The following links and articles are a sampling of innovative health benefit design programs, products and initiatives both locally and nationally. This list is by no means comprehensive, nor are the programs necessarily endorsed by the Taskforce.
Innovations in Employment-Based Health Benefits
By Tracey Young, Employee Benefit Research Institute
An article from the Employee Benefit Research Institute about Health Benefit Innovations. Discusses innovations in financing, Patient Centered Medical homes, and Health Improvement Plans- health plans that give participants monetary incentives or savings to modify their health and health care use.
Innovative Plan Designs in the National and Regional Marketplaces
Bailit Health Purchasing, LLC
In a report prepared for the Office of The Health Insurance Commissioner, Bailit Health Purchasing, LLC examined innovative health insurance plan designs both regionally and nationally to see what’s available and how Rhode Island is faring relative the current environment. Unfortunately, but not surprisingly, few plans were willing to share pricing information or obtain plan design details for all of the plans discussed in the report.
What is encouraging is that Bailit’s research shows successful innovations in benefit design that address three major cost drivers: lowering the price of services, increasing efficient use of care services, increased member health management responsibility to reduce long-term costs of care. The report discusses these innovations in detail, providing cost savings data wherever available.
Consumer Directed Health Plan
A Consumer Directed Health Plan (CDHP) differs from a more traditional plan, in that the consumer is required to assess their health needs from both a medical and financial perspective. CDHP usually cost less, have higher deductibles and are offered in tandem with a tax exempt health spending or savings account. The consumer decides how much money to set aside to pay for their care needs and then pays out of their spending account until the deductible is reached. Employees have the option of making contributions into the health fund of their employees. Health funds may be able to roll over to the following year and accumulate.
CDHP participants, when compared to participants in traditional plans, are:
50% more likely to ask their provider about cost
33% more likely to independently verify treatment alternatives
3 times more likely to choose less extensive or less expensive treatment
25% more likely to engage in healthy behaviors
20% more likely to participate in wellness programs
30% more likely to get an annual checkup
20% more likely to follow treatment regimens
Twice as likely to inquire about drug cost
According to the Towers Perrin 2008 Health Care Cost Survey, HSA plans cost 20% less than traditional PPO plans while HRA plans cost 11% less.
PCMH or CSI:
The Patient Centered Medical Home is an innovative and comprehensive approach to wellness care that increases the quality, and not cost, of health care. A Patient Centered Medical Home (PCMH) is not actually a home, rather it is a model designed with the patient at its center, surrounded by a core team of health care professionals who customize care to the individual’s needs. In a PCMH providers are compensated based on the wellness of their patients, not the number of patients seen. PMCH provide accessible, comprehensive, compassionate, and culturally effective care.
PCMH are the foundation of the Rhode Island Chronic Care Sustainability Initiative
http://www.emmisolutions.com/medicalhome/transformed/english.html (great video animation about PCMH)
Tiered Provider & Prescription Copay Plans:
Some medical plans offer tiered copayments to providers. The insurance agency groups providers into tiers according to the services they provide, the states in which the practices reside relative to the program offered, and whether they are in our out of network. Plans also offer tiered copayments for prescription drugs, with generic being in the cheapest tier (tier 1), name brand drugs that the insurance company has gotten favorable pricing on (tier 2), and all other brands (tier 3). In both of these plans, premium costs are lower than traditional plans, passing on the expense of higher cost treatment or drugs to the consumer if they choose that more costly treatment.
Innovative Health Reform in the US:
Maryland All-Payer System:
Since 1976 Maryland has instituted an all payer system for health insurance. In this system all insurers use the same rate schedule for reimbursement. In Maryland, the Health Services Costs Review Commission (HSRC) sets the fee schedule. They are an independent agency of government appointed by the Governor, but who does not report to any administration. Any appeal of HSRC must be appealed in court. The goals of the HSRC, as described by the HSRC Executive Director as described in this article (http://www.governing.com/topics/health-human-services/maryland-all-payer-hospital-rate-setting-system.html) are as follows:
The first and foremost [goal], I would argue, is cost containment. The second is access to care. One of the reasons hospitals strongly supported rate regulation when it was created here [was because] we were looking for a way to pay for uncompensated care. So, we built into rates additional amounts to cover reasonable levels of uncompensated care. Arguably, we have better access to hospital care, as a result of that. The third [goal] was to have an equitable, fair payment system. We prohibit the so-called cost shifting that takes place elsewhere. Hospitals can’t try to mark up their charges to the private sector like they do in other states. We also are required to provide sufficient funds for hospitals to remain solvent, the caveat being that we are only required to maintain solvency for “efficient and effective” hospitals. The last two [goals] are transparency and accountability. More recently, we focused on quality improvement and linking quality measures to payment rewards and incentives in the payment system.
5% of Population spend 50% of health dollars:
MA health cost control Bill:
Innovations in RI:
HealthPact insurance plans are a cost-saving alternative to traditional insurance products that require consumer commitment and participation. HealthPact plans can save the purchaser 15-20% than a comparable plan by requiring the consumer to find a primary care doctor, complete a health risk assessment and make a pledge to the HealthPact principles. Further cost savings will result in the second year of enrollment as the individual makes additional health care commitments.
The Affordable Care Act provides incentives for physicians to join together to form Accountable Care Organizations (ACO). ACO’s receive incentives or penalties based on the health outcomes of the patients in their organization. Because of this, ACO’s are designed to provide a high level of coordinated care, ensuring better care, lower costs and patient participation, Because the care is coordinated, ACO’s can reduce unnecessary hospital admissions.
As of July 10, 2012, Coastal Medical became the first Rhode Island ACO. Coastal not only functions as an ACO within Medicare’s shared savings program, but has also set up a similar program through BCBSRI. Through each of these shared savings plans, Coastal Medical is allowed to keep a percentage of the medical expenses that it saves though care coordination.
Notable RI Insurer Plan Innovations
Destination Wellness: Wellness Planning and consultants.
The Tufts Insurance company provides free wellness plan development resources and has consultants available to develop wellness plans for employers who carry their insurance. Tufts offers a range of seminars and on-site health screening/testing for additional fees.
Blue Cross Blue Sheild:
Blue Cross is collaborating with local network hospitals to create and implement a new Hospital Quality Program. This program will help improve the quality, safety, and efficiency of healthcare by using standard, evidence-based measures to evaluate hospital performance—and by providing financial incentives to hospitals that successfully meet those measures….
Risk Assessments (HRAs) need to become best practice, and if necessary, employees should be financially rewarded in order to drive maximum participation. Employers also need to explore employee incentive plans that offer more attractive co-pays and co-insurance plans for those who participate in HRAs, wellness programs, and maintain good health status.
Human Capitol/ Wellness Committee
Healthy workforce should be a capitol assent on the company’s balance sheet. Employers can demand some kind of active participation in self wellness to retain benefits. Integrated data systems between health programs and employers to figure out which areas their expenditures can be improved. End silo mentality: pharmacy + medical expense costs= medical episode costs, and can show that appropriate medications reduce hospitalization and medical costs.
Health Savings Account
- sponsors on-site health screening
- encourages exercise during work hours
- provides exercise and shower facilities
- designs physical work-site features to accommodate physical activity