Promoting Engagement: How a Nonprofit Health Insurer Is a Catalyst for Change in Minnesota

1. Promoting Engagement: How a Nonprofit Health Insurer Is a Catalyst for Change in Minnesota David Tilford President and CEO Medica

2. Nonprofit health insurer $2.5 billion annual revenue 90% of premiums go to care Primary business is in Minnesota and the upper Midwest Able to offer national coverage in partnership with other insurers Most customers are employers ~ 1.4 million members ~ 86% employer-based ~ 9% Medicaid ~ 4% Medicare ~ 1% Individual Regional & national networks Overview of Medica

3. Employer Engagement • Benefit plan design options • Traditional plans • Copay/coinsurance • Consumer-directed • Health spending accounts • Activating employees • Fitness programs • Healthy behavior rewards • Customer service • Care coordination/navigation • Multiple education/information channels, Web sites • Network options • Open access • Tiered • High-value care systems Network Design • A Predicted Health Risk Score is assigned to each member • Predictive modeling has led to > $300 PMPM reduction in care costs Cost Health Status Plan Design

4. Initiatives to Engage Physicians • $27 million paid in performance-based incentives • Predictive modeling • Predicted Health Risk Score assigned to members • ~ $300 PMPM savings achieved • Clinic-based chronic care coordination WellnessManagement CareManagement RiskManagement DiseaseManagement HealthDecisionSupport

5. Catalysts for Community-Based Change • Investing benefits in the community • 2003 “premium holiday”: $86 million returned to stakeholders • Medica Foundation: > $6 million in grants since 2003 • MN Partnership for Biotechnology & Medical Genomics: $5 million • Community-based collaborations • Minnesota Community Measurement • Institute for Clinical Systems Improvement (ICSI) • The challenge: How best to balance competing demands