57
Practice what you Preach: NAHU’s Ideas in Action Presented by: Susan Rider April 21, 2011
Practice what you Preach NAHUrsquos Ideas in Action
Presented by Susan RiderApril 21 2011
Practice what you Preach NAHUrsquos Ideas in Action
Susan Rider- President
Indianapolis Association of Health Underwriters
2 Hour Continuing Education Course
Provider Indy AHU
Since this course was filed PPACA became the law of the land
NAHUrsquos Healthy Access Plan would help reduce the number of uninsured there is no guarantee that any of NAHUrsquos recommendations will be adopted
Fortunately there are a number of actions that insurance agents can take TODAY that will help to stabilize their clientsrsquo rapidly rising health insurance premiums and to ensure that more employees take advantage of the health insurance coverage offered by their employer
Our goal is to give you a few ideashellip
Course Objectives
Constraining Constraining Medical CostsMedical Costs
Claims CostClaims Cost8888
Administration12
Administrative Expensesa convenient scapegoat
American Academy of Actuaries September 2009
Summary of Activities by Functional Category Marketing
Provider amp Medical Management
Account amp Member Administration
Corporate Services
American Academy of Actuaries September 2009
Behavior15
Other Claims Other Claims CostCost
729729
Administration12
Behavior amp Lifestyle
Aon Consulting Research Brief ldquoThe Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumersrdquo 2007
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Practice what you Preach NAHUrsquos Ideas in Action
Susan Rider- President
Indianapolis Association of Health Underwriters
2 Hour Continuing Education Course
Provider Indy AHU
Since this course was filed PPACA became the law of the land
NAHUrsquos Healthy Access Plan would help reduce the number of uninsured there is no guarantee that any of NAHUrsquos recommendations will be adopted
Fortunately there are a number of actions that insurance agents can take TODAY that will help to stabilize their clientsrsquo rapidly rising health insurance premiums and to ensure that more employees take advantage of the health insurance coverage offered by their employer
Our goal is to give you a few ideashellip
Course Objectives
Constraining Constraining Medical CostsMedical Costs
Claims CostClaims Cost8888
Administration12
Administrative Expensesa convenient scapegoat
American Academy of Actuaries September 2009
Summary of Activities by Functional Category Marketing
Provider amp Medical Management
Account amp Member Administration
Corporate Services
American Academy of Actuaries September 2009
Behavior15
Other Claims Other Claims CostCost
729729
Administration12
Behavior amp Lifestyle
Aon Consulting Research Brief ldquoThe Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumersrdquo 2007
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Since this course was filed PPACA became the law of the land
NAHUrsquos Healthy Access Plan would help reduce the number of uninsured there is no guarantee that any of NAHUrsquos recommendations will be adopted
Fortunately there are a number of actions that insurance agents can take TODAY that will help to stabilize their clientsrsquo rapidly rising health insurance premiums and to ensure that more employees take advantage of the health insurance coverage offered by their employer
Our goal is to give you a few ideashellip
Course Objectives
Constraining Constraining Medical CostsMedical Costs
Claims CostClaims Cost8888
Administration12
Administrative Expensesa convenient scapegoat
American Academy of Actuaries September 2009
Summary of Activities by Functional Category Marketing
Provider amp Medical Management
Account amp Member Administration
Corporate Services
American Academy of Actuaries September 2009
Behavior15
Other Claims Other Claims CostCost
729729
Administration12
Behavior amp Lifestyle
Aon Consulting Research Brief ldquoThe Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumersrdquo 2007
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Constraining Constraining Medical CostsMedical Costs
Claims CostClaims Cost8888
Administration12
Administrative Expensesa convenient scapegoat
American Academy of Actuaries September 2009
Summary of Activities by Functional Category Marketing
Provider amp Medical Management
Account amp Member Administration
Corporate Services
American Academy of Actuaries September 2009
Behavior15
Other Claims Other Claims CostCost
729729
Administration12
Behavior amp Lifestyle
Aon Consulting Research Brief ldquoThe Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumersrdquo 2007
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Claims CostClaims Cost8888
Administration12
Administrative Expensesa convenient scapegoat
American Academy of Actuaries September 2009
Summary of Activities by Functional Category Marketing
Provider amp Medical Management
Account amp Member Administration
Corporate Services
American Academy of Actuaries September 2009
Behavior15
Other Claims Other Claims CostCost
729729
Administration12
Behavior amp Lifestyle
Aon Consulting Research Brief ldquoThe Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumersrdquo 2007
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Summary of Activities by Functional Category Marketing
Provider amp Medical Management
Account amp Member Administration
Corporate Services
American Academy of Actuaries September 2009
Behavior15
Other Claims Other Claims CostCost
729729
Administration12
Behavior amp Lifestyle
Aon Consulting Research Brief ldquoThe Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumersrdquo 2007
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Behavior15
Other Claims Other Claims CostCost
729729
Administration12
Behavior amp Lifestyle
Aon Consulting Research Brief ldquoThe Impact of Consumer-Directed Health Plans with Integrated Health Improvement Services on Health Care Consumersrdquo 2007
