High Performing Health Plan Case Study

Transcription

1 High Performing Health Plan Case Study

2 Town of Mount Pleasant Our 2014 High Performing Health Plan Winner Led by Eric DeMoura, Town Administrator, Charlie Potts, CFO, Meghan Kelly, Human Resource Officer, and Lauren Sims, Assistant to Town Administrator

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7 Rose Marchek Rose is the HR Director at Mitsubishi Polyester Film, Inc. Which is an Americas affiliate of Mitsubishi Plastics, Inc. and offers a wide array of polyester films for existing markets such as industrial labels and liners, flexible packaging, and also for many of today s new emerging markets in energy and electronics. Mitsubishi Plastics, Inc. has additional polyester film assets in Germany, Japan, Indonesia and China. Mitsubishi Plastics, Inc., the parent company of Mitsubishi Polyester Film, Inc., manufactures and sells various high performance products and services including functional films, electronics materials, industrial and construction materials. Mitsubishi Plastics, Inc. is part of the Mitsubishi Chemical Holding Corporation, one of the largest chemical companies worldwide with annual revenues of approximately $35 billion. She started her career over 34 years ago as a process engineer at the same facility where she now works. She then worked in Human resources followed by several years in Sales at the companies Chicago office. After returning to the Greer plant she managed several different manufacturing areas until she was promoted to Manufacturing Director. Then in 2010 she transferred to her current role as Human Resources Director and member of the Mitsubishi Plastics Global Human Resources Committee. Rose attended the University of Florida, where she obtained a BS in Chemical Engineering, and then attended Clemson for her MBA. She is married with two children, and lives with her family in Greer, SC. She enjoys reading, sewing, and dancing. 7

8 Mitsubishi Polyester Film, Inc Health Care Initiative Updated Through 2012

9 Free Preventative Care MFA s Health Care Model Our Goal is to maintain and/or improve the health of our employees, retirees and their families while controlling our health care costs. Co- Insurance (Earn HRA $ s to Cover) High Deductible (Earn HRA $ s to Cover) Consumer Driven Healthcare Plan (CDHP) Wellness Programs Health Assessment, Health Management, Smoking Cessation, Skin Cancer screening, Vaccines, Health publications On-Site : EAP, Medical Providers, Occupational Testing, Health Coach, Exercise Equipment, Weight Watchers, Exercise/Yoga classes, Off-Site Gym Discounts Convenient On- Site, Low Cost Medical Care (Family Medical Center) Keys: High Deductible with earned HRA, free preventative care, network discounts. Keys: Low cost and convenient on site care and health support.

10 Beginning of Year MPF Health Care Plan-How it Works End of Year Preventative Care Paid by MPF Deductible Portion 100% paid by you or Use HRA $ s you earned Co-Insurance Portion *80% paid by MPF *20% paid by you or use HRA $ s you earned You do not pay more than your Out of Pocket Max each year. Pharmaceuticals Co-Insurance MPF Pays: Generic: 100%; Brand: 80%; Non- Preferred: 60% Earn and use HRA $ s to cover your deductible and co-insurance on Medical and Pharmaceuticals. If you don t use it.save it until you need it. *% is for In-Network

11 Family Medical Center Helps Reduce Medical Costs Reduces the cost of Doctors visits -Cost per visit (Nurse Practitioner) -Time away from work (visits and illness) -Reduces visits to specialists (Mole removal, Orthopedic, ENT, etc) -Reduces trips/cost to ER or other after hours care since at work. Facilitates Health Management Program: -Improves Health-reduces costs (less specialist, hospital and pharmacy costs) -Assure preventative care. -Controls who earns HRA. Reduces cost of Labs: -Done on site-much cheaper -Less time away from work. Reduces Pharmacy Costs -Prescribe generics when ever possible. Reduces cost of other services by referral to lower cost provider. (colonoscopies, GI endoscopies, arthroscopy, mamograms, radiology rather than hospital)

12 Health Management Program Formerly Disease Management Current Program covers: Diabetes Dyslipidemia (high cholesterol) Weight Management (BMI 30 and above) Hypertension (high blood pressure) Capped Drugs for Participants in Compliance: Generics: Free Preferred brand: Lesser of co-insurance or $35 Non-preferred brand: Lesser of co-insurance or $45

13 Health Management Program-Simplified BMI 28 or less or reduce weight by 2 BMI points

14 CONFIDENTIAL MFA Medical Costs vs. National Average Increase Health Care Initiative CDHP started Fully transition to CDHP and opened FMC 2006 increase in Retiree Medical sharing and number Of retirees. Health Programs 2007 Provider issues Not good Data

15 Medical Costs per Employee/Retiree Company Confidential Health Care Initiative CDHP started Fully transition to CDHP and opened FMC Health Programs 2007 Provider issues Not good Data

