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2013 Healthcare Program. Trustees Finance & Audit Committee, April 2012. Current Status – April 2012. 17,300 FT Employees; 16,150 enrolled in medical 37,000 plus covered lives 4 medical plans: PPO networks, with member cost sharing Salary-based premiums, with credit for non-use of tobacco
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2013 Healthcare Program Trustees Finance & Audit Committee, April 2012
Current Status – April 2012 • 17,300 FT Employees; 16,150 enrolled in medical • 37,000 plus covered lives • 4 medical plans: PPO networks, with member cost sharing • Salary-based premiums, with credit for non-use of tobacco • HDHP & HSA with 8,100 employee enrollments • PPACA compliant • No post-65 Retiree Healthcare liability • FY 2011/12 IU Budget for Healthcare = $186.6 m • FY 2012/13 IU Budget = $197.8 m • or $11,433 per eligible employee
Assumptions for CY 2013(as of April 2012) • Same or lower number of covered employees • Same medical plan options as 2012 • increase enrollment in the HDHP & HSA plan • Moderate increase in total premiums • small or no increase in HDHP plan premiums • PPACA: • new “Summary of Benefits and Coverage” • annual limit of $2,500 for health FSA contribution, starting 2013 • Form W-2 reporting for 2012 health coverage • Cost Increases: 1) provider fees and 2) medical utilization
IU’s Employee Medical Plans Relationship Between Members and Plan Costs 1% 12% 15% 29% 43% 8% of members = 58% of costs 28% of members = 87% of costs 71% of members = <14% of costs 14% of members with no costs 37% 20% 21% 7% 1%
IU’s Employee Medical Plans Relationship Between Members and Plan Costs for 2011 $ Per Member 5,180 mbrs 14% $ 0.0 --- $ 0 / yr 5,550 mbrs $ 1.9 m --- $ 342 /yr 15% 29% 43% 15,910 mbrs $ 22.8 m --- $ 1,433 / yr 7,400 mbrs 20% $ 55.1 m --- $ 7,446 / yr 2,590 mbrs $ 70.3 m --- $27,143 / yr 7% 1% 370 mbrs $ 39.9 m --- $107,838 / yr
Major Medical Program Initiatives • Initiatives that • Are applicable across all medical plan options • Complement or supplement provider and member activities • Integrated Clinical Care Services -- details to follow • Personal Health Record (PHR) • Personal web-based access to medical records, such as: contact info, medications, immunizations, illnesses, medical history, allergies, biometric tracking, legal documents, etc. • Data integration with Medco, Anthem, and IU Health/HealthSmart • Support for Clinical Care Services program (clinical portal) • Transparency • Member web-based access to: location of PPO providers; “price” for services by provider; “cost” for episodes of care by provider group/healthcare system; and quality measures & patient satisfaction
Major Medical Program Initiatives • Integrated Clinical Care Services • Improve access to primary care providers, for routine and urgent care • Dedicated care management team, for patients with chronic and/or complex medical conditions • Connectivity of medical records
Integrated Clinical Care Services • Virtual patient centered medical home • Essential components: • Primary care provider group(s) • Dedicated team of nurse care-managers • Electronic medical records system (EMR) • IU-based resources • Promotion to plan members • Expansion opportunities
Integrated Clinical Care Services • Primary Care Provider Groups • Physicians, nurse practitioners, physician assistants • Walk in care, same day appointments • After hours access: telephone, e-visits • Electronic Medical Records (EMR) system • Quality Health First program measures • Participate in care management activities
Integrated Clinical Care Services • Primary Care Provider Groups • Proposed initial rollout in Bloomington • East of the IU Bloomington campus • Sare Rd. – Premier Healthcare • Clarizz Blvd. – IU Health Southern IN Physicians • West of the IU Bloomington campus • Landmark Ave. – Premier Healthcare • Rogers St. – IU Health Southern IN Physicians
Integrated Clinical Care Services • Primary Care Provider Groups -- Proposed
Integrated Clinical Care Services • Nurse Care-Managers (including pt pharmacist) • Care transitions: hospital home, p-care specialty care • Medication management for chronic conditions • Registries for diabetes, high blood pressure, high cholesterol, asthma, heart failure, COPD • Outreach to patients with a chronic condition • Support self-management by patients • Triage agent
Integrated Clinical Care Services • Electronic Medical Records (EMR) System • Connectivity across all providers • Meet NCQA medical home standards • Includes e-prescriptions • Additional features: • Order & retrieval of lab and imaging tests • Patient portal for medical records, scheduling appointments, prescription refills, referrals • Connected with IU Health and IU Health Physicians
Integrated Clinical Care Services • IU-based Resources • Membership data: employees, retirees, graduate assistants and their families, who are covered by IU medical plans • Coordinate with existing care-management programs • Anthem, Aetna, Medco • Interface with existing programs: 24-hour nurse line, tobacco cessation, nutrition & weight management, Employee Assistance • Written and website communications
Integrated Clinical Care Services • Promotion to Employee/Retirees/Graduate Assistants • Greater access to primary care • Nurse care-manager for consultation • Enhanced medical plan coverage • Enhanced dental plan coverage • Electronic connectivity • Electronic Medical Record (EMR) • Personal Health Record (PHR)
Integrated Clinical Care Services • Expansion Considerations • Pediatrics in Bloomington • Adults in • Ellettsville • Bedford • Spencer • Nashville • Adults and pediatrics at other Indiana regions, especially where meaningful numbers of plan members reside
