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Section 1: Current Marketplace & Trend - The Increasing Cost of HealthcareWhy Costs are Increasing?Questions & Answers
Section 2: Employee Awareness - Maximize Your Health Plan Benefits!Tools and ResourcesMaintaining Affordable CoverageWhat You Can Do To Be Better Consumers
CURRENT MARKETPLACE AND TRENDSWHY ARE COSTS INCREASING?
• Fact: Since 2002, health insurance premiums have increased by 117.5%, more than four times the 23.1% increase in California’s overall inflation rate
• Why?– Aging Population – Increasingly Sophisticated Medical Technology– Defensive Medical Treatment/Premiums for Malpractice Insurance– Increased Utilization– Consolidation of Health Care Providers– Prescription Drugs– Medical Inflation– Compliance & Legislation– Provider Cost Shifting– Recession– Fraud and Abuse– Wasted Expenditure – Lack of Employee Awareness– Healthcare Reform Fees
-Hoag and St. Joseph Health System
-Mandatory coverage – autism, sex change
-Reduction in Medicare payments – shifting payment to group and individual plans
-Over prescribing of high dollar diagnostic treatments no database to capture multiple prescribers
CURRENT MARKETPLACE AND TRENDSWHY ARE COSTS INCREASING?
Prescription drug costs and usage
Specialty Drugs – New cancer drugs can cost $100,000 per patient during the course of treatment, and the Specialty Drug sector is only expected to grow in the future
Half of all adults in the U.S. take at least one drug per day 7% of adults in the U.S. take at least five drugs per day 2/3 of people who walk into a doctor’s office, walk out with a
prescription Some Brand Name drugs, such as Lipitor and Nexium, have
gone Generic, so pharmacy trend is expected to go down for non-specialty drugs and expected to increase for specialty Pharmacy Trend for non-specialty – 5-7% Pharmacy Trend for Specialty – 25-40%
At Express-Scripts.com you can log in and complete the one-time registration. You are then routed to the member website for a personalized, plan-specific experience.
KAISER PERMANENTEMAXIMIZE YOUR HEALTH PLAN BENEFITS!
The Power of Connection My Health Manager
E-mail your doctor View most test results as soon as they become available Order prescription refills (most can be mailed and it’s postage paid) Request, cancel, or review routine appointments Act on behalf of a family member (e-mail your child’s doctor and more)
Reshape Your Life Healthy living classes [kp.org/healthyliving]
Tai chi, yoga, stress management, nutrition, weight management, asthma, diabetes, etc.
On-line health programs [kp.org/healthylifestyles] Succeed for a total health assessment Balance for weight management and physical fitness Relax for stress reduction Nourish for good nutrition Breathe for smoking cessation
Alternative care and fitness [kp.org/choosehealthy] Reduced rates for massage therapy, acupuncture, and chiropractic care Reduced rates and free shipping for on-line health products Preferred rates on select fitness club memberships
10,000 Steps program [kp.org/10000steps] Get in better shape, one step at a time
UHC Health Discount Programs Non-Covered Health and Wellness (10%-25% off) for Dental care- teeth whitening,
Vision care-Laser eye surgery, Alternative care-acupuncture, chiropractic care, massage therapy and natural medicine, Long-term care- Skilled nursing facilities, assisted living and respite programs, Infertility treatment and Hearing devices
Fitness Club Discounts (10%-25% off) for Bally Total Fitness, Snap Fitness, Gold’s Gym, Curves, Anytime Fitness and MyGym (for children)
Weight loss (10%-25% off) for Jenny Craig, Nutrisystem and Nutrition counseling Fitness equipment and apparel Smoking cessation programs
UHC Health and Wellness Resources Healthy Mind Health Body Newsletter-Can be personalized based
topics of interest, offers videos and seminars during the year Nurse Health Information Program-available 24 hours, 7 days a week
speak with a registered nurse about your specific needs Personal Health Record-track medications, procedures, test results Online Health Trackers and Tools: Personal health record, exercise
and weight loss trackers, Body Mass Index tool, calorie calculatorshealth quizzes
Preventive Care Guidelines-schedule for health screenings and vaccinations Comprehensive Library of Health and Wellness Information Online Health Assessment and Health Coaching Healthy Pregnancy Program
• Pick a primary care physician and build a relationship
• If diagnosed with a condition and surgery or aggressive treatment is recommended – get a second opinion and research your options
• Understand the cost of services and impact to you and the plan• Use tools and resources to educate yourself
• Choose other alternatives of care when prudent • Use urgent care instead of emergency for non-emergent conditions• Ask your doctor if you can use a generic drug versus a brand• Use Minute Clinics or retail clinics for acute care
• Retail outlets are about ½ the cost of an office visit and typically take less time (CVS Minute Clinics, Rite Aid walk in clinic, Walgreens healthcare clinic, etc.)
• Be a better consumer by understanding the cost of treatment and overall impact to our plan
• “You” as consumers make healthcare decisions and will ultimately drive the cost of our plan