Dr. Rick Cartor, Custom Healthcare Designs / BB&T
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Case Study: Six Straight
Years of Declining Healthcare
Costs--Presentation and Case Study--
Dr. Rick Cartor, Custom Healthcare Designs / BB&T
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1. Our Purpose Today2. The Company3. The Summary Statement4. The Timeline & Results5. Why it works & Advice
AGENDA
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Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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Our Purpose Today
The purpose of this session is generate ideas that may enhance the value1 of the healthcare benefits your company provides its employees, by sharing the details of one company’s very successful2 health care benefit system.
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1. Value: low cost, high quality, accessible care 2. Success: decreasing PEPY spending, improved health, positive reactions, accessible quality care
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About the company
• Description
• History & Purpose– The Mary Byron Foundation
• Products/Services
• Awards
• VP, HR @ 150– Healthcare experience and vision
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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The Summary StatementA long term incremental introduction of an integrated system that engaged employees in primary care by creating a collaborative culture of health awareness by:
• aligning incentives, • analyzing and sharing data (information) • contracting for convenient primary care• establishing and steering to a narrow network
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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The “integrated system”
• Health assessment and promotion– “Wellness” with incentives / disincentives– Continuum of coaching
• Contracted accessible care– Fixed rate (lower and more predictable)– On-site or near site x Solo or shared
• Data acquisition and analysis– Analytics, information and transparency
• Narrow network and steerageDr. Rick Cartor, ChD / BB&T
(502) 489-5972 Page 6#kyshrmconf
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20132006 2007
2008
2009 2011
20121 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Committee
START:ExistingCare planHDHP/HSAJan. 1$1
Timeline You are here
(09/27)
Renewal
!?!?
WELLNESS SELF-FUND
HRA
ONSITE CARE
Stop HRAAdd Sr+
ChD
Incentives (+PCC) for partnersNicotine test to attest
Drawing: F2T
Rewards: Participation to ZT to results
Steerage
BHN EXCLUSIVE NETWORK
Coaching2010
Biometrics (Eddington)
½ fitness fees +
Non-smoker reward to smoker fees
Free e-cigs
Coaching & DMHealthcare
to HRHealthcare
to HR
$$
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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rickcartor.wordpress.com
Data Actions
• PMPM data
• Recidivists (biometrics)– Targeting repeat high risk factor employees
• Effects (biometric scores healthcare costs)– Focus wellness programs, activities
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
2006 2007 2008 2009 2010 2011 2012 2013
On Site PCC
Self Fund
$210
Wellness
BACK
Data Actions
• PMPM data
• Recidivists (biometrics)– Targeting repeat high risk factor employees
• Effects (biometric scores healthcare costs)– Focus wellness programs, activities
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
Page 10#kyshrmconf
rickcartor.wordpress.com
Why it Works (1-5 of 11)
01. Primary and preventive care Dr. Barbara Starfield, Johns Hopkins, etc.
02. Transaction costs: doctor visits / meds & pharmacy / lab work
03. Coaching & disease management
04. ER, ICC use
05. Procedures, Inpatient care, Meds
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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Why it Works (6-11 of 11)
06. In Network + Transparency = Lower costs
07. Self-funding: incentive management, steerage
08. Unbundled: transparency, competition, value.
09. Data driven decisions
10. Zero Trend basis (P’MaintainImprove)
11. Integration: system design
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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Unsolicited Advice (…or free consulting!)
01. Believe. 02. Emphasize primary care, prevention.03. Stop Idea Whack-a-Mole.04. Think small / act locally.05. Use a formal PSDM process.06. Agree on goals, objectives, criteria.07. Think > 12 month (Plan & ROI).
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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08. Follow up with chronic conditions.09. Consider exclusive (“narrow”) networks.10. Insist on acquiring / analyzing data.11. Align on healthiness.12. Integrate the system…13. Stay vigilant: “No victory is final or complete.”
Dr. Rick Cartor, ChD / BB&T(502) 489-5972
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Unsolicited Advice (…or free consulting!)