ACO = HIE + Analytics - a Healthcare IT Presentation
Kick-Off Presentation - July 30, 2009
1. Get in the game with Humana!
Broker Kick Off Event - Thursday, July 30
Let’s huddle up to
discuss Humana’s
integration with
Cariten Healthcare!
1
2. Game Plan
Welcome & Humana Overview - Evans Looney
Integration Update - Tim Moorhead
Products, Solutions and Quote Processes
– Large Group & Specialty - Tim Moorhead
– Small Business & Specialty - Bryan Wenger
Q&A
2
4. National Snapshot
Fortune 100 company with revenues of approximately
$30 billion, employing 29,000 associates
One of the nation’s largest publicly traded
health benefits companies; founded in 1961 as nursing
home and later evolved to hospital operator
10.4 million medical members nationwide
More than 5 million specialty product members
110 hospital system clients; largest single industry
Integrated national networks with 450,000+ providers
First health benefits company awarded ISO 9000
Ranked #6 among all U.S. companies in all sectors for
technology leadership
Offer full spectrum of consumer-choice solutions
Industry-leading clinical, network, eHealth, service and
technology solutions
4
6. Integration Journey
Where we have been…
Acquired Cariten/PHP on October 31, 2008
Developed an integration plan to leverage strengths of both
organizations
Aligned Cariten teams within Humana structure
Combined Cariten’s regional network with Humana’s national network
to increase provider access and employer savings
Added Open Access HMO and NPOS products to Humana-
Tennessee’s portfolio of Traditional and Consumerism solutions
6
7. Commercial Network Strategy
Humana Provider Networks
PPO
Cariten Provider Networks ChoiceCare
ChoiceCare +
Preferred PPO
PPO HMO
HMO HMO Premier
POS HMO Select
POS
Expansion to Preferred POS - OA
national & NPOS-OA
regional NPOS-OA+
network solutions
7
8. Network Strength
Highly stable networks and positive provider
relationships
Humana ranked #1 in annual PayerView rankings by
Phyisician’s Practice magazine
Leading the industry to streamline claims process,
simplifying back office systems for doctors’ offices
In short – providers prefer us and that means
fewer network disruptions for members
8
9. Our Medical Networks
Tri-Cities
Knoxville
National PPO & NPOS Networks
HMO (Most Competitive Cost of Care)
Humana Preferred Networks (HPN)
9
10. Commercial Product Strategy
Humana Portfolio
• PPOs
Cariten Portfolio • HDHP & HRA Plans
• PPOs • Gated HMO
• HDHPs • Open Access HMO
• Gated HMO Planful transition • National POS
• POS to Humana • CoverageFirst
• Sevier First solutions as • SmartSuite
• Vendor RX Support business renews • SmartResults
• HumanaRewards
• HumanaRX Solutions
• HumanaOne
• Humana Specialty
10
12. Integration Journey
Where are we going…
New Humana Product Portfolio with Enhanced Network
Quote new business starting 8/1/09 for 9/1/09 and later effectives
Offer Humana renewals to existing business starting 12/1/09
Create a Superior Experience …
Broker and employer education sessions
Provider communications and education sessions
Member communications
12
13. New Business Quotes
Quoting & Effective Dates
– Medical Products
– Quoting August for effective dates of September and later
– Dental, Life, Disability, Voluntary, Stop Loss and Worksite Products
– Already in place
Get a Quote!
– Small Business
– Contact your sales representative for 2-99 eligible employee groups
– Go online to Easy Rate at Humana.com for single-location, 2-50 groups
– Call Easy Rate at 1-800-327-9728 or 1-800-243-6827 for 2-99 groups
– Fax to 1-800-344-3294 or 1-800-432-4805 for 2-99 groups
– Email ezrate@humana.com for 2-99 groups
– Large Group
– Contact your sales representative for 100-999 eligible employee groups
– Contact Barry Boster at 615.221.2155 ext. 1030610 for 1000+ groups
13
14. Integration of Cariten Producer Compensation
Maintain (i.e., “grandfather”) existing commission schedules on customers initially sold
Cariten plans, even after migration to Humana products and platform
All new business sold with a September or later effective date will be compensated
based on Humana commission schedule and our Volume Growth bonus programs
(Cariten had no volume-based program. We will credit all Cariten medical production,
in force prior to 2009 and new in 2009, towards Humana's bonus(es) and Leader's
Club criteria.)
