High Performing Health Plan Case Study - …€¦ · Case Study . ARTHUR J. GALLAGHER ... Town...

High Performing Health Plan – Case Study

ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™

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

ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ 3





Rose Marchek

7

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.


Mitsubishi Polyester Film, Inc

Health Care Initiative

Updated Through 2012


Co-

Insurance (Earn HRA $’s

to Cover)

MFA’s Health Care Model

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

Consumer Driven Healthcare

Plan (CDHP)

Our Goal is to maintain and/or improve the health of our employees, retirees and their families while controlling our health care costs.

Keys: High Deductible with

earned HRA, free

preventative care, network

discounts.

Keys: Low cost and

convenient on site care

and health support.

High

Deductible (Earn HRA $’s

to Cover) Fre

e P

reven

tati

ve C

are

Convenient On-Site, Low Cost Medical Care

(Family Medical Center)


Pharmaceuticals Co-Insurance

MPF Pays: Generic: 100%; Brand: 80%; Non-

Preferred: 60%

Co-Insurance

Portion

*80% paid by MPF

*20% paid by you

or

use HRA $’s you earned

MPF Health Care Plan-How it Works

Deductible

Portion

100% paid by you

or

Use HRA $’s you

earned

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.

Preventative Care

Paid by MPF

Begin

nin

g o

f Y

ear

End o

f Y

ear

*% is for In-Network

You do not pay more than your “Out of Pocket Max” each year.


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)


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


Health Management Program-Simplified

BMI 28 or less or

reduce weight by 2

BMI points


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.

2007 Provider issues Not good Data

Health Programs

CONFIDENTIAL


Medical Costs per Employee/Retiree

Health Care Initiative CDHP started

Fully transition to CDHP and opened FMC

2007 Provider issues Not good Data

Health

Programs

Company Confidential


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

Mitsubishi’s Healthcare Initiatives


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.

• 2006

• Increased retiree % cost.

• 2007

• Changed Carrier for deeper discounts.

• 2008

• Change Carrier for better service with CDHC.

• Added Tobacco Surcharge

• 2009

• Increased Retiree Prem.

• 2010

• 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.

• 2007

• Added on site EAP.

• Introduced Health Management.

• FMC Bonus for results on health improvement of Employees Health.

• 2009

• Added Occ. Health and Pre-employment to FMC resp.

• 2010/2011

• Improved HA & HM

• Modified FMC Bonus

• Added Medicare/other Ins. Billing.

• 2002

• Voluntary Health Assessment

• 2005

• HA required for HRA $’s

• Health Support Wt. Watchers-Free and on site.

• Voluntary Tobacco Succession Program.

• 2007

• On Site/Free Health Coach & EAP.

• 2008

• Smoke Free Site

• 2009

• Health Mgt. Participation to earn HRA $’s.

• BMI initiative for HRA $’s.

• 2010 Capped drugs with HA and Health Mgt. Participation.

• 2011

• Increased exercise activities/equip.

• Health Management Kaizen


Live Better!-MFA Health Mgt. Process

Health

Assessment

Health

Management

Program

Earn HRA $’s

and Capped

Drugs

BMI

Challenge

Hypertension Lipidemia Weight

Mgt. Diabetes

Health

Issue?

Yes

Follow-up

as

required?

Yes

Health

Assessment

(Weigh In)

<28 BMI

or loose 2

pts. From

last HA?

Earn BMI

HRA $’s

Do Not Earn

BMI HRA $’s

Yes Yes

No No

No

No

Do Not Earn

HRA $’s and

Capped Drugs


MFA’s Health Care Process

*Supervisor’s

Meeting

Aug. 17th

*Employee

Meetings

Aug. 17-19 A/B/E

Aug. 22-24 C/D/E

Retiree

Meetings

Sept.

Letter to Homes

August

PET Press Article

Sept.

(Aug. 15th

deadline)

Employee/Retiree

Completes

Enrollment Form

“ONLY IF CHANGE”

Return Forms to

HR by Sept. 26th

Confirmation

Statement Mailed

to Homes Nov.

Schedule Health Assessment

(HA) and Blood Work (BW)

*Mandatory

Enter Changes into

the Payroll System

Oct.

HRA/Capped Drugs

Compliance List from

FMC

Enter Benefit

Information into

CIGNA system.

Earn HRA and

Capped Drugs

Earn Extra

HRA

NO HRA or

Capped Drugs

(Letter to Home)

-Diabetes

-Hypertension

-Dyslipidemia

-Wt. Mgt.

Issues

Discuss HA

Results

No Complete

BW and

HA on

Time.

Yes

Do

You

Have?

Complete

Req. Health

Support

Visits?

BMI<28

or 10%

Wt.

Red.

No

No

Yes

Yes No

Extra

HRA

Yes

Data

Benefit Enrollment Benefit Administration Live Better


• 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

Support Systems


MPF Health Care Plan-Details

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

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

MPF Medical Coverage (In Network/Out of Network)

CONFIDENTIAL

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