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HealthCheck360 Medical Cost Gap Analysis
1. Medical Plan Cost Gap Analysis
AWellness Solution
April, 2014
HEALTHCHECK360.COM
Direct Phone: 563.587.5415
Roy.Lines@HealthCheck360.com
Presented By: Roy Lines, CFP®, CRPS®
2. Business stakeholders have a choice:
“Pay now through wellness programs or
pay much more in health care costs later…”
3. How does HealthCheck360° effectively limit rising health care costs?
Through a Performance – Based Health Management Program
A systematic way – to keep healthy employees healthy, improve the health of the
unhealthy and enables better care compliance for those with chronic conditions.
4. Our system has three broad categories of
benefits to business clients and prospects:
1. Cost Effectiveness
2. Ease of Administration
3. Verifiable & Manageable Results
4
How to Set Up HealthCheck360°’sValue Proposition
5. True or False?
All growth oriented business owners are
continuously searching for a competitive edge to
increase shareholder value.
and;
You want to be the one to share it with them.
5
How to Set Up HealthCheck360°’sValue Proposition
6. I thought of you while working on a medical cost
reduction strategy for another good client of mine. I’ve
done some additional analysis on your plan and I’d like
to show you a business financial strategy that is showing
some really good results in reducing health care spend
and improve operational efficiency by increasing
employee productivity at little or no cost to you? It’ll
only take about 8 minutes of your time.
6
How to Set Up HealthCheck360°’sValue Proposition
7. HealthCheck360°Trend Cost Gap Analysis
Plan information needed for HC360° to perform (medical plan
cost) trend gap analysis & show HC360 impact.
1. # of plan eligible EE’s
2. Type of Plan (Self/Partially/Fully Funded-PPO/POS, HMO etc.)
3. Medical trend rate for the past 3 years
4. Average plan cost/employee
5. Industry/Region
6. Type of HM program currently in place (if any)
8. WHY HAVE A HEALTHCHECK360° WELLNESS PROGRAM ?
$8,852
$9,054
$8,365
$8,967
$8,823
$8,247
$7,429
$7,861 $8,334
$9,033
$9,730
$10,346
0
2,000
4,000
6,000
8,000
10,000
12,000
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13
To Reduce Health Plan Medical Costs per Covered Employee
HC360 Actual Mercer Large Employers Trend
Question: Why are their health costs continuing to go up?
Answer: Traditional wellness programs are not financially focused
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Source: Mercer National Survey of Employer Sponsored Health Plans 2012 (Page 17)
12. IS IT COST EFFECTIVE?
$-
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
Year 1 Year 2 Year 3 Year 4 Year 5
HC360 Plan: Cost Reduction by 1% per Year
ABC + HealthCheck 360
Mercer 500
ABC
Savings:
Year 2: $29,232
Year 3: $100,266
Year 4: $228,276
Year 5: $431,219
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13. VERIFIABLE RESULTS
$6,000
$6,500
$7,000
$7,500
$8,000
$8,500
$9,000
$9,500
$10,000
$10,500
$11,000
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13
$8,852
$9,054
$8,365
$8,967
$8,823
$8,247
$7,588
$8,107
$8,506
$9,012
$10,221
$10,581
$7,429
$7,861
$8,334
$9,033
$9,730
$10,346
Health Plan Costs per Covered Employee
Actual Manufacturing Large Employers
A health plan competitive cost disadvantage of $1,264 per employee has been transformed into a competitive
advantage of $2,334 per employee
N=2,000 HC360 Manufacturing Client
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14. HC360° PROCESS: IDENTIFYTHE ROOT PROBLEM
IFYOU CAN MEASURE ITYOU CAN MANAGE IT
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Biometric Screening Findings
• 111 with glucose in diabetic range
• 580 with glucose in pre-diabetic
range
• 549 individuals with elevated
systolic and diastolic blood
pressure readings
• 815with elevated cholesterol
• 883 with BMI readings > 30, of
which 396 (44.8%) are also pre-
diabetic
Claims Information
• 50 individuals have claims with
diabetes or pre-diabetes
• 78 individuals have claims with
hypertension
• 98 individuals at risk of a heart
attack
N = 1,750 Manufacturing Firm
Management may already know… What if they knew…
15. QUANTIFY HEALTH RISK INYOUR POPULATION
15
0
20
40
60
80
100
120
140
160
180
40%
20%
35%
31%
19%
Projected Health Risks in ABC Population
# Health Risks
N=450
16. 12
4
16
4
16
4
100 Points
All of these health conditions
can be modified by a
combination of an employer’s
decision on financial incentives,
health behavior intervention &
compliance management
programming.
Most importantly, by the
employee’s health decisions!
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16
Scoring Model
17. CORRELATE RISK LEVELSTO HEALTH SCORE
HealthCheck360° Scorecard
Risk Level Correlated to HC360° Health Score
Ideal ≥ 86
Low 71-85
Moderate 61-70
High 51-60
Very High ≤ 50
HealthCheck360° has an easy to interpret scoring system that translates biometric
values into a simple to understand score that is highly correlative to health risk factors.
Ease of interpretation for both participants and company reports for analysis and
planning. Financial incentive strategies easily integrate with this progressive scoring
system and simplifies the reasonable alternative process.