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Constraining Medical Costs
Centers for Disease Control amp Prevention 2006 Behavioral Risk Factors Surveillance System
Behavior amp Lifestyle Weight Gain rsquo86-rsquo06
No Data lt10 10ndash14 15ndash19 20ndash24 25ndash29 ge30
No Country Can Fund All the
ConsequencesHypertension
Type 2 Diabetes Osteoarthritis
Stroke Coronary Heart
GallbladderSleep Apnea
Respiratory Issues
Some Cancers
Obesity Trends Among US Adults (BMIgt30)
1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos Ideas
Incorporate wellness and disease-management into all government employee programs
Encourage employer wellness programs
What You Can Do
Recommend Consumer-Directed Plans the first step to getting employees to care what health care costs
Recommend Wellness Programs with incentives to participate
Behavior and Lifestyle Solutions
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Behavior15
Other Claims Other Claims CostCost
676676
Inefficiencies33
Administration14
System Inefficiencies
PriceWater Coopers ldquoThe Price of Excessrdquo April 2008
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos IdeasImprove system inefficiencies in doctor and medical facilitiesFederal standards for interoperable electronic medical records
What You Can DoConsumer-directed health plans will incentify consumers to police doctors who order duplicate or high-dollar proceduresUse transparency tools and third party vendors to locate more efficient providersPortable electronic medical records might be a short-term fix
System Inefficiencies Solutions
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Behavior15
Other Claims Other Claims CostCost
626626
Malpractice5
Administration14
Medical Malpractice
Inefficiencies33
Towers Perrin ldquoUS Tort Costs 2005 Updaterdquo March 2006PricewaterhouseCoopers ldquoThe Factors Fueling Rising Healthcare Costs 2006rdquo February 2006
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos Ideas
Malpractice reform limits
What You Can Do
Communicate ideas of tort reform with your legislators
Medical Malpractice Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Behavior15
Other Claims Other Claims CostCost
451451
Uninsured Cost Shift
8
Government Cost Shift
95
Administration14
Cost Shifting
Inefficiencies33
Malpractice5
bullMargaretann Cross ldquoConfronting the Medicare Cost Shiftrdquo Managed Care Dec 2006bull2003 Health Affairs ldquoKaiser Commission Report on Medicaid amp the Uninsuredrdquo
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc
Cost-Shifting Solutions
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Government Cost-Shifting to Hospitals
143
-182-185
-250
-200
-150
-100
-50
00
50
100
150
200
Pro
fit
Ma
rgin
Commercial Margin
Medicare Margin
Medicaid Margin
Hospital BreakevenPoint
Premera Blue Cross May 2006 Payment Level Comparison Between Public Programs and Commercial Health Plans for Washington State Hospitals and Physicians
Breakeven
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos IdeasRequire Medicare Medicaid and SCHIP to reimburse doctors and hospitals at same level as the Federal Employees Health Benefit PlanProvide incentives for states to streamline the application process for government programs
What You Can DoGrassroots ndash make consumers angry by educating them through presentations the media etc We only have 20k members but millions of voters can get the legislatorsrsquo attentionDonate to HUPAC and ISAHUPACTransparency ndash make sure members are using transparency tools that are already available
Cost-Shifting Solutions
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Behavior15
Other Claims Other Claims CostCost
451451
Government Cost-Shift
95
Administration14
Decreasing Utilization
Inefficiencies33
Malpractice5Uninsured
Cost-Shift8
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos Ideas
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Increase health care cost transparency
What You Can Do
Expand consumerism
Health Savings Accounts (HSAs)
Health Reimbursement Arrangements (HRAs)
Flexible Savings Accounts (FSAs)
Promote transparency tools
Decreasing Utilization Solutions
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
AccessAccessforforAllAll
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Are you listening to what people are saying
Your clients arehellip
We get info from NAHU but our clients donrsquotIf we donrsquot educate our clients where will they get their information
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
February 2005 Blue Cross Blue Shield Association analysis of Census Bureaursquos ldquoIncome Poverty and Insurance Coveragerdquo report
Most Uninsured Not A Crisis
Eligible for Government
Program
(but not signed up)
$50000+
Annual Income
Temporarily Uninsured
Long-Term Long-Term Uninsured Uninsured
46 Million Considered Uninsured
3434
8080
1414
2020
3232
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos IdeasThe federal government should require that all states have at least one private guaranteed purchasing option (risk pool)Seed grants to states creating high-risk poolsRisk-pool premium subsidies to low-income citizens and older beneficiaries to help ensure continued coverage for early retirees
What You Can DoHelp People need assistance understanding and enrolling in
Risk poolSCHIPMedicaidMedicareLTC partnership
Eligible for a Government Program
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Indianarsquos Uninsured Children 131000 Children Are Uninsured in Indiana 1048708 More than one in 13 children in Indiana is uninsured (79 percent of
Indianarsquos children) Indianarsquos Uninsured Children Come from Working Families 1048708 The vast majority of uninsured children in Indiana (953 percent)
come from families where at least one parent works 1048708 Approximately two-thirds of uninsured children (671 percent) in Indiana live in households where at least one family member works full-time year-round