Leaders Club
Concierge service to handle your claims,
billing, and enrollment, as well as customer service issues
HumanaWatch, a daily e-mail with news coverage about
Humana, our competitors, and the healthcare industry
Preferred quote and new case processing
Invitation to special events with Humana leaders
Free continuing education courses
14
16. Our Approach
A comprehensive approach to help
members manage their health through
behavior change and improve their
experiences in choosing, financing
and using their benefits
•Engages consumers in sustainable
behavior change
•Involves action and participation of all
parties
• Employers, members, providers,
brokers, and Humana
•Results in improved health status
for employees and an improved
bottom line for employers
16
17. The Humana Guidance Solution
Product and Network Design
2000 Clinical Programs and Forecasting
• Traditional plans • Disease Management
• Transplant Management
• Utilization Management
• Concurrent Review
Product and Clinical • Case Management
Network Programs and • HumanaBeginnings
Design Forecasting • HumanaFirst®
The
Humana
Guidance
Solution
Consumer Education
Financial Analysis and Forecasting
Consumer Financial
Education Analysis and
Forecasting
17
18. The Humana Guidance Solution
Product and Network Design 2008 Clinical Programs and Forecasting
• Traditional plans • Disease Management
• Real-time operating platform • Transplant Management
• SmartSuite® • Utilization Management
• CoverageFirst® PPO • Concurrent Review
• HumanaAccessSM card • Case Management
• RxImpact • HumanaBeginnings
• Wellness programs Product and Clinical Programs • HumanaFirst®
• Medical spending accounts Network and Forecasting • Humana Health Assessment
Design • Personal Nurse®
• HDHP with Health Savings Account
• Humana Preferred The • MyHumana personal web page
• 90-Days-at-Retail Program • Maximize Your Benefit
• RightSourceSM Humana • Predictive modeling
• SmartResultsSM Guidance • Health Agent
• Pharmacy MEDS Team
Solution
Consumer Education Financial Analysis and Forecasting
Consumer Financial
• Online Enrollment Center and Wizard Education Analysis and
Forecasting • SmartStart
• MyHumana personal Web page • Customer Reporting Package
• Physician Finder Plus • Benefit Utilization Director for brokers
• Transparency tools • Employer portal tools
• Healing Kitchen • RxCalculatorSM
• Family Health Budget • Pharmacy Repricing and Formulary
• Comparative Pricing by Pharmacy • Verisight Analysis
• YourHumana Handbook • MD Consultation
• SmartSummarySM
18
19. Product: A Multi-Year, Phased Approach
Premise #1: 12 months does not make a trend Smart Products and Population
Premise #2: Consumers want choice Health Management
Premise #3: There is no silver bullet • 3-6 plans (min. of 2 CDHPs)
• Defined contribution strategy
• Reduce risk/cost variability
• Moderate cost trends over time
High
Traditional Plans and
Value of Benefits Strategy
• Behavior change via actionable
Disease Management information/transparency, clinical
• Reduce acute illness costs outreach/guidance and wellness/
• No consumer engagement workplace productivity initiatives
Transitional Plan Strategy
Single & Dual and Clinical Guidance
• Triple option, incl. a CDHP
Option Traditional • “Bridge” contribution strategy
Plans Only • Reduce acute illness and chronic
condition costs
• Early-stage impact on cost trend via
initial consumer engagement
No/Low
Low Employer/Employee Engagement High
19
20. SmartResultsSM In Three Easy Steps
• Offer Humana HMO
• Include a CDHP • Offer SmartSuite
or PPO plan
1
Traditional Transitional SmartSuite
Employer chooses
the plan strategy • Trend factor • Trend factor •Trend factor
as low as 9% as low as 7.5% as low as 6.0%
2 Health risk data for Employee participation Ongoing partnership
earlier intervention in for better choices and with long-term
Partnered approach health conditions better health impact
for employee
engagement
Review Scorecard progress during
3 Track
service level consultative sessions
performance
Employer, broker &
Humana monitor View progress on participation goals
progress against
targets Detailed program participation data
20
21. Member Guidance: Humana Pharmacy Solutions
We employ over 1,600 employees and approximately 160 pharmacists
We process over 250 million prescriptions and over $13 billion in spend, approximately
$11.5 billion is Humana’s risk
One of the first PBMs to earn the URAC Pharmacy Benefit Management Accreditation
Products: Rx3, Rx4, RxImpact and Mail-Order Rx (RightSource)
Humana Pharmacy manages its book of business using a “net cost management”
approach versus a “rebate maximization approach”
In 2007, Reden & Anders compared our Rx claims data against their benchmark
database (Caremark, ESI, Medco, United, etc.)
