Practice what you preach nahu s ideas in action
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Practice what you Preach: NAHU’s Ideas in Action. Presented by: Susan Rider April 21, 2011. Practice what you Preach: NAHU’s Ideas in Action. Susan Rider- President Indianapolis Association of Health Underwriters 2 Hour Continuing Education Course Provider: Indy AHU.

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Practice what you preach nahu s ideas in action

Practice what you Preach: NAHU’s Ideas in Action

Presented by: Susan Rider

April 21, 2011


Practice what you preach nahu s ideas in action1

Practice what you Preach: NAHU’s Ideas in Action

Susan Rider- President

Indianapolis Association of Health Underwriters

2 Hour Continuing Education Course

Provider: Indy AHU


Practice what you preach nahu s ideas in action

Since this course was filed, PPACA became the law of the land.

NAHU’s Healthy Access Plan would help reduce the number of uninsured, there is no guarantee that any of NAHU’s recommendations will be adopted.

Fortunately, there are a number of actions that insurance agents can take TODAY that will help to stabilize their clients’ rapidly rising health insurance premiums and to ensure that more employees take advantage of the health insurance coverage offered by their employer.

Our goal is to give you a few ideas…

Course Objectives


Practice what you preach nahu s ideas in action

Constraining Medical Costs


Administrative expenses a convenient scapegoat

Administrative Expenses:a convenient scapegoat

Administration

12%

Claims Cost

88%

American Academy of Actuaries September 2009


Summary of activities by functional category

Summary of Activities by Functional Category

  • Marketing

  • Provider & Medical Management

  • Account & Member Administration

  • Corporate Services

American Academy of Actuaries September 2009


Behavior lifestyle

Behavior & Lifestyle

Administration

12%

Other Claims Cost

72.9%

Behavior

15%

Aon Consulting, Research Brief “The Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumers,” 2007


Constraining medical costs

Centers for Disease Control & Prevention, 2006 Behavioral Risk Factors Surveillance System

Constraining Medical Costs

Behavior & Lifestyle: Weight Gain ’86-’06

No Country Can Fund All the Consequences:

Hypertension

Type 2 Diabetes

Osteoarthritis

Stroke

Coronary Heart

Gallbladder

Sleep Apnea

Respiratory Issues

Some Cancers

2006

1993

1985

1986

1987

1988

1989

1990

1991

2005

1992

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

1994

Obesity Trends Among U.S. Adults (BMI>30%)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Incorporate wellness and disease-management into all government employee programs

Encourage employer wellness programs

What You Can Do

Recommend Consumer-Directed Plans: the first step to getting employees to care what health care costs.

Recommend Wellness Programs with incentives to participate

Behavior and Lifestyle: Solutions


System inefficiencies

System Inefficiencies

Administration

14%

Other Claims Cost

67.6%

Behavior

15%

Inefficiencies

3.3%

PriceWater Coopers, “The Price of Excess” April 2008


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Improve system inefficiencies in doctor and medical facilities

Federal standards for interoperable electronic medical records

What You Can Do

Consumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar procedures

Use transparency tools and third party vendors to locate more efficient providers

Portable electronic medical records might be a short-term fix

System Inefficiencies: Solutions


Medical malpractice

Medical Malpractice

Administration

14%

Other Claims Cost

62.6%

Behavior

15%

Inefficiencies

3.3%

Malpractice

5%

Towers Perrin, “U.S. Tort Costs: 2005 Update,” March 2006

PricewaterhouseCoopers, “The Factors Fueling Rising Healthcare Costs 2006,” February 2006


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Malpractice reform limits

What You Can Do

Communicate ideas of tort reform with your legislators!

Medical Malpractice: Solutions


Cost shifting

Cost Shifting

Administration

14%

Other Claims Cost

45.1%

Behavior

15%

Inefficiencies

3.3%

Government Cost Shift

9.5%

Malpractice

5%

Uninsured Cost Shift

8%

  • Margaretann Cross, “Confronting the

  • Medicare Cost Shift,” Managed Care, Dec. 2006

  • 2003 Health Affairs, “Kaiser Commission Report on Medicaid & the Uninsured”


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Require Medicare, Medicaid, and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit Plan.

Provide incentives for states to streamline the application process for government programs.

What You Can Do

Grassroots – make consumers angry by educating them through presentations, the media, etc.

