those with private coverage
Medical Liability
It is estimated that .10 of every premium dollar is spent on medical liability and defensive medicine
Regulations, Mandated Benefits & Taxes
State & Federal regulations, benefit mandates, and taxes increase the cost of coverage

5. Workplace Wellness - Why
Affordability of Coverage
Health Insurance premiums continue to increase 8-9% per year and at this pace will double over the next 8 years.
The average cost per employee is quickly approaching $12,000 annually
Deductible and Out of Pocket exposure continue to increase placing a larger burden an employee’s budget for care
Lifestyle choices lead to increase costs for All
Many health problems are a result of an unhealthy lifestyle; smoking, lack of exercise, poor diet, excess stress, etc.
Lost productivity due to absenteeism, depression, and stress cost companies $70 billion annually
Cost of Care for Unhealthy employee behaviors cost U.S. employers an average of $670 per employee each year
Opportunity
Researchers have estimated that preventable illness make up approximately 70% of the burden of illness and the associated costs in this country.
Implementing a successful wellness plan can have a significant impact on an employees health and an employers bottom line
Improved productivity as healthy employees tend to perform better
Reduction in sick leave absenteeism
Improved reputation as a company who cares about their employees – aids in recruiting and community perception
Improved employee morale and stronger employee retention
Sources: Society for Human Resource Management, The World Health Organization, The Wellness Councils of America,

6. Workplace Wellness Trends
Many employers have begun their Wellness Journey with tactics that can help improve employee health and productivity, but the plans effectiveness are difficult to measure.
Weight management programs
Health fairs
On Site Flu Shots
Health risk assessments
Smoking cessation programs
Education classes
Subsidized use of fitness facilities
Internal policies/programs that promote healthy behavior
Wellness Day off
What is the next step to enhance the Program and produce measurable results?
Policy changes that affect the health of employees
Outcome based Incentives, Cash, Credits in HSA, HRA, FSA
Outcomes based employee medical premium differentials
Mandatory enrollment in the Wellness Program to be eligible for the medical plan
Integrating your Medical / Rx claims data with your Wellness reporting on a single platform
Worksite wellness programs are designed to promote healthy lifestyles for employees and their families. These programs can be simple or complex, and can require a minimal investment of time and money, if done correctly. More substantial programs often use more resources, yet there are many benefits to supporting and encouraging employee health and safety – and they typically outweigh the costs.

7. Creating a Workplace Wellness Program
Workplace Wellness programs should be long-term strategies that help improve the quality of employees’ lives, reduce benefit costs, and increase productivity through sustained improvements in workforce health.
Top Management Support & Participation
Management must understand the benefits of the program
Link health promotion to business goals, values and strategic priorities
Create a Wellness Team
Individuals who will have a role in program development, implementation and evaluation
Develop a program that is responsive to the needs of all participants
Tailor Your Initiatives to Employee Needs
Employee interest surveys
Health risk assessments
Claims data analysis to determine current employee disease risks
Biometric testing
Create an Annual Plan
An annual operating plan should include a mission statement for the program, along with specific, measurable short- and long-term goals.
A means to evaluate the effectiveness of the program.

8. Creating a Workplace Wellness Program
Choose Appropriate Programs and Initiatives
Select health initiatives that are relevant to the data you collected.
Address specific risk factors of employees
Programs are in line with what management and employee culture
Create an Annual Operating Plan
Vision statement outlining what you are trying to achieve with the program
Goals for the program
A timeline, budget, communication plan, implementation plan
Evaluation – measuring success of the program
Create a Supportive Environment
Provide employees with ongoing encouragement, support, opportunities and rewards
Offer healthy food choices in your vending machines
Reward healthy achievements
Consistently Evaluate Outcomes
Take a close look at your goals and objectives, and determine whether you have achieved the desired result
Evaluation allows you to celebrate achieved goals and discontinue efforts that are not as successful
Surveying employees again can be effective – after participating in the wellness program thus far, they can provide feedback about what they liked, what they would change, etc.