Reden & Anders Comparison
Humana Benchmark Difference
Total PMPM 55.56 59.82 -7.10%
Cost/Day 2.43 2.52 -3.60%
Utilization 274.5 284.41 -3.50%
21
22. Clinical: The Guidance Solution Delivers
Better health outcomes
– Health promotion and disease prevention
– Condition management
– Increases productivity
Better opportunity for cost savings
– Enhanced identification and engagement
– Focus on major clinical conditions / cost drivers
Better health benefits experience – for everyone
– Member support, whether ill or healthy
– High employee satisfaction
– Ease of administration (HumanaFirst)
The bottom line
• Commercial members engaged 14%
• Total costs engaged with Health Resources 64%
• Total cost savings 4-6%
• Savings PMPM $11-$15
22
24. Consumer: Health & Wealth Guidance
www.staysmartstayhealthy.com
Click Here
24 Click Here
25. Wellness Designed to Fit
A Continuum of Wellness Solutions
Core Wellness Package Wellness Plus Package Custom Wellness (a la carte)
• Self-help web content • Tailored Web Program • Wellness Consulting
(MyHumana) • Telephonic Health • Onsite Wellness Programs
• Wellness Monthly Coaching • Print Collateral
Calendar (Tobacco Cessation, Stress
Management, Back Care, Weight
• Physical Activity Incentive
• Preventive Reminders Management, Physical Activity, and Reward Program
• Humana Health Nutrition)
Assessment (HHA)
Humana’s CareHub
•Complete integration of infrastructure and data (2008)
•A single view of the member
HumanaFirst Personal Nurse Case Management
HumanaBeginnings Disease Management Transplant Management
NICU Case Management (CAD, HF, Cancer, Asthma, CKD, ESRD, Utilization Management
Behavioral Health Management Diabetes, Rare Diseases) Employee Assistance Programs
25
26. Virgin HealthMiles
The first-of-its-kind incentive program for physical activity
Engagement and communications to promote increased activity and track results
– Members log exercise, count steps, measure results: BMI, body fat percentage, and blood
pressure using the LifeZone web site, GoZone pedometer, and HealthZone kiosk
Flexible Incentive fulfillment platform
– Accumulate HealthMiles for effort, measurement, and achievement, then redeem miles for
rewards at over 40 leading U.S. retail partners
26
27. Our Results: Behavior Change and Improved Health
Smoking
Smoking Weight Mgmt/
Weight Mgmt/ Stress
Stress
Nutrition
Nutrition Back Care
Back Care
Cessation
Cessation Physical Activity
Physical Activity Management
Management
Over 52% Over 57% lost 95% have Over 56% Over 47%
remained weight made a decreased improved and
smoke free positive personal better manage
Of those with a
after 180 days change in their symptoms of back pain
BMI of >30:
of beginning eating habits stress after
29% lost more
the program enrolling in the
than 5% of
program
their body
weight
10% lost more
than 10%
27
29. What is Perfect Service?
What Perfect Service means to Humana
Delivering unexpected value and quality
Providing guidance on complex needs
Going beyond satisfaction
Creating engagement with those we
serve.
Building a proactive culture.
Making what’s most important to those we
serve, most important to us
An aspirational journey
– that changes as those we serve
and as we ourselves change.
29
30. Member Service
How we measure performance:
National Call Quality
Enhanced our National Call Quality processes and measurements are
aligned with Perfect Service in a new Call Quality form. Implemented -
January 2007
ECHO – Voice of the Customer
Provides a random outbound-automated survey to our members,
helping us ‘hear’ real opinions of their experience with Humana.
Implementation – Pilot in progress
REACH
New version rewards CCS for using the Perfect Service filter in what they do every day by a
changed weighting system that better balances quality and time. Implemented - January 2007
30
31. Member Service: Customer Satisfaction Technology
Customer Rep knows that
Customer Rep knows that
in the past 30 days almost
in the past 30 days almost
94% of her customers
94% of her customers
have been satisfied or
have been satisfied or
very satisfied with the
very satisfied with the
service she provides.
service she provides.
Rep can
Rep can
access
access
specific
specific
information by
information by
clicking on
clicking on
any of these.
any of these.
CCS = Customer Care Specialist 31
32. How do we measure up?
Just released for 2009, J.D. Power ranks Humana # 1 in overall
satisfaction and service delivery among all national health plans!