Cost-Shifting: Solutions


Practice what you preach nahu s ideas in action

Government Cost-Shifting to Hospitals

Breakeven

Premera Blue Cross, May 2006: Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Require Medicare, Medicaid, and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit Plan.

Provide incentives for states to streamline the application process for government programs.

What You Can Do

Grassroots – make consumers angry by educating them through presentations, the media, etc. We only have 20k members, but millions of voters can get the legislators’ attention.

Donate to HUPAC and ISAHUPAC

Transparency – make sure members are using transparency tools that are already available

Cost-Shifting: Solutions


Decreasing utilization

Decreasing Utilization

Administration

14%

Other Claims Cost

45.1%

Behavior

15%

Inefficiencies

3.3%

Government Cost-Shift

9.5%

Malpractice

5%

Uninsured Cost-Shift

8%


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Expand consumerism

Health Savings Accounts (HSAs)

Health Reimbursement Arrangements (HRAs)

Flexible Savings Accounts (FSAs)

Increase health care cost transparency

What You Can Do

Expand consumerism

Health Savings Accounts (HSAs)

Health Reimbursement Arrangements (HRAs)

Flexible Savings Accounts (FSAs)

Promote transparency tools

Decreasing Utilization: Solutions


Practice what you preach nahu s ideas in action

Access

for

All


Are you listening to what people are saying

Are you listening to what people are saying?

Your clients are…

  • We get info from NAHU, but our clients don’t.

  • If we don’t educate our clients, where will they get their information?


Practice what you preach nahu s ideas in action

February 2005 Blue Cross Blue Shield Association analysis of Census Bureau’s “Income, Poverty and Insurance Coverage” report

Most Uninsured Not A Crisis

46 Million Considered Uninsured:

Eligible for Government Program

(but not signed up)

34%

80%

$50,000+

Annual Income

32%

Temporarily Uninsured

14%

Long-Term Uninsured

20%


Practice what you preach nahu s ideas in action

NAHU’s Ideas

The federal government should require that all states have at least one private guaranteed purchasing option (risk pool).

Seed grants to states creating high-risk pools

Risk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees.

What You Can Do

Help!!! People need assistance understanding and enrolling in:

Risk pool

SCHIP

Medicaid

Medicare

LTC partnership

Eligible for a Government Program


Indiana s uninsured children

Indiana’s Uninsured Children

  • 131,000 Children Are Uninsured in Indiana

  • 􀂄 More than one in 13 children in Indiana is uninsured (7.9 percent of Indiana’s children).

  • Indiana’s Uninsured Children Come from Working Families

  • 􀂄 The vast majority of uninsured children in Indiana (95.3 percent) come from families where at least one parent works. 􀂄 Approximately two-thirds of uninsured children (67.1 percent) in Indiana live in households where at least one family member works full-time, year-round.

  • 􀂄 Still, 48.2 percent of Indiana’s uninsured children come from low-income families (families with income below twice the poverty level, or $35,200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise.

  • Most Uninsured Children in Indiana Come from Two-Parent Households

  • 􀂄 Among uninsured children living with a parent, more than half (62.3 percent) live in two-parent households.

2008 Analysis conducted by the Census Bureau for Families USA


Karma

Karma

Good things happen to good people!

When you help others…

  • You gain a new perspective and may be able to identify new opportunities.

  • They sometimes refer business to you.


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Educate lawmakers and the media about the true makeup of the uninsured.

What You Can Do

We’re the salespeople – if people aren’t signing up, we’re to blame. Maybe we’re selling the wrong product or using the wrong approach.

Every time we sell a group and don’t get 100% participation, we’re contributing to the number of uninsured.

$50k+ Annual Income


Practice what you preach nahu s ideas in action

NAHU’s Ideas

Educate lawmakers and the media about the true makeup of the uninsured.

What You Can Do

Sell short-term policies to employees in their waiting period – get the employer to sell it for you.

Recommend short-term policies when people quit in lieu of COBRA. Send brochures with the COBRA notice.

Short term policies: an affordable option for dependents.

Temporarily Uninsured


Crisis

CRISIS!!!

  • 47 million uninsured

    Health Insurance Crisis

  • Health insurance is expensive because health care is expensive:

    Health Care Crisis

  • Maybe we’re to blame – it’s a behavioral issue:

    Health Crisis

  • Center for Health Care Strategies:

    Health Literacy Crisis


What is health literacy

What is Health Literacy?

