Proposed Medical Insurance Policies in Milwaukee County, Wisconsin
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1 PROPOSED MILWAUKEE COUNTY HEALTH INSURANCE BENEFIT CHANGES Milwaukee County Board of Supervisors Committee of the Whole September 9, 2004 presentation by Department of Audit 1
2 Current Plan Preferred Provider Organization (Conventional) Self-insured PPO administered by Humana Wide selection of providers 2003 costs approximately $49.4 million, currently 10,566 members Humana Health Maintenance Organization Fully insured HMO Restricted to Humana network of providers 2003 cost $26 million, currently 8,432 members Aurora Direct Exclusive Provider Organization Self-funded EPO, benefits /deductibles similar HMO Restricted to Aurora network 2003 costs approximately $5.7 million, currently 1,197 members 2
3 Proposed Plan Continue PPO Significantly expand co-pays and co-insurance Increase premiums significantly Continue HMO Expand and increase co-payments Moderately increase Family premiums, decrease Single Aurora Direct EPO (if offered) Expand and increase co-payments Moderately increase Family premiums, decrease Single Implement New Consumer Driven Plan (Coverage First) 3
4 Proposed Plan Coverage First Enhanced employee financial stake with significantly expanded out-of-pocket costs Uses same network as Humana PPO $500 benefit allowance per person with higher annual deductibles beyond allowance Lower monthly premiums than existing plans 4
5 Monthly Premiums Conventional (PPO) Current Proposed Single $80 $130 Family $100 $260 HMO / EPO Single $80 $65 Family $100 $130 Coverage First Single NA $25 Family NA $50 5
6 Current Plan Features Out-of-pocket expenses Conventional (PPO) Annual deductibles: $150 Single (in network) $450 Family (in network) Annual limits: $1,500 Single $2,500 Family HMO / EPO Annual deductibles: $0 Limits: Not applicable 6
7 Proposed Plan Features Out-of-pocket expenses Conventional (PPO) Co-payments increased for prescriptions and added for office visits ($30 primary / $40 specialist excludes wellness and prevention) Co-insurance applies to nearly all procedures Co-payments excluded from out-of-pocket limits HMO / EPO Co-payments added for office visits ($25 primary / $35 specialist), in-patient hospitalization ($200), emergency room ($50 if not admitted), Co-payments increased for prescription drugs 7
8 Proposed Plan Features Out-of-pocket expenses (continued) Coverage First $500 allowance, does not apply to co-pays including prescriptions Annual deductible of $1,000 Single and $3,000 Family in network ($3,000 / $9,000 out of network), excludes co-pays Most services covered 100% after allowance and deductible and some co-pays, some services covered 80% including lab Out-of-pocket limits excluding deductibles and co-pays $2,000 Single and $6,000 Family (in network), ($6,000 / $18,000 out of network) 8
9 Projected 2005 County Savings Status Quo Total Cost $118,686,000* County Portion $112,823,000 Employee Premium $5,862,000 Plan Design Changes Only Total Cost $99,967,000 County Portion $90,524,000 Employee Premium $9,443,000 Design Changes and Coverage First Total Cost $102,879,000 County Portion $96,109,000 Employee Premium $6,771,000 *9/7/04 revised=$115,869,000 ($110,262,000 County / $5,607,000 Employee) 9
10 Total Employee Impacts Total number employees with health care 4,631 Represented 3,915 Non-Represented 716 Total employee salaries $10,000 to $49,999 3,522 employees $50,000 to $89,999 1,002 employees $90,000 and higher 102 employees 10
11 Non-Rep Impacts Proposed plan is initially for non-rep employees Non-reps salaries $10,000 to $49, employees $50,000 to $89, employees $90,000 and higher 66 employees 11
12 Impact on Employee A Low-Use Single Coverage Salary $45,598 (Represented) 2003 Out-of-Pocket Expenditures (including premiums) $1, Expenditures (including premiums) PPO with changes $1,948 HMO/EPO with changes $1,025 Coverage First $459 12
13 Impact on Employee B Low-Use Family Coverage Salary $57,165 (Non-Rep) 2003 Out-of-Pocket Expenditures (including premiums) $1, Expenditures (including premiums) PPO with changes $3,421 HMO/EPO with changes $1,760 Coverage First $740 13
14 Impact on Employee C Mid-Use Single Coverage Salary $30,113 (Represented) 2003 Out-of-Pocket Expenditures (including premiums) $1, Expenditures (including premiums) PPO with changes $2,839 HMO/EPO with changes $1,388 Coverage First $2,303 14
15 Impact on Employee D Mid-Use Family Coverage Salary $34,109 (Represented) 2003 Out-of-Pocket Expenditures (including premiums) $2, Expenditures (including premiums) PPO with changes $5,784 HMO/EPO with changes $2,185 Coverage First $2,840 15
16 Impact on Employee E High-Use Single Coverage Salary $52,196 (Represented) 2003 Out-of-Pocket Expenditures (including premiums) $2, Expenditures (including premiums) PPO with changes $6,181 HMO/EPO with changes $3,179 Coverage First $9,515 16
17 Impact on Employee F High-Use Family Coverage Salary $91,666 (Non-Rep) 2003 Out-of-Pocket Expenditures (including premiums) $3, Expenditures (including premiums) PPO with changes $8,660 HMO/EPO with changes $4,219 Coverage First $14,940 17
18 Conclusions on Proposed Plan Positive Features Significant savings Enhanced employee financial stake in care choices Appropriate focus on increases to family plans, some retirees (via co-pays and deductibles) and those with more expensive coverage Concerns Does not address provider discounts Limited focus on employee education Unintended consequences of steerage to HMO / EPO Magnitude of potential impact on employee costs 18
19 Other Cost Reduction Strategies Provider Pricing- Discounts with hospitals and physicians Behavior changes Volume of service used Price of service used Long-term partnerships with other governments, both state and local, and with businesses 19
20 Other Cost Reduction Strategies Intensive Management Discounts Utilization Contract management Wellness and disease management Employee education on provider pricing and quality 20
21 Other Cost Reduction Strategies Health Reimbursement Arrangement Health Savings Account Plan parity for post-65 retirees Potential for Humana Gold 21
22 Other Matters for Consideration Health insurance in context of other wage and benefits decisions Implementation timetable 22
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