2009 Overall Plan Rankings
& Satisfaction Score
1. Humana 718
2. Wellpoint 708
3. CIGNA 706
4. Aetna 698
5. United 696
SOURCE: JD Power 2009 Commercial Health Insurance Plan Study
High = top 25th percentile, Medium = middle 50th percentile, Low = bottom 25th percentile
32
33. Large Group Client Support Team
Report/
Implement Serve/ Serve
Renew
Lisa Johnson
Director,
Melissa Trelfa Melissa Trelfa
Account Management
Director, Director,
Account Services Account Services
(Plan build oversight) (Escalated service issue
Sales Executive Account Advisor oversight)
(OE meeting (Escalated service
oversight) issue owner/liaison)
TBA
Account Implementation Account Executive
Manager or Coordinator (Overall client
(Plan build project manager) relationship owner)
Corporate Resources Market Resources Corporate Resources
33
35. Enhancing Our Product Portfolio
30+ years of experience 18 years of experience 50 years of experience
Dental, life and vision Dental and vision services Single source solution for
services 4.8M members ancillary services and
2.9M members Broad dental and vision voluntary benefits
Broad dental and vision networks Well-respected TPA
networks 1.1M members
Specialty Benefits
35
36. Options to Fit Your Clients’ Needs
You can offer employer-sponsored or voluntary funding
options to clients of all sizes.
Dental Vision Health & productivity
PPO Vision Care Plan Employee assistance
Traditional Preferred Advantage, Focus, & work-life
Advantage Plus Optimum Wellness / healthcare
DHMO
Preventive Plus coaching
Disability
Short-term income Behavioral health
Life protection
Basic term
Long-term disability
Voluntary term
Level term
AD&D Accident
Whole life Critical illness
Lifestyle – Care Life
and Critical Life Supplemental health
36
39. Sales Support and Service
You’ll receive exceptional sales support and
service to sell and keep more business, and to
maximize your earnings:
Local Humana sales executive helps you sell new
business
Retention executives and online resources help Other benefits include:
you renew cases
• Centralized billing
and enrollment
Dedicated Small Business Customer Care team to • Group-dedicated
serve your clients billing representative
• State-specific plan change
and service teams
39
40. Our Business Is to Help You Grow Yours
Here’s what you can expect:
Exceptional sales support and service
Online resources to quote, enroll, and manage your business
Broad product portfolio
Direct access to underwriters
Convenient, fast quotes
Welcome calls to all new groups
Wellness and employee assistance programs
Plan utilization reports
Comprehensive renewal reports
Competitive commission and recognition programs
40
41. Our Broad Product Portfolio
With Humana’s broad product portfolio, you can deliver an even
more competitive benefits package to your customers. We offer
employer-sponsored and voluntary benefits including:
• Medical • Disability
• Dental • Critical Illness
• Vision • Supplemental Health
• Accident
• Life
41
42. Humana Product Continuum
Traditional benefits with a wide
range of out-of-pocket options
First step toward
consumer-directed plans
Innovative, cost-saving solutions
with banking arrangements
42
43. P0S Product Small Business
POS: Cariten to Humana
Plan Design In-Network Out of Pocket (excludes deductible)
• 100/60 to 100/70 • $750 to $2000
• 90/70 to 90/60 • $1000 to $1000 (90% plan)
• 80/60 to 80/50 • $1000 to $2000 (70% and 80% plan)
• 70/50 to 80/50 • $1500 to $2000
• $1750 to $2000
ER Copay • $2000 to $2000
• $100 to $150 • $2250 to $3000
• $3000 to $3000
In-Network Copay
• $3500 to $4000
• $20/$35 to $20/$40
• $4000 to $4000
• $25/$40 to $30/$50
• $5000 to $4000
• $30/$45 to $30/$50
• $5500 to $4000
• $35/$50 to $30/$50
• $40/$55 to $30/$50
In-Network Deductible Additional Deductible Options:
• $250 to $250 $3000
• $500 to $500 $4000
• $750 to $1000 $5000
• $1000 to $1000 $6000
• $1500 to $1500 $7000
• $2000 to $2000 $8000
• $2500 to $2500
43
44. PPO Product Small Business
PPO: Cariten to Humana
Plan Design In-Network Out of Pocket (excludes deductible)
• 100/60 to 100/70 • $750 to $2000
• 90/70 to 90/60 • $1000 to $1000 (90% plan)
• 80/60 to 80/50 • $1000 to $2000 (70% and 80% plan)
• 70/50 to 70/50 • $1500 to $2000
• $1750 to $2000
ER Copay • $2000 to $2000
• $100 to $150 • $2250 to $3000
• $2500 to $3000
In-Network Copay • $3000 to $3000
• $20 to $25 • $3500 to $4000
• $25 to $25 • $4000 to $4000
• $30 to $35 • $4500 to $4000
• $35 to $35 • $5000 to $4000
• $40 to $35 • $5500 to $4000
In-Network Deductible Additional Deductible Options:
• $250 to $250 $3000
• $500 to $500 $4000
• $750 to $1000 $5000
• $1000 to $1000 $6000
• $1500 to $1500 $7000
• $2000 to $2000 $8000
• $2500 to $2500
44
45. Standard PCA (HRA)
A coinsurance PPO plan combined with a personal healthcare
spending account
Positively engage consumers — generates long-term savings
Employer funded
HumanaAccess card
45
46. Personal Care Account (PCA)
How does it work?
