Dr. Rick Cartor, Custom Healthcare Designs / BB&T

Dr. Rick Cartor, Custom Healthcare Designs / BB&T

1#kyshrmconf rickcartor.wordpress.com

Case Study: Six Straight

Years of Declining Healthcare

Costs--Presentation and Case Study--

Dr. Rick Cartor, Custom Healthcare Designs / BB&T

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1. Our Purpose Today2. The Company3. The Summary Statement4. The Timeline & Results5. Why it works & Advice

AGENDA

rickcartor.wordpress.com

Dr. Rick Cartor, ChD / BB&T(502) 489-5972

Our Purpose Today

The purpose of this session is generate ideas that may enhance the value1 of the healthcare benefits your company provides its employees, by sharing the details of one company’s very successful2 health care benefit system.

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1. Value: low cost, high quality, accessible care 2. Success: decreasing PEPY spending, improved health, positive reactions, accessible quality care


About the company

• Description

• History & Purpose– The Mary Byron Foundation

• Products/Services

• Awards

• VP, HR @ 150– Healthcare experience and vision


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The Summary StatementA long term incremental introduction of an integrated system that engaged employees in primary care by creating a collaborative culture of health awareness by:

• aligning incentives, • analyzing and sharing data (information) • contracting for convenient primary care• establishing and steering to a narrow network


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The “integrated system”

• Health assessment and promotion– “Wellness” with incentives / disincentives– Continuum of coaching

• Contracted accessible care– Fixed rate (lower and more predictable)– On-site or near site x Solo or shared

• Data acquisition and analysis– Analytics, information and transparency

• Narrow network and steerageDr. Rick Cartor, ChD / BB&T

(502) 489-5972 #kyshrmconf


20132006 2007

2008

2009 2011

20121 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

Committee

START:ExistingCare planHDHP/HSAJan. 1$1

Timeline You are here

(09/27)

Renewal

!?!?

WELLNESS SELF-FUND

HRA

ONSITE CARE

Stop HRAAdd Sr+

ChD

Incentives (+PCC) for partnersNicotine test to attest

Drawing: F2T

Rewards: Participation to ZT to results

Steerage

BHN EXCLUSIVE NETWORK

Coaching2010

Biometrics (Eddington)

½ fitness fees +

Non-smoker reward to smoker fees

Free e-cigs

Coaching & DMHealthcare

to HRHealthcare

to HR

$$


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Data Actions

• PMPM data

• Recidivists (biometrics)– Targeting repeat high risk factor employees

• Effects (biometric scores healthcare costs)– Focus wellness programs, activities


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1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

2006 2007 2008 2009 2010 2011 2012 2013

On Site PCC

Self Fund

$210

Wellness

BACK

Data Actions

• PMPM data

• Recidivists (biometrics)– Targeting repeat high risk factor employees

• Effects (biometric scores healthcare costs)– Focus wellness programs, activities


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Why it Works (1-5 of 11)

01. Primary and preventive care Dr. Barbara Starfield, Johns Hopkins, etc.

02. Transaction costs: doctor visits / meds & pharmacy / lab work

03. Coaching & disease management

04. ER, ICC use

05. Procedures, Inpatient care, Meds


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Why it Works (6-11 of 11)

06. In Network + Transparency = Lower costs

07. Self-funding: incentive management, steerage

08. Unbundled: transparency, competition, value.

09. Data driven decisions

10. Zero Trend basis (P’MaintainImprove)

11. Integration: system design


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Unsolicited Advice (…or free consulting!)

01. Believe. 02. Emphasize primary care, prevention.03. Stop Idea Whack-a-Mole.04. Think small / act locally.05. Use a formal PSDM process.06. Agree on goals, objectives, criteria.07. Think > 12 month (Plan & ROI).


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08. Follow up with chronic conditions.09. Consider exclusive (“narrow”) networks.10. Insist on acquiring / analyzing data.11. Align on healthiness.12. Integrate the system…13. Stay vigilant: “No victory is final or complete.”


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Unsolicited Advice (…or free consulting!)

Dr. Rick Cartor, Custom Healthcare Designs / BB&T

Documents

Transcript of Dr. Rick Cartor, Custom Healthcare Designs / BB&T