1048708 Still 482 percent of Indianarsquos uninsured children come from low-income families (families with income below twice the poverty level or $35200 for a family of three in 2008) who are likely eligible for Hoosier Healthwise
Most Uninsured Children in Indiana Come from Two-Parent Households
1048708 Among uninsured children living with a parent more than half (623 percent) live in two-parent households
2008 Analysis conducted by the Census Bureau for Families USA
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Karma
Good things happen to good people
When you help othershellip
bull You gain a new perspective and may be able to identify new opportunities
bull They sometimes refer business to you
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can DoWersquore the salespeople ndash if people arenrsquot signing up wersquore to blame Maybe wersquore selling the wrong product or using the wrong approach
Every time we sell a group and donrsquot get 100 participation wersquore contributing to the number of uninsured
$50k+ Annual Income
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos IdeasEducate lawmakers and the media about the true makeup of the uninsured
What You Can Do
Sell short-term policies to employees in their waiting period ndash get the employer to sell it for you
Recommend short-term policies when people quit in lieu of COBRA Send brochures with the COBRA notice
Short term policies an affordable option for dependents
Temporarily Uninsured
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
CRISIS47 million uninsured
Health Insurance Crisis
Health insurance is expensive because health care is expensive
Health Care Crisis
Maybe wersquore to blame ndash itrsquos a behavioral issue
Health Crisis
Center for Health Care Strategies
Health Literacy Crisis
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
What is Health Literacy
Health Literacy is the ability to read understand and act on health care information
More specifically functional health literacy is ldquothe ability to read and comprehend prescription bottles appointment slips and the other essential health related materials required to successfully function as a patientrdquo ndash AMA Council of Scientific Affairs
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Why is Health Literacy Important
Studies show that limited literacy skills are a stronger predictor of an individuals health status than age income employment status education level and
racial or ethnic group
CHCS strives to improve health literacy for people in government programs like Medicaid amp Medicare
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
People with low functional health literacy are less likely to
Understand written and oral information given by physicians nurses pharmacists and insurers
Act upon necessary procedures and directions such as medication and appointment schedules
Be able to navigate the health system to obtain needed services
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
People with low functional health literacy are more likely to
Receive health care services through publicly financed programs even after controlling for such factors as age education or socioeconomic status
Incur higher health care costs A study of Medicaid patients found those reading below third-grade level had average annual health care costs four times those of the overall Medicaid population
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Who Has Health Literacy Problems
Health literacy problems affect people from all backgrounds especially those with chronic health problems
Older people non-whites immigrants and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information
Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need
But you canrsquot tell by looking
Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Impact of Low Health Literacy Skills on Annual Health Care Expenditures
Poor health literacy can have profound financial consequences In 2001 low functional literacy resulted in an estimated $32 to $58 billion in additional health care costs
According to the National Adult Literacy Survey (NALS) as many as 44 million people (age 16 and older) or 23 of all adults in the United States are functionally illiterate
An additional 28 of all adults mdash 535 million people mdash had only marginally better reading and computational skills
This suggests that nearly 50 of all adults may have problems understanding prescriptions appointment slips informed consent documents insurance forms and health education materials
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Health Literacy and Understanding Medical Information
Patients with poor health literacy skills struggle to understand basic medical forms and instructions
It is especially difficult for less literate patients to fill out intake forms enroll in insurance programs for which they may be eligible get services once enrolled follow medical instructions or give informed consent
Most informed consent and insurance forms and most medication package inserts are written at high school level or higher
Of 979 emergency department patients with inadequate health literacy
81 could not read the rights and responsibilities section of a Medicaid application
74 did not know if they were eligible for free care
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
NAHUrsquos Ideas
All health insurance consumers both private and public should have access to quality information and assistance regarding their health care coverage
NAHU will assume responsibility for training insurance agents in all coverage options both public and private through the creation of a designation programmdashthe Certified Health Care Access Advisor
What You Can Do
CHCS educates people in government programs - itrsquos the agentrsquos job to educate people covered by private insurance