You use funds to pay for eligible medical and
pharmacy expenses
PCA funds can be applied to the deductible
Once all the funds are spent, you must satisfy the
deductible and pay the specified coinsurance
amount
You always have protection against medical
expenses for catastrophic illness or injury
Simple plan design:
– Preventive covered 100%
– Exception endoscopic services for Small
Business
– Everything else coinsurance after deductible
46
47. Humana HDHP 08 With Optional HSA
An HSA qualified HDHP plan available with or
without an HSA
Preventive care at 100 percent
Medical and pharmacy—integrated deducible
HSA covers medical plan deductible,
coinsurance, and other qualified services
HSA offered through UMB Bank
Both integrated and embedded family
deductibles available
47
48. Humana CoverageFirst 08
The easy first step toward
consumer-choice plans
No banking arrangements
All the benefits of a full PPO
plus an up-front allowance of $500
Allowance built in to the plan design
Motivates employees to
use their benefits wisely
Guides employees in becoming
informed consumers of health care
48
49. CoverageFirst
Product Details
$500 allowance covers:
– Doctor’s office visits
– Routine outpatient labs and x-rays
– Hospital services, emergency room services and outpatient surgery
– Other services such as home health care, physical therapy and
hospice care
Allowance does not cover:
– Prescription drugs
– Mental health treatments (unless mandated) – only until 11/1/09 due to
Federal Mental Health Parity
– Copayments
– Services from non-participating providers
Unused funds do not carry-over from year to year
49
50. CoverageFirst
Positioning
Feels like traditional PPO plans
– Par/Nonpar providers
– Copayments for some benefits; ded/coins for others
First dollar coverage
– $500 per member
– Allowance is used for expenses prior to paying the deductible
Allowance promotes financial involvement and incentives
– Members see allowance as “their” money
– Members more apt to take active role in decision-making and budgeting
– Encourage utilization from participating providers
Preventive covered at 100% after copay
NOT a lower price alternative, but a baby step into consumerism
50
51. Benefit Design Solutions for Today and Tomorrow
Provide guidance with choice and flexibility
Traditional benefit designs
– Rx4: Tiered by cost, more sophisticated
Value-based benefit designs
– RxImpact: Unique
51
52. Rx4
Most plans group drugs by generic, preferred brand, non-preferred brand and specialty
– This is not sophisticated enough given the variance in the gap between
generic and brand drug pricing
Humana’s Rx4 groups drugs by cost
– Tier 1 – lowest cost brands and generics
– Tier 2 – higher priced brands and generics
– Tier 3 – high cost (mostly) brands with less expensive alternatives
– Tier 4 – Specialty drugs
Some drugs have been moved to less expensive tiers due to proven medical efficacy
(e.g., Procrit and Lovenox)
52
53. RxImpact
Drugs grouped based on:
– Medical efficacy
– ROI
– Timeframe for “medical payoff”
Each drug in a class is in the same level
Group A Evidence-based short-term effectiveness (acute)
(asthma, infections, juvenile diabetes, antidepressants)
Group B Evidence-based long-term effectiveness (chronic)
(cancer, heart disease, MS)
Group C Drugs that provide symptom relief
(antihistamines, anti-inflammatory, antacids)
Group D Drugs that may impact lifestyle
(sexual dysfunction, cosmetic, obesity, smoking cessation)
Turns the member into the ultimate consumer
53
54. RxImpact Example
Each tier has an allowance assigned to it
– Members pay the difference between the allowance and the
discounted cost of the drug
– Members had $0 expenses 65% of the time
Retail Plan
Drug name Quantity Allowance Member Pay
Cost Pays
Fluoxetine 20mg 30 $14.99 $30.00 14.99 $0.00
Lexapro 20mg 30 $89.99 $30.00 $30.00 $59.99
Cymbalta 30mg 30 $130.32 $30.00 $30.00 $100.32
Drug price source: www.drugstore.com, 10/01/2008
54
55. Pharmacy Choices
Rx Impact Rx4
Employers save 2 to 5 percent Eliminate unexpected charges
on premium at the pharmacy
About 60 percent of prescriptions Drugs are grouped into four levels, each
have no out-of-pocket cost to with corresponding copayment amounts
employees
85 percent of prescriptions filled are those
If there is a cost to the employee,
the average is $16 with the lowest copayments—those in the
first two levels
Out of pocket protection
– $100 cap per prescription
– $2,500 annual maximum
(groups A, B, C)
55
56. Fast, Convenient Quotes
Receive medical, dental, and life quotes in easy-to-use
Excel and PDF formats. You can:
• Quickly compare health plan choices
• See market popular plans
• Filter data to view specific plans and
benefit options
• Model premium costs for your clients
and their employees
