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The Trust and MiPCT Partnerships in Health Care Innovation

The Trust and MiPCT Partnerships in Health Care Innovation. Devorah E. Rich, PhD Senior Program Director UAW Retiree Medical Benefits Trust. The mission of the Trust is to serve as a source for retiree health care coverage for its members: Creating a new model of health care for retirees

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The Trust and MiPCT Partnerships in Health Care Innovation

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  1. The Trust and MiPCTPartnerships in Health Care Innovation Devorah E. Rich, PhD Senior Program Director UAW Retiree Medical Benefits Trust

  2. The mission of the Trust is to serve as a source for retiree health care coverage for its members: • Creating a new model of health care for retirees • Partnering with members, health plans, and providers to improve the health and quality of life for retirees • Prudent purchaser of health benefits focused on providing the best value for its members • Responsible steward of the fund’s assets

  3. The Trust … • Manages health care benefits for 820,000 members • Uses data to identify opportunities • Actively engages in partnerships that test and spreads innovations in health care delivery • Must live within its means, now and in the future

  4. Who We Serve

  5. Membership Demographics Trust Population by State MI 40.4% WI 2.6% NY 4.5% IL 2.3% OH 11.8% CA 1.3% IN 8.7% NJ 1.3% MO4.0% KY 1.9% TN 2.3% AL 1.5% GA 2.5% TX 1.6% Top 10 states (yellow + gold) – 83% of population Top 15 states (yellow + blue) – 90% of population FL 3.7% 1% is approximately 8,300 covered lives

  6. Multi-Generational Trust Membership Z Baby Boomers Born 1946-1964 Silent Generation Born 1925-1945 Children of the Great Depression Y X G.I Generation Born 1901-1924 WWII Veterans Also called Traditional or Veterans Pre-65 Post-65 Current Dependents Future Retirees 104,000 145,000 149,000 117,000 101,000 87,000 55,000 64,000 58,000 48,000 Figures rounded to nearest thousand as of December 2011 Member Age Buckets

  7. Trust Demographics • Over 521,000 households • Single people represent 48% of all households • 40,700 dependent children • Age ranges from zero to 112 • 58% of members are 65 or older • 25% are 75 or older • Approximately 20,000 members (2.4%) are 90 or older (71% women)

  8. Future Demographics • Approximately 2,000 members die each month • 64% of members covered by Medicare • Future retirees: Potentially 104,000 • Medicare Members will increase with aging of population • 34,500 turn 65 in 2012 • 30,000 turn 65 in in 2013

  9. Trust Membership in Major Michigan Metropolitan Service Areas

  10. Estimated Yearly Health Care Spend ______________ $4.4 Billion Medical Pharmacy 10

  11. Annual Medical Spend • Medical spend: 68% of Trust’s total health care spend • Approximately 168,000 admissions • Over 262,000 emergency room visits • Variation in care and quality evident across markets and care providers

  12. Trust Annual Pharmacy Spend • Pharmacy spend: 32% of Trust’s total health care spend • 14 million prescriptions filled in 2011 • Increased generic utilization rate from 68% to 80% • 47% of Trust Medicare members take 10 or more prescriptions Source: Medco 2011

  13. Patient StratificationUtilizing Pharmacy Data Well Constipation/ Hemorrhoids, Contraception/ Hormone Therapy, Skin Conditions Acute Colds & Flu, Strep Throat, Ear Infection, Headache, Sprains Chronic Complex Heart Disease, Diabetes, Arthritis, High Blood Pressure, High Cholesterol,Dementia, Back Pain Multiple Chronic Conditions such as Heart Failure & Diabetes, Cancer, AIDS, Multiple Sclerosis, Metabolic Syndrome Patient Care Needs • Provides specialized patient-centric care for members with chronic or complex conditions. • 76.2% of the population are Chronic or Complex patients • Chronic and Complex represent 99.5% of Plan Cost Source: Medco Q2- 2011 13

  14. MiPCT Matters to the Trust • 75% of members have chronic disease • Trust provides member coverage over their lifetime • Trust manages its resources to provide coverage for many years into the future • Need innovative models that engage patients in managing chronic disease Source: Medco 2011

  15. Trust Active MiPCT Supporter • Steering Committee • Data and Evaluation Committee • Incentive Working Group • Patient Advisory Council—Co-Chair Source: Medco 2011

  16. Measurable Results Paramount • Trust has a wealth of data • Trust uses data to show variation and opportunities • Key improvement areas: • Radiology • Avoidable Admissions • ER Utilization • Cancer • Diabetes • Advance Illness management Source: Medco 2011

  17. Road to Best Value for Members • A new model of health care • Driving innovations in care • Providing measurable value based upon the Triple Aim: • Superior Quality • Superior Customer Experience • Affordable Care • MiPCT affords opportunity to manage patients with chronic disease

  18. Impact of Chronic Disease Management • Reduced Emergency Room visits • Reduced avoidable hospitalizations • Reduced readmissions • Healthier retirement • Sustainability of Trust funding over time

  19. The Golden Years Source: Medco 2011

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