Health Literacy is the ability to read, understand, and act on health care information.

More specifically, functional health literacy is “the ability to read and comprehend prescription bottles, appointment slips, and the other essential health related materials required to successfully function as a patient.” – AMA Council of Scientific Affairs


Why is health literacy important

Why is Health Literacy Important?

Studies show that limited literacy skills are a stronger predictor of an individual's health status than age, income, employment status, education level, and racial or ethnic group.

CHCS strives to improve health literacy for people in government programs like Medicaid & Medicare.


People with low functional health literacy are less likely to

People with low functional health literacy are less likely to:

  • Understand written and oral information given by physicians, nurses, pharmacists, and insurers .

  • Act upon necessary procedures and directions such as medication and appointment schedules.

  • Be able to navigate the health system to obtain needed services.


People with low functional health literacy are more likely to

People with low functional health literacy are more likely to:

  • Receive health care services through publicly financed programs, even after controlling for such factors as age, education, or socioeconomic status.

  • Incur higher health care costs. A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population.


Who has health literacy problems

Who Has Health Literacy Problems?

Health literacy problems affect people from all backgrounds, especially those with chronic health problems.

  • Older people, non-whites, immigrants, and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information .

  • Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need.

    But you can’t tell by looking.

  • Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients.


Impact of low health literacy skills on annual health care expenditures

Impact of Low Health Literacy Skills on Annual Health Care Expenditures

  • Poor health literacy can have profound financial consequences. In 2001, low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs.

  • According to the National Adult Literacy Survey (NALS), as many as 44 million people (age 16 and older), or 23% of all adults in the United States are functionally illiterate.

  • An additional 28% of all adults — 53.5 million people — had. only marginally better reading and computational skills.

  • This suggests that nearly 50% of all adults may have problems understanding prescriptions, appointment slips, informed consent documents, insurance forms, and health education materials.


Health literacy and understanding medical information

Health Literacy and Understanding Medical Information

Patients with poor health literacy skills struggle to understand basic medical forms and instructions.

  • It is especially difficult for less literate patients to fill out intake forms, enroll in insurance programs for which they may be eligible, get services once enrolled, follow medical instructions, or give informed consent.

  • Most informed consent and insurance forms, and most medication package inserts, are written at high school level or higher.

  • Of 979 emergency department patients with inadequate health literacy:

    • 81% could not read the rights and responsibilities section of a Medicaid application.

    • 74% did not know if they were eligible for free care.


Strategies to assist low literate health care consumers

Strategies to Assist Low-Literate Health Care Consumers

  • Surrogate readers / family members can help patients understand key information.

  • Tailoring medication schedules to fit a patient’s daily routine / color coding medicines

  • Providers can ask patients to “teach back” by restating the instructions.

  • Use commonly understood words: “keeps bones strong” instead of “prevents osteoporosis”

  • Slow down and take time to listen. Create an atmosphere of respect and comfort.

  • Limit info given to patients at each visit. Less than half of the info provided during each visit is retained.


Practice what you preach nahu s ideas in action

NAHU’s Ideas

All health insurance consumers, both private and public, should have access to quality information and assistance regarding their health care coverage.

NAHU will assumeresponsibility for training insurance agents in all coverage options, both public and private, through the creation of a designation program—the Certified Health Care Access Advisor.

What You Can Do

CHCS educates people in government programs - it’s the agent’s job to educate people covered by private insurance

Health literacy starts with understanding your coverage & how to access benefits. The agent should be both teacher & coach.

Public/Private Producer Community Education Partnership


Commencement

Commencement

“This isn’t so much a commencement – an ending – as it is a new beginning.”


Lesson plan

Lesson Plan

  • Consumer-Directed Plan Designs

  • Transparency

  • Wellness

  • Education & Communication

  • Tying it all Together


Consumer directed health care

Consumer Directed Health Care

“managed care is fading away”

- Chaliese Rippey


Consumer directed health care1

Consumer Directed Health Care

  • Starts with a consumer directed plan as an option:

    • Flexible Spending Accounts (FSA’s)

    • Health Reimbursement Arrangements (HRA’s)

    • Health Savings Accounts (HSA’s)

  • Consumerism includes much more than just plan design

  • Give employees choices – that’s part of consumerism.