56
57. Talk Directly to Your Underwriter
Humana’s underwriters provide you with the support you need to sell more
cases, both new and existing business:
Direct access to underwriters
Local expertise to ensure your clients receive the
best fit in products and rates
Meet face-to-face with your underwriting team
during Underwriting Days
– Next session: September 16t and 17
Express underwriting/phone, fax and e-mail, or
produce a quote request online and receive a firm
risk rate, in most cases, within 48 hours
57
58. See How Your Clients Used Their Benefits
Using Humana’s exclusive
Benefit Utilization Director (BUD)*,
you can view how often employees:
• Visit their doctors
• Purchase prescription drugs
• Meet deductibles and
out-of-pocket maximums
Knowing how health benefits are
Plus, create a customized packet used will help you build more effective
to share with your clients. strategies for your clients.
* Available for groups with 5 - 99 employees
58
59. Easily Explain Your Clients’ Renewals
The Renewal Center provides transparency of the renewal
process and helps you clearly explain your clients’ renewals.
The Renewal Center contains:
• Client renewal letters
• Renewal rates and rate details
• Census information and health status
• Alternate quote summaries
• Enrollment and plan change forms
You can view the data the way
you prefer: e-mail, paper, or Web.
59
60. Communicate With Employers
Humana works closely with you to help your clients manage
their plans and control healthcare costs. We provide:
Welcome calls to all new groups
Employer welcome kit sent to every new group
HealthMatters, which offers ideas on how to control
healthcare costs and tips for managing their plan
Humana Health Plan Guide, which shows employers
how their employees use their benefits
60
61. Help Members Choose, Use and Finance Their Benefits
We help employees manage their plan, take control of their
health, and better understand their healthcare costs by offering:
Member enrollment kit
Member welcome kit
Educational materials on Humana’s wellness
resources
SmartSummarySM, a quarterly statement to
help employees keep track of their healthcare
spending
MyHumana, a password-protected personal
page on Humana.com
61
62. Humana’s Health Resources
Your 2 - 99 clients automatically receive
a comprehensive health and wellness
program that includes:
• Humana Health Assessment
• Personal health coaching
• Discounts on health products
and gym memberships
• Employee assistance program Healthier employees use
fewer healthcare dollars,
• Disease management / clinical programs
and have fewer claims,
miss less work, and are
more productive.
62
63. Quote, Enroll and Manage Your Business Online
The agent section on Humana.com has resources to help you do
business with us, and service your clients. You can:
• Order marketing materials If you haven’t registered yet,
go to Humana.com and
• Submit a quote
click on “Agents” and
• View utilization reports “Register Today.”
• Access comprehensive renewal information,
including rate detail and census information
• Perform administrative functions on behalf of
your clients
• Get details about our compensation, bonus,
and Leaders Club recognition programs
63
64. Producer Partnership Plan
Strong first-year and renewal
commissions for all lines of coverage
– 2-3 lives per case 5%
– 4-25 lives per case 7%
– 26-50 lives per case 5%
– Paid on base premium
Quarterly bonuses for growing block of
business with Humana
64
65. Leaders Club
Become a member of Leaders Club and enjoy the
beauty of San Francisco, along with other rewards
such as: 20th Anniversary of
Humana’s Leaders Club
Concierge service to handle your claims, The Ritz-Carlton Half
billing, and enrollment, as well as customer Moon Bay, California
service issues May 2-7, 2010
HumanaWatch, a daily e-mail that links news
coverage about Humana, our competitors,
and the healthcare industry
Preferred quote and new case processing
Invitation to special events with
Humana leaders
Free continuing education courses
65
66. Summary
100 percent of our small business
products are distributed through you,
our valued broker partners
We help you educate your clients on
solutions to control their healthcare
costs
We give you information so you can
recommend the most appropriate,
cost-effective healthcare plan
We listen to you and act on your
feedback
66
68. Kick-Off Contest
First three producers who place Humana medical product sale
(8/1 and later quote date) will receive Garmin GPS devices
Producer who places first multi-line sale (8/1 and later quote date)
will receive:
8 tickets and use of skybox
UT vs. Auburn Game
October 3, 2009
Medical + Dental / Life / Voluntary / Worksite
68
69. Get in the game with Humana!
Thanks for
attending!