Health literacy starts with understanding your coverage amp how to access benefits The agent should be both teacher amp coach
PublicPrivate Producer Community Education Partnership
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Commencement
ldquoThis isnrsquot so much a commencement ndash an ending ndash as it is a new beginningrdquo
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Lesson Plan
Consumer-Directed Plan Designs
Transparency
Wellness
Education amp Communication
Tying it all Together
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Consumer Directed Health Care
ldquomanaged care is fading awayrdquo
- Chaliese Rippey
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Consumer Directed Health Care
Starts with a consumer directed plan as an option
Flexible Spending Accounts (FSArsquos)
Health Reimbursement Arrangements (HRArsquos)
Health Savings Accounts (HSArsquos)
Consumerism includes much more than just plan design
Give employees choices ndash thatrsquos part of consumerism
Defined contribution and dual option strategy
8 year projection of $350 rate at just a 10 annual increase
$350 - $385 - $424 - $512 - $564 - $620 - $682 - $750
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Transparency Tools
Price TransparencyCarrier ToolsThird-party pricing guidance
Quality TransparencyIf we only compare price we turn health care providers into a commodityCarrier ToolsConsumer reports and third-party quality guidance
Legislative initiatives and the future of transparency
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Wellness Programs
What Is ldquoWellnessrdquo OverviewWhat Is ldquoWellnessrdquo Overview
Reducing Risk FactorsReducing Risk Factors
What A Complete Wellness Program Looks LikeWhat A Complete Wellness Program Looks Like
Engaging Employees in WellnessEngaging Employees in Wellness
Case StudiesCase Studies
How To Measure ResultsHow To Measure Results
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Education and Communication
Employer Proposal
Employee Communication Pieces
Enrollment Meeting
Benefits Websites
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Employer proposal
Stop spreadsheeting Identify what makes each plan unique
Define all insurance terms and acronyms
Make it look easy to understand Use pictures
Introduce out-of-the-box solutions with multi-year projections
Make a recommendation The employer wants guidance
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Member pays 100 of first $3000
Member pays 20of next $15000
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
PLAN
$3000
20
$3000
$6000
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Member pays 100 of first $500
Member pays 20of next $17500
Insurance pays 80 of next $15000
Insurance pays 100 up to $5 million
DoctorMember pays
$35
RxMember pays $10-30-50
EO EC ES EF Total
Carrier A
Carrier B
Carrier C
Carrier D
Other In-Network Services
Monthly Premium
DED
COIN
CSL
OOP
OLD NEW
$3000 $500
20 20
$3000 $3500
$6000 $4000
Employer pays 80 of next $2500 (MERP)
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Strategies to Assist Low-Literate Health Care Consumers
Surrogate readers family members can help patients understand key information
Tailoring medication schedules to fit a patientrsquos daily routine color coding medicines
Providers can ask patients to ldquoteach backrdquo by restating the instructions
Use commonly understood words ldquokeeps bones strongrdquo instead of ldquoprevents osteoporosisrdquo
Slow down and take time to listen Create an atmosphere of respect and comfort
Limit info given to patients at each visit Less than half of the info provided during each visit is retained
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Employee communication amp enrollment meetings
Start early ndash give the employee a chance to review with family
Make communications easy to understand and make them look easy to understand Use pictures
Donrsquot forget about non-English speakers
Ask employees to explain their plan back to you
Hit the high points Too many details can be confusing
Allow plenty of time for questions Be patient and listen to what employees are asking
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Benefits websites
Common for large groups ndash new trend for small groups
Allow employer to brand their benefits package
Includes all products and is consistent from one year to another
Inexpensive ndash big return on investment
Even more useful for HR manager than for the employee
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Benefits Selling Magazine ndash Employer Survey
77 of employers thought it was important or very important that their broker make a recommendation
73 of small employers believe the personality of the broker is key
52 of employers believe it is very important for the broker to be accessible
77 of employers want their broker to visit them
85 of employers believe it is important for a broker to have expertise in and represent a wide variety of products
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Donrsquot Be Afraid to Ask for HelpExcerpt from Sharon Altrsquos October column in Benefits Selling
ldquoPerhaps agents should think of themselves as a general contractor When building ndash or these days flipping ndash a house most people donrsquot try to do everything themselves And they shouldnrsquot When you think about the multitude of tasks that need to be done ndash building painting plumbing electrical work landscaping etc ndash itrsquos almost ridiculous to think one person could do it all
And in the insurance world therersquos an overwhelming list of products we can offer our clientshellipwhen a client requests a line of coverage that wersquore not that familiar with we might do well to partner with someone with more experience than us Sure we might give up some commission in the process but remember that itrsquos better to have part of something than all of nothingrdquo
Questions
The End
Questions
The End
The End