18. TRANSLATE HEALTH RISKS INTO AN ACTION PLAN
(POPULATION HEALTH DISPERSION)
30.70% 31.10%
18.90%
10.20%
9.10%
Ideal
(85+)
Low Risk
(71-84)
Moderate Risk
(61-70)
High Risk
(51-60)
Very High Risk
(<60)
HC360 Sample Population Study: N=10,262 2012
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Keep
this
Group
Healthy
Improve
this
Group’s
Health
Drive
Behavior
Change &
Manage Care
Compliance
20. ESTABLISH YEAR 1 BASELINE TO SHOW Y-O-Y
POPULATION HEALTH IMPROVEMENT
R² = 0.9662
R² = 0.8815
66
68
70
72
74
76
78
80
82
84
20 25 30 35 40 45 50 55 60 65
HRATotalScore
Age
HC360 Repeat Participants vs Baseline
Baseline
HC360 Participants
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HC360 Sample Population Study, Baseline N = 38,000 2012
21. CORRELATING CLAIMS COSTSTO RISK LEVELS
HealthCheck360°
Risk Level Cost
Ideal $1680.35
Low $2279.46
Moderate $2855.74
High $3040.94
Very High $3879.80
Competitor
Risk Level Cost
“Best” $2260.85
“Moderate” $2676.97
“Poor” $3012.15
HealthCheck360° includes two additional levels of stratification to accurately identify
health risk levels. This gives consultants and business owners more accurate data to
create targeted interventions resulting in a much higher probability for cost reduction.
22. HealthCheck360° is unique because we provide a progressive
program that integrates participatory, activity-based and outcome-
based programming into one effective program.
Over 90% of our clients migrate towards outcome-based incentive
structures within 2-3 years.
HC360° can (and often does) integrate our Condition Management
(disease and compliance management) programming.
22
Why is HealthCheck360° Unique?
23. HEALTHCHECK360° 5-STEP BEST PRACTICES
• Objective biometric collection process
– Identify & measure health risks
• remove subjective predispositions from self-reported HRA
• Superior scoring algorithm
– Translate lab values into an easy to understand health score
• correlated to established benchmarks that are highly predictive of health costs
• Flexible and effective incentive management
– Motivate participation with flexible design that evolves with program
• Reward progress not perfection while maintaining HIPAA & ACA compliance
• Mitigate known and unknown health risks
– Multimedia engagement programs driven by individual biometric data
• Health coaching & Condition management programming
• Manage to maximize results
– Participation analysis, Engagement levels & Risk migration
• Claims integrated client specific reporting
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24. HealthCheck360° is not just another wellness provider.
HealthCheck360° has a financially focused, easy to
adopt 5-step best practices health management
program that is unique, cost effective and delivers
verifiable results to enable company stakeholders to
effectively mitigate and manage health care costs while
at the same time improve the health and productivity of
their employees.
24
HealthCheck360°’sValue Proposition
25. HealthCheck360°sValue Proposition
HealthCheck360° provides stakeholders with an easy to adopt and implement
five step best practices health management system.
Our system is unique, cost effective, delivers verifiable result and reduces the
administrative burden of doing it alone saving both time and money.
When integrated with a well designed health plan, our results driven system
leads to healthier and more productive employees resulting in increased
operational efficiency and a reduction in total health care costs.
Provide management with insightful and actionable information.
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26. BENEFITS GAINED
Effectively manage your wellness program –
• like you manage your business; with employee accountability, goal achievement and more predictable outcomes
A systematic way to achieve better health outcomes –
• which will mitigate your health spend while increasing productivity resulting in higher operational efficiency and profitability
Expert consultation enables you to set realistic goals and benchmarks –
• Enables management, employee benefits team, consultants and providers to effectively monitor, measure & manage for program success
Saves you valuable time in the strategic planning process –
• results in developing an evolving program that is congruent with your corporate goals and initiatives
Effectively analyze your population’s health risk migration –
• and correlate to claims data; better enabling predictive modeling alignment with ROI expectations
Program is designed to be cost neutral –
• program hard costs will have minimal impact on cash flow if implemented as recommended
Program is administratively simple and efficient –
• Saving you both soft & hard dollars on administering your wellness program
With access to an employee’s Personal Health Information –
• we are in the best possible position to influence a shared vision of good health and healthy habits
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27. BENEFITS GAINED
Expertise with HIPAA and HITECH regulations –
• compliance oversight maintains your program integrity and reduces time and cost for staff
Expert consultation on prudent financial incentive strategies –
• that are intuitive and member specific programming will foster high participation and engagement; ensuring program sustainability and overall goal
achievement
Empowering employees to take more personal responsibility –
• Over their health increases their confidence in the program resulting in sustainability
A trusted partner –
• you can depend on HealthCheck360° for world class customer service and support
A systematic way –
• to keep your healthy employees healthy, improve the health of the unhealthy and enables better care compliance for those with chronic conditions
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28. HEALTHCHECK360° CONTACT
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For a meeting, webinar or plan proposal call or email:
Roy C. Lines, CFP®, CRPS®
Sales Executive
Office 563.587.5415 | Cell 563.599.2844 | Fax: 563.587.6602
www.HealthCheck360.com | Roy.Lines@HealthCheck360.com
HealthCheck360° 800 Main Street | PO Box 1475 | Dubuque, IA 52004-1475
