2013 Performance-Based Health Plan Design May 22, 2012. Mission: Performance-based Health Plan Design. We will continue to engage our faculty and staff in personal health and wellness through our health plan benefits by incenting behavior change that leads to long-term health benefits.
Our demographics, behaviors, and conditions all contribute to a higher claims experience than comparison data*.
* Data based on Aon Hewitt’s Health Value Initiative™ (HHVI), which is an annual study of over 350 employers (representing over 1,800 health plans in 140 U.S. market areas) to collect and summarize information to improve the understanding of health plan cost and value among employers.
National Year-Over-Year Trend
In order to combat the negative impact of rising costs, we must act.
*Mental Health/Substance Abuse
¹ PHA Completion rate-to-date: 42%
2 Action Plans
Currently, action plans are created and maintained by health coaches and care coordinators for individuals that have been identified as moderate or high risk
The rollout of the enhanced 2013 personalized action plans should allow all risk levels to create, maintain, and complete action plans
Action plans should be interactive and allow each individual to access, view, and update their plan
Roll out of Action Plans2 during 2013 (timing TBD)
Eligibility for 2013 plan options—Based on PHA completion from 10/01/2011–09/30/20121
Participating Medical Plan Option
1. Complete PHA(encourage completionof biometrics)
NonparticipatingMedical Plan Option
Employee Contributions Differ
Participating (PHA) Plan Design
Maintain choice of 5 current plan options
Add plan design incentive – waive out-of-pocket costs for covered PCP office visits for all members1
Increase subsidy for faculty/staff from 85% to 86% (to offset elimination of the current $360 PHA premium credit)
Decrease subsidy for dependents from 84% to 82%
Nonparticipating (No PHA) Plan Design
One Default Plan
Increased medical plan deductibles and out-of-pocket maximums
Reduced medical coinsurance level
Higher cost-sharing and out-of-pocket maximums for prescription drugs
(Detailed plan design comparison included in the Appendix)
Faculty/staff subsidy reduced from 85% to 80%
Dependent subsidy reduced from 84% to 78%2013 Proposed Performance-Based Plan Design& Subsidy
The amount a covered individual or family would have to pay for eligible services incurred during a single plan year before the plan begins to pay benefits (excludes copay services)
A flat dollar amount that a covered individual owes for a particular covered service
The percentage of a provider’s allowed fee that a covered individual owes after the annual deductible amount has been met
The total amount a covered individual or family would have to pay for eligible services incurred during a single plan year before the plan begins to pay eligible expenses at 100%
The portion of the total health plan cost that is paid by the university
Without Action:Our health-related costs will escalate as the health of our members deteriorates.
With Action:We can focus on improving health and slowing the increase of risk and cost trend over time.Our Data Reveals a Need for Action
Health and Behavior Risks
Amongst the 56%of enrolled faculty & staff who completed the PHA in 2010, the following health concerns were exhibited:
Based on F&S and dependents enrolled in medical coverage from 2006–2010: