MBGH Yearly Gathering MAY 10-11, 2007 Medical advantages GPS-Mapping Your 2008 Technique.


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MBGH Yearly Meeting MAY 10-11, 2007 Medical advantages GPS-Mapping Your 2008 Technique Paying For Quality Medicinal services Advantages With Activities, Not Money Hank Scheff, American Organization of State, Province and Metropolitan Representatives (AFSCME) Gathering 31
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MBGH ANNUAL CONFERENCE MAY 10-11, 2007 Health Benefits GPS-Mapping Your 2008 Strategy Paying For Quality Health Care Benefits With Actions, Not Cash Hank Scheff, American Federation of State, County and Municipal Employees (AFSCME) Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash Health Care Benefits at AFSCME: History What is AFSCME Council 31? 254 grown-up members (165 representatives/retirees) Comprehensive PPO, self subsidized, with unobtrusive expense sharing Like all around else, expenses debilitate the present state of affairs Voluntary screenings, Health Risk Assessments and medicinal self consideration preparing Negotiated with workers Employees as moderators are medical advantages canny AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash A New Direction in 2007 Build on what was set up Preserve quality advantages by increasing the behavioral stake for members Stress member skills key to better interchanges with wellbeing experts and wellbeing influencing choice making Adopt a “Value Based Benefits” method Integrate imaginative advantage expense imparting and “sculpting” to obligatory instruction, preparing and (attendant) consideration advising to make members be esteem co-makers – not just esteem recipients AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash 2007 Benefit Program Attributes Two arrangements supplanted the previous arrangement: The Health Improvement Plan (HIP) —better, “sculpted” advantages if secured grown-ups took after a Personal Health Improvement Prescription (PHIP) The Standard Plan - lesser advantages and higher expenses for grown-ups who don\'t wish to take after a PHIP and endeavor to enhance their wellbeing Health Care Counselors supplanted past use audit and case administration AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash 2007 Benefit Program Attributes (cont’d) another drug store advantage chief was named, and more noteworthy accentuation set on the clinical suitability of endorsed solutions Existing PPO systems and TPA held An as good as ever Council 31 Pathways to Health site that: Connects members to their PHIPs, individual wellbeing data and individuals from their wellbeing group Helps members figure out how to end up proficient and viable donors to their wellbeing AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash Why Join the Health Improvement Plan? Budgetary Incentives! PPO Deductibles: $200 HIP/$400 Standard Plan Coinsurance: 90%/80% HIP; 80%/70% Standard Plan Annual OOP Limits: $1,250 HIP; $2,500 Standard Plan AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash Why Join the Health Improvement Plan? Money related Incentives! (cont’d) Double above for family; twofold again for non-PPO suppliers Lifetime Limits: $2 million HIP; $1 million Standard Plan Contributions (surprisingly!): HIP: 0.5% of pay for a life partner STANDARD: 1.0% of pay for worker; 2.0% for a mate = 3% of compensation! Every grown-up makes their OWN SELECTION, they don’t must be in the same arrangement. Kids are naturally in the HIP AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash The Change “Navigator”-the PHIP A CONFIDENTIAL wellbeing competency advancement plan for every grown-up in light of blended wellbeing danger appraisal, health screening, and cases information It may oblige the utilization of specific administrations at different phases of determination and treatment taking into account individual wellbeing variables Compliance will be followed and rebelliousness will bring about ineligibility for the Health Improvement Plan and exchange to the Standard Plan AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash Examples of the PHIP’s Targeted Actions and Competencies Participate in CONFIDENTIAL wellbeing danger evaluations and health screenings Designate an essential consideration doctor and figure out how to correspond all the more viably with him/her Become consideration cost and advantages astute by comprehension what constitutes the “right” care and figuring out how to make care and expense exchange offs Learn to stay solid; decrease dangers of ailment, illness, harm, and unexpected passing; enhance capacities, personal satisfaction Adopt fitting early discovery hones AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash Examples of the PHIP’s Targeted Actions and Competencies (Cont’d) Effective utilization of data innovation Self treat wellbeing issues suitably Help counteract restorative slips Help facilitate their own consideration Work with the medicinal services instructor Actively partake in treatment arranges and go along completely with them Access end-of-life assets AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash Five Months In, What Have We Learned? Bunches of regulatory glitches brought about by presenting new program components, coordinating new administration suppliers and binds grown-up members to their own particular arrangements. Adjusting a Value Based Benefit theory with traditional stop misfortune bearer usage audit necessities is difficult Building the “right” site requires some serious energy, and inspiring members to utilize it in meeting their PHIP prerequisites and improving wellbeing change and consideration decisions is another outskirts Participants are excusing, and above all “get” what we’re attempting to do AFSCME Council 31

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Paying For Quality Health Care Benefits With Actions, Not Cash QUESTIONS? NEED TO KNOW MORE?

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