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State of Ohio Health Care Model

State of Ohio Health Care Model. Dirk Raderstorf, Senior Benefits Manager. Current Picture of State Health Care. 60,000+ employees eligible from 220+ different locations throughout the state Roughly 53,000 employees currently have elected health care coverage. Health Plan Options .

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State of Ohio Health Care Model

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  1. State of Ohio Health Care Model Dirk Raderstorf, Senior Benefits Manager

  2. Current Picture of State Health Care • 60,000+ employees eligible from 220+ different locations throughout the state • Roughly 53,000 employees currently have elected health care coverage

  3. Health Plan Options • 1 PPO: Ohio Med (SI*) – State-wide coverage • 5 HMOs • Aetna (SI) – 70 Ohio counties • UnitedHealthcare (SI) – 63 Ohio counties • Paramount (FI**) – Northwest Ohio coverage • Qualchoice (FI)- Northeast Ohio coverage • The Health Plan (FI) – Southeast Ohio coverage • At least 2 health options per county *Self-Insured **Fully-Insured

  4. Current Plan Design • PPO & HMO are very similar • PPO – deductibles; out-of-network benefit; mandatory mail-order for drugs • HMO – no deductibles; no out of network benefit; voluntary mail order

  5. Employee Health Premium Contributions • 10% of premium through FY05 • 15% for FY06

  6. Financial Experience: PEPY* 13% 17.7% 8.6% 4.4% 3.6% 4.2% % Increase *Per Employee Per Year **Projected

  7. State’s Health Care Spending *Projected

  8. Health Care Trends *Projected

  9. State Strategies • Carved out behavioral health: All Plans (’90) • Mandatory mail-order: Ohio Med (’92) • Aggressive cost shifting to employees in last collective bargaining agreement (FY04-FY06) Consumerism • Carved out disease management: Ohio Med (’04) • Joint Health Care Committee (JHCC)

  10. So, Do We Have The Health Care Problem Solved? Absolutely Not!

  11. What Happens If We Stay Status Quo? *FY06 based on trended experience to date and FY07-FY09 based upon 10% annual trend rate

  12. Future Strategies • Expand Disease Management Programs • Current Conditions; • Asthma, Coronary Artery Disease, Diabetes, and Cancer • New: • Congestive Heart Failure, Severe low back pain and Obesity • Promote Consumerism • Health risk assessment with incentives • Population Health Management Programs • Eligibility Management • Every organization/consortium/.... has its own objectives, culture issues, utilization experience,.... that needs to be reconciled for a pooling concept to be successful.

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