  • Defined contribution and dual option strategy.

  • 8 year projection of $350 rate at just a 10% annual increase

    $350 - $385 - $424 - $512 - $564 - $620 - $682 - $750


Transparency tools

Transparency Tools

  • Price Transparency

    • Carrier Tools

    • Third-party pricing guidance

  • Quality Transparency

    • If we only compare price, we turn health care providers into a commodity

    • Carrier Tools

    • Consumer reports and third-party quality guidance

  • Legislative initiatives and the future of transparency


Wellness programs

Wellness Programs

  • What Is “Wellness?” / Overview

  • Reducing Risk Factors

  • What A Complete Wellness Program Looks Like

  • Engaging Employees in Wellness

  • Case Studies

  • How To Measure Results


Education and communication

Education and Communication

  • Employer Proposal

  • Employee Communication Pieces

  • Enrollment Meeting

  • Benefits Websites


Employer proposal

Employer proposal

  • Stop spreadsheeting! Identify what makes each plan unique.

  • Define all insurance terms and acronyms

  • Make it look easy to understand. Use pictures.

  • Introduce out-of-the-box solutions with multi-year projections

  • Make a recommendation! The employer wants guidance.


Practice what you preach nahu s ideas in action

Rx

Member pays $10-30-50

Doctor

Member pays $35

Other In-Network Services

Member pays 100% of first $3,000

Member pays 20%

of next $15,000

Insurance pays 80% of next $15,000

Insurance pays 100% up to $5 million

Monthly Premium


Practice what you preach nahu s ideas in action

Rx

Member pays $10-30-50

Doctor

Member pays $35

Other In-Network Services

Member pays 100% of first $500

Member pays 20%

of next $17,500

Employer pays 80% of next $2,500 (MERP)

Insurance pays 80% of next $15,000

Insurance pays 100% up to $5 million

Monthly Premium


Strategies to assist low literate health care consumers1

Strategies to Assist Low-Literate Health Care Consumers

  • Surrogate readers / family members can help patients understand key information.

  • Tailoring medication schedules to fit a patient’s daily routine / color coding medicines

  • Providers can ask patients to “teach back” by restating the instructions.

  • Use commonly understood words: “keeps bones strong” instead of “prevents osteoporosis”

  • Slow down and take time to listen. Create an atmosphere of respect and comfort.

  • Limit info given to patients at each visit. Less than half of the info provided during each visit is retained.


Employee communication enrollment meetings

Employee communication & enrollment meetings

  • Start early – give the employee a chance to review with family

  • Make communications easy to understand and make them look easy to understand. Use pictures.

  • Don’t forget about non-English speakers

  • Ask employees to explain their plan back to you.

  • Hit the high points. Too many details can be confusing.

  • Allow plenty of time for questions. Be patient and listen to what employees are asking.


Benefits websites

Benefits websites

  • Common for large groups – new trend for small groups

  • Allow employer to brand their benefits package

  • Includes all products and is consistent from one year to another

  • Inexpensive – big return on investment

  • Even more useful for HR manager than for the employee


Benefits selling magazine employer survey

Benefits Selling Magazine – Employer Survey

  • 77% of employers thought it was important or very important that their broker make a recommendation.

  • 73% of small employers believe the personality of the broker is key.

  • 52% of employers believe it is very important for the broker to be accessible.

  • 77% of employers want their broker to visit them.

  • 85% of employers believe it is important for a broker to have expertise in and represent a wide variety of products.


Don t be afraid to ask for help

Don’t Be Afraid to Ask for Help

Excerpt from Sharon Alt’s October column in Benefits Selling:

“Perhaps agents should think of themselves as a general contractor. When building – or these days, flipping – a house, most people don’t try to do everything themselves. And they shouldn’t. When you think about the multitude of tasks that need to be done – building, painting, plumbing, electrical work, landscaping, etc. – it’s almost ridiculous to think one person could do it all.

And in the insurance world, there’s an overwhelming list of products we can offer our clients…when a client requests a line of coverage that we’re not that familiar with, we might do well to partner with someone with more experience than us. Sure, we might give up some commission in the process, but remember that it’s better to have part of something than all of nothing.”


Questions

Questions?


The end

The End


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