69
Hinweis der Redaktion
- PPO and NPOS in every state. NPOS uses the best available contract with the doctor and hospital. For example, if we have the doctor contracted on an HMO and a PPO, the NPOS network will use the HMO negotiated fee in place of the PPO for claims. HPN available where noted HMO available where noted
Industries have educated consumers to move along a “ sophistication” spectrum of products and services When the movement happens it’s barely noticed because it happens over time and then is ingrained-- ATM’s, cell phones, lap tops Because movement takes place in so many areas, one area influences others-- lattes and sushi (new higher-end foods) What does migration mean to the consumer? Better products, greater value, new ways to get things done, and options/choice/control
Integration is key.
SCRIPT: There are three simple steps, or phases to implement SmartResults. Let’s look at those three steps in a little more detail: Chose the strategy you and your employees are comfortable with Over the three years, you can stay in one category, or move toward better trend mitigation by embracing consumerism. In setting your claims cost guarantee, we will apply a trend factor to set your next year's claims cost target. Based on the plan chosen and how well you rate on your Scorecard employee/employer participation levels, your trend factor is capped at a particular percentage. For instance, if you are a SmartSuite group and you meet your Scorecard participation levels, your trend factor is capped at 6%. And if your actual claims projection considering the behavior change credit is lower than the claims projection using 6% trend, then the actual claims projection prevails. Be rest assured you will always benefit from the lowest claim projection. Partner with us for engagement and improved health outcomes which involves three key elements: Health Risk Data Obtaining health risk data for earlier intervention includes collecting the information that helps identify those with chronic health conditions. Data collection includes: For new employers -- providing an electronic file of pharmacy claims data for new 1000+ accounts, Clinical programs participant list from previous carrier Completion of disclosure forms for large claims and high-cost conditions, Encouraging employees and spouses to complete Humana Health Assessment Employee Participation Getting employees actively involved leads to better health benefit choices and health improvement. Participation includes: Providing valid phone numbers for employees, using Humana’s communications package, and allowing Humana to contact employees directly, Supporting Humana’s clinical programs and encouraging employees to switch to lower-cost Rx when applicable for employees, Consider buying-up to Humana core wellness offerings for employees Ongoing Partnership Humana is seeking a partnered approach with you and your broker to deliver healthier outcomes and keep costs in line for everyone. This means agreeing to a three-year program commitment, purchasing Humana’s full spectrum of products – no carve-outs for mental health, pharmacy, etc., and having face-to-face meetings with your broker and Humana. 3. Review results with Humana and your broker, using the Scorecard As we work together we will track and review your progress through a scorecard. Based on the scorecard results, we’ll work together to make any needed changes to the action plan. The scorecard is delivered periodically, avoiding surprises late in the year.
Ultimately, what does all this mean for Humana’s customers? We reach over 14% of members with our focused / nursing interventions. This 14% represent about 64% of medical spending. This does not mean that those members that represent the remaining 36% of spend are not supported. For these lower utilization members, Humana offers a wealth of tools and information through the personalized website, MyHumana. Additionally, the new Smart Summary connects with members on the individual level, allowing for tailored clinical messaging. Through the use of the focused programs and services, Humana is able to reduce the total costs of medical services by around 5%. This is money taken off the table, as members have better outcomes and use the health care system more efficiently. Bottom line – Humana saves $11-$15 per member per month. This is not a per participant number… but per Member . These calculations were based across the fully insured commercial book of business. Particular savings and participation levels may differ depending on product selection (HMOs often see more financial savings than PPOs), demographic of population, proper contact information, etc.
Lisa had been diagnosed with asthma, a chronic disease, about 10 years ago. She recently worked with a Personal Nurse to get her asthma under control. Before being insured by Humana, Lisa had a partial knee replacement of her left knee. Her doctor recently told her she needed a replacement of the right knee. Lisa shared this information with her Personal Nurse. When Lisa expressed interest in a second opinion, the PN showed Lisa how to access My Humana to find a physician in her network, and then helped Lisa compile a list of questions for the doctor. The PN started pre-service guidance, then referred Lisa to a Case Manager for assistance getting post-op rehab. After the surgery, Lisa resumed working with her PN on her return to full mobility and a healthy life.
