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WELCOME MEMBERS , SPONSORS and GUESTS ! NCBGH FALL 2018 MEETING

Join us for the NCBGH Fall 2018 Meeting as experts discuss the impact of caregiving on employers and the healthcare community. Gain insights on Medicaid transformation and PBM transparency. Network with industry leaders and be part of the unified voice on healthcare issues.

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WELCOME MEMBERS , SPONSORS and GUESTS ! NCBGH FALL 2018 MEETING

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  1. WELCOME MEMBERS, SPONSORS and GUESTS! NCBGH FALL 2018 MEETING Proximity Hotel – October 5, 2018

  2. WELCOME!!NCBGH FALL AGENDA • Arrival and Breakfast, 8 am • Welcome: Jon Rankin, NCBGH President (8:45 am – 9:00 am) • 9:00 a.m.Helen Mack, a Gerontologist and member of the NC AARP Executive Council • AARP's perspective on what employers need to know in regard to caregiving. • 10:00 a.m. Mandy Cohen, Secretary of the NC Dept. of Health and Human Services • Update on Medicaid Transformation and the Impact to the Business Community • 11:00 a.m.  Nick Conway (AVP of Analytics) and Armand Dilanchian (Managing Director) from NFP Rx Solutions PBM Transparency • 12:00 Buffet Lunch (Please return to seats for final presentation over lunch) • 12:15 Moderator: Mike Miesch, from Aon’s Health Transformation Team   • Panelists will include: • Mike Pitkowicz, Director, Wellness Coalition America, • Virginia Peddicord, Director, Global Employee Population Health; Merck & Co., Inc. • David Eller, Director of Human Resources, Precision Fabrics Group, Inc. • 1:00 Questions & Answers; Event Wrap Up 1

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  5. ABOUTNCBGH • What isNCGBH? • 501c(6), Non-profittradeassociation. We are an advocacy group ofseniorHR and Finance leaders from area employers, with a common goal to positively impact and improve healthcare in NorthCarolina • Why should I beinvolved? • NC lawmakers and other stakeholders in the healthcare delivery system need a unified voice on healthcare issues that impact the businesscommunity. • What does it cost toparticipate? • –Membership is only $100per year and allows for you and a colleague to attend 2 meetings peryear • and gain access to unmatched “content”and • “influence”. 5

  6. Mission andCharter • North Carolina Business Group on Health is a 501c(6) trade association which acts as advocacy group of employers who use their collective voice to influence decisions that impact the quality and cost of healthcare delivery systems. We will accomplish our mission and foster North Carolina’s economic development in the following ways: • Advocate – Create a business community with a shared vision and message on matters of healthcare policy, regulation, and legislation based on sound fiscal principles and quality standards. • Innovate – Seek creative, common sense solutions to improve the overall cost and quality of our healthcare deliverysystem. • Educate – Promote health and wellness education. Advocate for provider performance disclosure of both quality and outcomes to help employees become better consumers of healthcareservices. 6

  7. Membership and Marketing -Focusing on helping attract and retain quality HR Leaders throughout NorthCarolina who can help us grow NCBGH both now and into thefuture • Have you visited us atwww.ncbgh.org Our website is growing in Capabilities and great information! 7

  8. PLEASEWELCOME!! Helen Mack Gerontologist Member of the NC AARP Executive Council

  9. Helen M. Mack EdS AARP Volunteer Facilitation and Training Team NC AARP Executive Council

  10. Caregivers are often that whole world.

  11. How Many Caregivers in the U.S.? • Approximately 43.5 million caregivers have provided unpaid care to an adult or child in the last 12 months. • [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]

  12. About 34.2 million Americans have provided unpaid care to an adult age 50 or older in the last 12 months. • [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]

  13. The majority of caregivers (82%) care for one other adult, while 15% care for 2 adults, and 3% for 3 or more adults. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S

  14. Approximately 39.8 million caregivers provide care to adults (aged 18+) with a disability or illness or 16.6% of Americans. [Coughlin, J. (2010). Estimating the Impact of Caregiving and Employment on Well-Being: Outcomes & Insights in Health Management

  15. About 15.7 million adult family caregivers care for someone who has Alzheimer's disease or other dementia. • [Alzheimer's Association. (2015). 2015 Alzheimer's Disease Facts and Figures.]

  16. Economic Value • The value of services provided by informal caregivers has steadily increased over the last decade, with an estimated economic value of $470 billion in 2013, up from $450 billion in 2009 and $375 billion in 2007. • [AARP Public Policy Institute. (2015). Valuing the Invaluable: 2015 Update.]

  17. At $470 billion in 2013, the value of unpaid caregiving exceeded the value of paid home care and total Medicaid spending in the same year, and nearly matched the value of the sales of the world’s largest company, Wal-Mart ($477 billion). • [AARP Public Policy Institute. (2015). Valuing the Invaluable: 2015 Update.]