16 Mitsubishi s Healthcare Initiatives 1. Medical Cost Reduction Incentives: -Consumer Driven Health Plan-High deductible -One Health Care Provider-Higher Discounts -On-Site Medical Care -$1000 incentive to decline coverage. -Surcharge for Spouse if they have other insurance available. 2. Wellness Incentives: -Earn HRA dollars to cover employee s cost. -Annual Health Assessment -Health Management Participation -BMI Challenge-Healthy Weight -Pay Less if non-smoker. -Pay Less for Medication if in Health Management Program 3. Wellness Support: -Free On-Site Health Coach -Free On-Site Counseling -Free, On-site Weight Watchers Program -Free, On-Site Nutritionist -Free Smoking Cessation Program

17 Mitsubishi s Healthcare History CDHP (Consumer Driven Health Plan) FMC (On-Site Medical Clinic) Health Improvement (Wellness Programs and support) 2005 Transitioned from 3 plans to one with high deductible and earned HRA. Incentives to get people off plan Increased retiree % cost Changed Carrier for deeper discounts Change Carrier for better service with CDHC. Added Tobacco Surcharge 2009 Increased Retiree Prem Increased Dental Premiums Added Vision 2011 Modification for Obama Care >65 supplement changed to CDHP Retiree Reinsurance 2005 Opened FMC-$20 per visit Developed system to do HA s for HRA $ s Added EAP and Dietitian Added on site EAP. Introduced Health Management. FMC Bonus for results on health improvement of Employees Health Added Occ. Health and Preemployment to FMC resp. 2010/2011 Improved HA & HM Modified FMC Bonus Added Medicare/other Ins. Billing Voluntary Health Assessment 2005 HA required for HRA $ s Health Support Wt. Watchers-Free and on site. Voluntary Tobacco Succession Program On Site/Free Health Coach & EAP Smoke Free Site 2009 Health Mgt. Participation to earn HRA $ s. BMI initiative for HRA $ s Capped drugs with HA and Health Mgt. Participation Increased exercise activities/equip. Health Management Kaizen

18 Live Better!-MFA Health Mgt. Process Health Assessment Yes Health Issue? No Yes Earn HRA $ s and Capped Drugs Health Management Program Follow-up as required? No Do Not Earn HRA $ s and Capped Drugs Lipidemia Hypertension Weight Mgt. Diabetes BMI Challenge Health Assessment (Weigh In) Yes <28 BMI or loose 2 pts. From last HA? Yes Earn BMI HRA $ s No No Do Not Earn BMI HRA $ s 18

19 MFA s Health Care Process Benefit Enrollment Benefit Administration Live Better *Supervisor s Meeting Aug. 17 th Employee/Retiree Completes Enrollment Form ONLY IF CHANGE Schedule Health Assessment (HA) and Blood Work (BW) *Employee Meetings Aug A/B/E Aug C/D/E Letter to Homes August Retiree Meetings Sept. PET Press Article Sept. (Aug. 15 th deadline) 19 *Mandatory Return Forms to HR by Sept. 26th Enter Changes into the Payroll System Oct. Confirmation Statement Mailed to Homes Nov. Enter Benefit Information into CIGNA system. HRA/Capped Drugs Compliance List from FMC No NO HRA or Capped Drugs (Letter to Home) No No Extra HRA Data Complete BW and HA on Time. BMI<28 or 10% Wt. Red. Yes Earn Extra HRA No Yes Discuss HA Results Yes Do You Have? Complete Req. Health Support Visits? Yes Earn HRA and Capped Drugs -Diabetes -Hypertension -Dyslipidemia -Wt. Mgt. Issues

20 Support Systems We have many support systems available to help employees and spouses be successful in reaching and maintaining good health. On-site medical facility Preventative care is paid 100% by the company Annual Company-paid health risk assessments/physicals Health Management Program -- Registered Dietician and Diabetes Educator BMI incentive for working towards a healthy weight Drug costs capped for diabetes, lipids, and hypertension disease management patients EAP-Free through CIGNA (life insurance/ltd insurance benefit) Free Tobacco Cessation Program On-site wellness coach On-site exercise classes and exercise equipment Exercise Facility Reimbursement Weight Watchers Annual flu shots Annual skin cancer screenings

21 CONFIDENTIAL MPF Health Care Plan-Details MPF Medical Coverage (In Network/Out of Network) Coverage Employee Only Employee Plus One Employee Plus Family Deductible $2000/$3000 $3000/$4500 $4000/$6000 Co-Insurance 80%/60% MPF 20%/40% Employee 80%/60% MPF 20% /40% Employee 80%/60% MPF 20%/40% Employee Maximum out of Pocket (Deductible plus Co- Insurance) $4000/$8000 $6000/$12000 $8000/$16000 Pharmaceuticals Generic: 100%; Brand: 80%; Non-Preferred: 60% Health Management Program - Participation Incentives Coverage Employee Only Employee Plus One Employee Plus Family Basic HRA $1000 $1500 $2000 *Extra BMI HRA $300 $600 $600 Cap on non-generic Pharmaceuticals Pharmaceuticals for High Cholesterol, Diabetes and High Blood Pressure Brand: Less of Co-Pay or $35; Non-Preferred: Less of Co-pay or $45 *BMI HRA Earned- $300 employee and $300 Spouse