Agenda 09/23/2008 Item #10CItem # 10C
September 23, 2008
Page 1 of 6
EXECUTIVE SUMMARY
A report to the Board regarding the integration of behavior based wellness
incentives into the Collier County Group Health Plan.
OBJECTIVE: To provide information to the Board regarding a plan to integrate
wellness incentives into the design of the Group Health Plan. The objectives of
the program are to identify and treat disease in the insured population; to engage
employees in the improvement of their health; to effectively focus healthcare
resources toward early detection and prevention; to reduce the number of
catastrophic cases by 25% over the first five years; to improve the quality of life
of covered employees and dependents; to promote employee productivity; to
protect the privacy of covered members; and to continue to provide a market
competitive health insurance program.
CONSIDERATIONS: On January 1, 2002 a significant change to the group
health insurance plan was implemented. At that time, staff reconfigured the core
benefit program from a medical only program to include medical, dental, and
disability in a basic core program. At the same time, the Board directed that the
county proceed toward an 80/20% split of health premium by January 1, 2006,
which was accomplished.
The county has successfully maintained a stable rate structure (0% rate
increase) during fiscal years 2006 through 2008. This is attributable to the
success of the existing wellness program; the proper structuring of reinsurance to
manage adverse impact to the plan; and prudent plan management on the part of
the agency. However, during the 2007 plan year, the number of catastrophic
claimants exceeding $87,500 in paid cost increased by 61 %. Specifically, there
were 27 claimants that incurred costs of $5,235,610 or 21 % of paid claims cost
for the year. This prompted staff to explore plan design options for
implementation in the 2009 plan year.
Medical plan inflation can be managed by increasing rates; negotiating favorable
provider fee schedules; increasing deductibles and co- payments; placing caps
on benefits; implementing changes to the reinsurance structure; shifting premium
cost to the employee; or a combination thereof. However, these types of
changes may not have an enduring impact on plan cost over the long term
because they do not address the underlying factors that cause catastrophic
cases. Therefore, in late 2007 staff began to explore a different type of plan
design structure that would provide participation incentives to members to
identify and measure their existing risk factors; to participate in wellness related
programs to help members reduce and /or manage these risk factors; to improve
the employee /physician relationship; and to provide one on one advocacy
services to assist employees with their healthcare needs.
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September 23, 2008
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Staff reviewed various models that encourage participation in wellness activities
and ultimately focused on a program developed by Manatee County, known as
the Manatee "Your Choice' model. Traditionally, many employers offer several
plan options that allow employees to purchase a higher level of benefit in
exchange for a higher employee contribution. Employees typically make their
plan selection on the basis of receiving a higher return from the plan than it costs
them to purchase the benefit. This approach, however; does not encourage
preventive activity nor does it address underlying cost issues.
Under the Manatee model, there are three plans offered which consist of a Basic
high deductible plan; and Better plan with higher co -pays; and a Best plan that
has the richest level of benefit. However, the difference lies in the fact that unlike
traditional options, each plan costs exactly the same to the employee.
Employees are enrolled in the Better or Best plans based upon their participation
in certain wellness related activities or "qualifiers ". These qualifiers include the
completion of a wellness assessment; the gathering of weight, height and waist
measurements; a complete blood analysis; age and gender based screenings;
and participation in diabetes management and smoking cessation programs. The
program utilizes the services of third party medical professionals or "advocates"
who provide individual support to covered members. Employees who do not
choose to participate in these programs are enrolled in the Basic plan.
Staff, in coordination with the county's benefits consultant, Willis, Inc. developed
a similar program for implementation effective January 1, 2009. The program
consists of three health plans that include a high deductible Basic plan
(deductible of $2,000 per person /$4,000 per family); a Select plan consisting of
primary and specialist office visit co- payments of $30 and $50 respectively and
deductibles of $500 per person /$1,000 per family; and a Premium plan consisting
of primary and specialist office visit co- payments of $15 and $25 respectively and
deductibles of $200 per person and $400 per family.
The County will maintain employee contribution rates for non - smokers that are
very close to current rates for calendar years 2009 and 2010. Smoker and non
smoker rates continue to be part of the rate structure. Plan design (co -pays and
deductibles) will not change for the three year period beginning with calendar
year 2009 and continuing through 2011.
Under the non - discriminatory provisions of HIPAA, plan enrollment must be
based upon participation and cannot be based upon outcomes. Enrollment in
each plan will be determined by an employee's participation in the following
activities or qualifiers:
Basic Plan- The employee does nothing.
Select Plan- The employee completes a health history; a lab draw with
metabolic panel; height, weight, and waist measurements. This
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September 23, 2008
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information is gathered into a personal wellness profile that is provided to
the employee by the Advocate and a plan of action is developed.
Premium Plan- The employee completes the Select Plan requirements;
completes age /gender based screenings (if applicable) through their
current physician or by referral by the Advocate; and completes a diabetes
management program and smoking cessation program (if applicable).
On January 1, 2009 all employees will be enrolled in the Select Plan. The 2010
qualifying period will run from January 1, 2009 through September 30, 2009. On
October 1, 2009, the employee's eligible plan will be determined and effective
January 1, 2010 the employee will be enrolled in their qualified plan. Covered
dependents of employees (if applicable) will be enrolled in the same plan as the
employee.