  18. The economic value of the care provided by unpaid caregivers ofthose with Alzheimer's disease or other dementias was $217.7 billion in 2014. [Alzheimer's Association. (2015). 2015 Alzheimer's Disease Facts and Figures

  19. The average duration of a caregiver’s role is 4 years. • Only 30% of caregivers provide care for less than a year. • 24% of caregivers provide care for more than 5 years. • 15% of caregivers provide care for 10 or more years. • Higher-hour caregivers are twice as likely to have been in their caregiving role for 10 years or more. • [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]

  20. Let’s do all we can to help caregivers.

  21. Prepare to Care Creating a Plan

  22. PLEASEWELCOME!! Mandy CohenSecretary of the NC Dept. Health and Human Services

  23. NC Department of Health and Human Services Buying Health in North Carolina Mandy Cohen, MD, MPH Secretary, NC Department of Health and Human Services October 5, 2018

  24. North Carolina is not as healthy as it could be North Carolina ranks 35th in overall state health rankings.

  25. We want to “buy” health and not just healthcare.

  26. Leveraging Changes in Medicaid

  27. Medicaid covers more than 2.1 million people $13 Billion/Year 15% of $ 30% of $ 45% of $ seniors children people with a disability

  28. LEVERAGING CHANGES TO MEDICAID Medicaid is moving to managed care beginning in 2019 • In 2015, the NCGA directed the transition of Medicaid from state administered to private health insurancemanaged care. • DHHS will delegate direct management of certain health services and financial risks to Prepaid Health Plans (PHPs), who will contract with providers. • In managed care, DHHS will remain responsible for all aspects of the Medicaid and NC Health Choice programs.

  29. LEVERAGING CHANGES TO MEDICAID Guiding principles for Medicaid Transformation • Focus on whole person health • Support clinicians and people in Medicaid • Promote quality and value • Promote access to care

  30. LEVERAGING CHANGES TO MEDICAID How we are leveraging this transformation • Examples: • Physical and behavioral health integration • Groundbreaking Advanced Medical Home program to support independent doctor practices. • Smart investments in Healthy Opportunities • Quality strategy • Value-based payments

  31. Closing the Coverage Gap

  32. CLOSING THE COVERAGE GAP We can increase access to affordable health care by closing the coverage gap • 900,000 North Carolinians are uninsured today. • The “coverage gap” refers to people who do not qualify for Medicaid today but who are too poor to qualify for subsidies on the Health Insurance Marketplace. • 34 red and blue states allow people in the gap to enroll in Medicaid.

  33. CLOSING THE COVERAGE GAP Covering more uninsured people lowers everyone’s premiums • Uninsured people often get care the one place they can: the ER. • The ER is expensive. When patients can’t pay, hospitals eat the cost. • Hospitals offset that loss with higher rates for insured patients. • That means higher premiums for everyone who buys insurance. • Premiums for individual market are 7% higher in states that have not closed their coverage gap.

  34. CLOSING THE COVERAGE GAP Closing the coverage gap is good for business and for the economy • 43,000+ • $4 billion • 90% • $0 • 400,000 • up to 150,000 Jobs created in the first five years of increase access Annual federal dollars NC leaves on the table by not increasing access Share of costs paid by the federal government New state appropriation needed to fund the expansion New projected enrollees if NC increased access People with opioid and other behavioral health needs who could enroll

  35. Addressing Healthy Opportunities

  36. ADDRESSING HEALTHY OPPORTUNITIES Mismatch: We are buying health care, not “health” • SOURCE: Schroeder SA. N Engl J Med 2007 The greatest opportunity to improve health lies in addressing a person’s unmet essential needs.

  37. ADDRESSING HEALTHY OPPORTUNITIES Healthy Opportunities Transportation Food Security Jobs Housing Stability Interpersonal Violence

  38. ADDRESSING HEALTHY OPPORTUNITIES Healthy Opportunities initiatives

  39. Fighting the Opioid Epidemic

  40. FIGHTING THE OPIOID EPIDEMIC Opioid overdose deaths by opioid type North Carolina residents, 1999-2016 Unintentional Opioid Deaths 1,360 people died from an opioid overdose in 2016– a more than 25% increase over 2015.

  41. FIGHTING THE OPIOID EPIDEMIC Total spent by large employers on opioid treatment $ millions • A recent survey found that 70 percent reported their workplaces have been directly affected by opioids.

  42. FIGHTING THE OPIOID EPIDEMIC NC’s Opioid Action Plan • Coordinate the state’s infrastructure to tackle opioid crisis. • Reduce the oversupply of prescription opioids. • Reduce diversion of prescription drugs and flow of illicit drugs. • Increase community awareness and prevention. • Make naloxone widely available. • Expand treatment and recovery systems of care. • Measure effectiveness of these strategies based on results. 1 2 3 4 5 6 7

  43. Work to Date • New legislation to limit opioid scripts and dosage; narcan without a Rx • Changes to Medicaid coverage policy for alternative pain control options • Purchase of nearly 40,000 naloxone kits • Projected to treat an additional 5,000 people through CURES grant dollars and new state funds in FY 2017-18 • Convened Payer’s Council • Collected & disposed of 89.2 million pills through Operation Medicine Drop since 2010 • Launched first Law Enforcement Assisted Diversion (LEAD) program in the Southeast and have expanded to 4 programs statewide • Track and report opioid data regularly with goal of reducing number of unintentional opioid-related deaths by 20%

  44. Early Childhood Education

  45. NC Early Childhood Action Plan • All North Carolina children will get a healthy start and develop to their full potential in safe and nurturing families, schools and communities. HEALTHY START  HEALTHY FUTURE

  46. Giving NC children a healthy start is important to all of us, including employers Healthy: Children are healthy at birth and thrive in environments that support their optimal health and well-being Safe and Nurtured: Children grow confident, resilient and independent in safe, stable and nurturing families, schools and communities Learning and Ready to Succeed: Children experience the conditions they need to build strong brain architecture and school readiness skills that support their success in school and life

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