9. Creating a Workplace Wellness Program
Implementing a wellness plan can be a difficult process. Depending on your current culture and employee readiness for change, a three year strategy may be necessary to ensure the success of the plan.
Participation Phase - Year 1
Start slow and communicate heavily
Get Employee Buy In
Promote Program and Drive Engagement with Rewards
Engagement Phase - Year 2
Employee and Leadership Accountability
Set Goals
Personal Alternatives
Reward Improvement
Outcomes Phase - Year 3
Continued Employee and Leadership Accountability
Outcomes Based Rewards / Premium
Integrate Data Analytics
Design Health Plan around known drivers of claims

10. Data Analytics
Reviewing and understanding your healthcare data and claims information is instrumental to your cost-controlling strategy.
Carrier Data is available depending on an employers size and funding arrangement, fully insured/self-funded
Traditional carrier data is somewhat limited but the Health Carriers have started producing reports that are much more detailed
Wellness Programs that include Personal Wellness Assessments and Blood Profiles can also be a good, but a limited data source
Integrating your medical and Rx claims data with your Wellness reporting on a single platform can enhance your ability to understand risk, create actionable plans, and measure the ROI of the plan

11. Integration Health Risk Assessment Clinical Services/ Health Coaching/
Disease Mgt
Biometrics/Lab
Data
Claims Data
Integration

12. Data Analytics & Predictive Modeling
Based on an employers size and the current carrier in force,
Data can be utilized in a manner to predict future claims
Review member gaps in care & pharmacy compliance
Negotiate fully insured premiums or stop loss contracts with carriers at an employer’s renewal.
Raw Carrier Data Create Predictive Model Apply to Health Plan
Medical Claims Drill Down Capability Forecast Cost & Risk
Rx Claims Forecasting Reports for each member
Member Eligibility Data Analytics Predict Clinical Events
HRA Identify Gaps in Care
Lab Results

13. Data Analytics Identifying Trends Budgeting
Data analysis allows employers to identify disease trends that impact their population.
Spikes in utilization
Gaps in evidence-based care standards
Disease prevalence
Admission rates
ER & Urgent Care Utilization
Rx Utilization
Budgeting
Data analysis platforms can help employers get a handle on current and future cost.
Allow for employers to make adjustments for risk to their plan
Measure plan performance
Refine wellness strategies
Track trends in cost
Establish pricing assumptions
Aids in the underwriting & premium negotiation process

14. Data Analytics Wellness Program Effectiveness
If employers better understand the overall health of their population, they can
Allocate resources focusing on their unique needs
Assess the programs participation, utilization, and effectiveness
Identify initiatives that work
Track ROI
Data Clarity and Transparency
Empowers employers to make informed decisions about premiums
Accurately quantify risk of their populations
Assist in benefit plan designing
Steering Employees to more affordable providers

15. Empower & Educate
In addition to developing a robust wellness Program, how can we help employees understand their impact on healthcare cost and empower them with tools to make educated decisions.
Dedicate time during Open Enrollment and throughout the year
Mandatory Meetings
Invite Spouses if they are eligible for coverage
Consider one on one meetings with employees to review their plans
Educate Employees
Discuss how a premium increase impacts their take home pay
If your company is self-insured make the employees aware of that
If you are large enough to receive claims data, share a summary of that data.
Share benchmarking with the employees showing them how their claims compare to other similar companies
Review Transparency Tools
Inform employees that the same service at different provider locations can vary dramatically in cost
Utilize the tools that the Carriers offer online and incentivize employees to do so
Look into Companies that will help steer employees to lower cost providers, Compass, Healthcare Bluebook, etc.
Review the cost of services like the ER compared to Urgent Care and their PCP.
Consider Tele-medicine for some types of treatment to reduce cost

16. Bend the Trend
A solid Wellness and Education Plan will empower your employees and impact your Healthcare Spend.
Plans are nothing; planning is everything.
Dwight D. Eisenhower