In addition to the participation in qualifying activities, the plan will also offer
Healthcare Reimbursement Accounts (HRA's) to encourage participation in
activities such as educational and exercise programs. Employees who complete
these programs will be able to earn healthy bucks in their account which can be
used to offset eligible expenses. Employees who do not complete the qualifiers
for the Select Plan will not be eligible for the HRA contribution. These programs
will be managed by existing wellness staff.
In June, 2008 Willis, Inc. conducted employee focus groups to identify areas of
concern that employees may have about the program. The concerns are
identified and addressed as follows:
Privacy- Employees are concerned that their health information remain
private and that it not be accessed by county personnel. This issue will be
assured by utilizing an existing contract with Community Health Partners
to provide Advocacy services and to handle and manage Personal Health
Information. A HIPAA Business Associate Agreement will be in place to
assure that all HIPAA privacy provisions are followed. CHP will also utilize
non - county IT infrastructure, thus information will not reside on county
computer systems.
Physician /Patient Relationships - Employees are concerned that the
programs not interfere with their existing physician relationships. This
issue will be addressed by providing an option for employees to utilize
their private physician for age and gender related screenings and follow
up treatment. In fact, the program should work to enhance and improve
their existing physician relationship.
Logistics /Resources - Employees and Managers are concerned about
the effect on productivity. Staff will address this issue by using Quest
Diagnostics (a CHP provider) who has extensive experience administering
onsite phlebotomy services for lab draws; by appropriately staffing a
sufficient number of Health Advocates to properly service the group; by
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September 23, 2008
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using the MedCenter for onsite care; and by using telephonic services for
low risk patients and one on one services for high risk patients.
Simplicity - Employees are concerned that the program be simple to
understand. Therefore, the communication of the program must be clear
and succinct and the logistics to support their understanding must be
readily available.
The plan will be rolled out to dependent spouses in either FY 2010 or FY 2011
once staff has had the opportunity to assess the issues and resources necessary
to effectively service this group.
Finally, staff met with leadership of the Community Health Partners Physician
Hospital Organization Dr. Gary Parsons, Dr. Greg Leach, and Dr. David Grieder
to review the program and have received the overwhelming support of the
physician community to proceed with this program.
Employee informational meetings will begin in October, 2008 to coincide with the
annual open enrollment period.
FISCAL IMPACT: The cost of the program has been anticipated in the FY 2009
rate structure. In October, 2008 staff will submit an amendment to the contract
with Community Health Partners to recognize the cost of providing on site
advocacy services. The estimated cost of advocacy services is $300,000 per
year.
GROWTH MANAGEMENT IMPACT: There is no growth impact associated with
this item.
LEGAL CONSIDERATIONS: There are no legal considerations associated with
this item.
RECOMMENDATION: No official action is required by the Board at this time.
Item # 10C
September 23, 2008
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A report to the Board regarding the integration of behavior based wellness incentives into the
Collier County Group Health Plan. (Jeff Walker, Risk Management Director)
Prepared By:
Department Date
Risk Management 8/15/2008 10:07:06 AM
Approved By:
Department Approval Date
Adminstrative Approved 8/27/2008 3:38 PM
Services
Approved By:
Department Approval Date
Office of
Management Approved 8/27/2008 4:42 PM
and Budget
Approved By:
Department Approval
County Approved
Manager's Office
ATTACHMENTS:
Name: Description:
D GroulpHealth Plan Report Executive Summary
E51.doc
D Letter of Recommendation CHP Letter of Recommendation
from_CHP0001..pdf
Date
8/27/2008 5:27 PM
Type:
Executive Summary
Backup Material
Item # 10C
--� Community Page of , 2008
Page 6 of 6
Health Partners -
PHYSICIAN HOSPITAL ORGANIZATION
August 20, 2008
To: Collier County Board of Commissioners
Regarding: Collier County Government Health Benefit Design supporting the Health
Advocate program
Please be advised that Community Health Partners Board of Directors support and
applaud the Collier County Government for their new health care initiatives. Studies
show that preventive care such as health and wellness screenings can identify and treat
potential health problems before they develop or worsen. The program is designed to
assist members in managing their health and improving quality of life.
This new program will be administered confidentially through Community Health
Partners Advocate Team, on -site at the government center. This team will work
collaboratively with local physicians to develop screening guidelines and protocols.
This new initiative has been presented and approved by our Board of Directors. We are
pleased to be part of this proactive approach to health care solutions. We value our long-
term relationship and look forward to improving the total well being of your members.
Sincerely,
Kathy Jardone RN, CRRN, Chief Operating Officer
On behalf of Community Health Partners Board of Directors
David Oreider, MD
Paul O. Jones, MD
Gregory E. Leach, MD
Gary Parsons, MD
Sunil Pandya, MD
Linell King, MD
Max Kamerman, MD
Robert Statfeld, MD
David Whalley, MD
Robert Wilson, DO
Brian Wolff, MD
851 5th Avenue North, x 201 . Naples, Florida 34102 • Phrnc: 239.659..7'00 . Fax! -139659.7799
wwwxhcaltlipariners.com