NATIONAL CALL QUALITY: As we continue on our journey towards Perfect Service, we see our roles and our tasks with a new and enhanced perspective. We now see them through the view provided by the Perfect Service Filter. When we apply the Perfect Service characteristics to the things we do every day, we see opportunities to improve the way we work and to improve our valued customers’ experience with Humana. To adapt to this new Perfect Service perspective, we enhanced our National Call Quality measurements and realigned them with Perfect Service as shown in the new Call Quality form. ECHO: To help us ‘ hear ’ the voice of our customer, Humana will be implementing a great tool called Echo. Echo is a program that will provide a random outbound-automated survey to our members. Echo provides an opportunity to listen to the voice of our customer and to gauge their experience with Humana. Our customers are asked a series of questions about their experience on their call with Humana and they can record comments about their experience. REACH: We received feedback from associates that the REACH (Rewarding Excellence for Associate Contributions to Humana) incentive program and our Perfect Service and Guidance strategies were not in alignment. For example, it became clear that the average handle time (AHT) metric prevented associates from guiding the customer to call resolution, and that it put too much emphasis on the number of calls taken and not enough on the number of calls resolved. In 2007, we will roll out a modified version of REACH that rewards associates for applying Perfect Service to what they do. The program recognizes that providing guidance and perfect service to all our consumers requires a balance of quality and time. The new REACH plan will help us realign and ensures that we’re rewarding Perfect Service experiences.
2007 Humana finished 2nd to last in the Midwest and South Regions Humana Satisfaction Results: 512,000 additional satisfied/very satisfied members 2008 vs 2007
Use voluntary benefits to complement existing employer paid plans Insure coverage gap and enhance family coverage Benefit decisions in the hands of the employee Mitigate employee dissatisfaction with reduction of employer sponsored benefits Maximize value added services that typically accompany voluntary benefits enrollments
For 1,000+ and renewals, discounts applied at underwriter’s discretion. For voluntary benefits products, discounts are subject to minimum participation requirements. Discounts are not applicable to DHMO or Advantage Plus products.
At this point in the Sales Onboarding presentation, stop and do the interactive activity. Divide the room into three groups and assign each group one of the following benefit designs: Rx3, Rx4, RxImpact. Ask each group to discuss the following 3 questions about the benefit design that was assigned to them: What are the advantages of the benefit design? How does it work? Why would employer offer it? Ask one person in the group to be the speaker. Give them about 15 minutes to discuss and ask each group to present. After each group answers the questions, go through the related slides and highlight what, if anything, they missed. Don’t forget to give Sales Bucks to the presenters! At the end of the activity, review HDHP and “Do they work”.
While most plans group drugs by generic, preferred brand, non-preferred brand and specialty, this is not sophisticated enough given the variance in the gap between generic and brand drug pricing. Rx4, Humana Pharmacy’s first consumer driven product, groups drugs by cost. Drugs are assigned to four levels, with member cost increasing as the level increases: Level 1: Lowest-cost generic and brand-name drugs. Some examples include Lanoxin and Atenolol. Level 2: Higher-priced generic and brand-name drugs. One example is Minocycline. Level 3: High-cost brand drugs with less expensive alternatives. Examples include Accupril, Lasix, and Lovenox, as well as all cold and cough (both brand and generic). Level 4: Specialty drugs. Examples are Arava, Infergen, Nutropin, and Sandostatin.
RxImpact is a revolutionary benefit design that groups drugs according to: Their ability to lower overall medical cost The timeframe in which they impact medical care All drugs within a class (e.g., antidepressants, proton-pump inhibitors, etc.), both brand and generic, are categorized in the same group. This is different from a traditional benefit design that would separate drugs by generic/preferred/non-preferred. RxImpact is designed as an allowance benefit structure – for each group of drugs, the plan pays a specific allowance amount and members pay the drug-cost balance, if any, instead of the traditional copayment structure. The allotted allowance amounts decrease from Group A to Group D and there is a maximum out-of-pocket protection per prescription and a yearly maximum out-of-pocket protection for Groups A-C. RxImpact is designed to generate year-over-year savings and eliminate the need to introduce new prescription drug benefits annually.
In conjunction with Corphealth, a wholly owned subsidiary, a leader in the behavioral health field.