Monday, May 03, 2010

#whccic - Lois Gargotto of Humana

More Real-Time notes from WHCC Innovation Congress

70% of disease is likely preventable
50% of cancer is avoidable
50% of accidents could be prevented

Lifestyle behavior also impacts the workplace.

Employers are looking for solutions to not just absenteeism and Presenteeism

Lifestyle behaviors tie to chronic diseases

Humana have 4M medicare eligible members, 2M Tricare, 4M ASO members

Other factors that erode the Value proposition:

- Little segment specific customization
- Wellness and rewards programs are nothing special
- Constant Payor consumer tool "feature warfare"
- Employer discomfort with yearly member cost share increase
- Provider "Gaming" (High cost speciality drugs dispensed in the office but available at lower cost  elsewhere - eg. human growth hormone, High markup on implant devices where doctors receive incentives from manufacturers).

Once people reach the claim deductible their utilization goes up. They pack in care to try and avoid having to spend against their deductible in succeeding years.

Humana's CoverageFirst  allowed spend pattern is lower.
The reasons:

- Aggregate family deductibles
- Integrated medical and RX deductibles
- HSAs (especially with employer funding) result in "first dollar" coverage
- Consumers not using e-tools to make informed decisions
- Federal MOOP limits lower than most PPOs due to what counts.
- Few plans have co-pays and coinsurance after deductible is met (100% plans)
- Vendetta Factor ie. people hate plans an when they reach deductible limit they "stick it" to the plan and spend like crazy.

The next generation:

Inspire well being and personal accountability

new provider network models

Mobile is critical component - point of care access

Humana - New Personal Health Allowance Product

Personalized consumerism solution that provides incentives for lifestyle accountability.

Tiered medical benefit that employs a personal spending allowance

Conceptual Design:
- Lean benefits with no behavior change. Change and get enhanced benefits

The product requires commitment which includes:
- Health lifestyle map, BMI screening,
BMI over 27 complete a weight management coaching program.
Smoking cessation
sign up for Mail order RX and eCommunications

Value Based Benefits. Focus on Chronic conditions. Good management leads to lower consumer costs.

The new paradigm is Well-Being Engagement

 CoverageFirst is the best performing product that Humana has ever produced. 
Lowest PMPM. Low ER utilization etc.

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