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【正文】 Dec 94 Dec 95 Dec 96 Dec 97 Dec 98 Dec 99 Dec 00 Dec 01 Dec 02 E nrol l ed 1, 26 3, 54 7 1, 38 9, 40 1 1, 56 5, 65 9 1, 81 1, 45 3 2, 26 8, 36 4 3, 08 9, 25 9 4, 11 5, 29 3 5, 21 1, 33 9 6, 05 5, 54 6 6, 34 7, 43 4 6, 26 0, 54 9 5, 48 0, 89 9 4, 92 9, 69 0% G r ow th n/ a 10% 13% 16% 25% 36% 33% 27% 16% 5% 1% 12 % 10 % P l an s 96 93 95 109 154 183 241 307 346 309 266 179 15501 , 0 0 0 , 0 0 02 , 0 0 0 , 0 0 03 , 0 0 0 , 0 0 04 , 0 0 0 , 0 0 05 , 0 0 0 , 0 0 06 , 0 0 0 , 0 0 07 , 0 0 0 , 0 0 08 , 0 0 0 , 0 0 0D e c 9 0 D e c 9 1 D e c 9 2 D e c 9 3 D e c 9 4 D e c 9 5 D e c 9 6 D e c 9 7 D e c 9 8 D e c 9 9 D e c 0 0 D e c 0 1 D e c 0 2Enrollment050100150200250300350400 of PlansT o t E n r H M O s49 Mercer Human Resource Consulting 2023 Medicare+Choice HMO Availability Even after pullbacks, slightly more than threequarters of Medicare Eligibles still live in counties which offer at least one M+C plan in 2023 PFFS Plan Locations Cover Approximately 35% of Medicare Eligibles Over 58% of Medicare Eligibles Live in M+C HMO Areas Source: CMS Medicare Plan Compare Data Sterling Life Insurance Company Coverage Data as of 3/31/023 50 Mercer Human Resource Consulting Medigap Overview Plans supplement “original Medicare” benefits ? Sold to individuals age 65+ (and certain other Medicare Eligibles under 65) ? Medigap carriers must accept all applicants for the first six months of eligibility ? The basic benefits included in every Medigap plan are – Part A coinsurance (for admissions of more than 60 days) – Coverage for 365 additional hospital days after Medicare benefits exhausted – Part B coinsurance – The first three pints of blood each year ? Product types – Standard products ? A through J sold from 1992 to present ? Only H, I and J cover prescription drug – Medicare Select ? Provides Medigap benefits with work discount and lower prices 51 Mercer Human Resource Consulting Medigap Policies Overview AARP and BCBS plans offer majority of products ? Only individual insurance plans permitted by law that can be issued to Medicare Eligible individuals ? Carriers cannot customize plans and must offer “standardized” plans ? Regulated by state insurance authorities within federal government guidelines ? Major providers include AARP, Blues plans, some insurers – AARP in all states with Plan A through J – Blues in all states but limited offering, particularly of plans H, I and J ? Most plans underwrite where allowed – Exception is AARP, with minimal underwriting requirements (only ESRD) except on plans H, I and J 52 Mercer Human Resource Consulting Medigap Policies Policy features Item Plan A Plan B Plan C Plan D Plan E Plan F Plan G Plan H Plan I Plan J Basic Benefits* Skilled Nursing Coinsurance Part A Deductible Part B Deductible Part B Excess Foreign Travel Emergency At Home Recovery Drugs** Preventive Care Approximate Monthly Premium Range $55$150 $90$190 $100$210 $90$200 $100$200 $110$210 $100$230 $150$230 $160$250 $200$290 *Basic Benefits = Part A coinsurance plus 365 extra days of hospital care plus Part B coinsurance plus three pints of blood/year **$250 deductible, 50% coinsurance to contract limit 53 Mercer Human Resource Consulting Medicare Select ? Same standardized plan designs (A through J) as other Med Supp policies – AARP offers it on Plan C only ? Works like a Preferred Provider Organization (PPO) – Full supplemental benefits available if work providers used – Reduction or loss of supplemental benefits if nonwork providers used – Always retain full Medicare benefits ? Most mon provider works are hospitals only – Hospital can waive Part A deductible via safe harbor from antikickback statutes – Limited ability to affect Part B cost – Negotiations with other vendors possible ? Lower cost than Medigap: typically 20% discount – AARP example: Ohio Plan C: $122。 no employer prefunding required – Payment options ? “Drawdown” on funds (retiree uses funds to pay portion of retiree medical cost。 changing as appropriate 27 Mercer Human Resource Consulting What is a HPN? High Performance Network: A health plan performance improvement method that steers care to providers that meet specific efficiency and quality criteria 28 Mercer Human Resource Consulting Rationale for HPNs ? New management approaches are needed in this era of cost acceleration ? Patients and physicians are the key drivers of health care costs – But they have limited or no incentive to care about costs ? The heart of the High Performance Network concept is to change the provider selection behavior of patients and/or physicians 29 Mercer Human Resource Consulting High Performance Networks Network models ? Limited Network – A subset of an existing provider work prised of high performing providers ? Tiered Network – Employee copay/coinsurance differentials to encourage use of high performing providers ? Physician Partnering – An arrangement with (typically) primary care physicians to enhance efficiency ? Consumer Driven – Deployment of performance information to consumers to improve provider selection 30 Mercer Human Resource Consulting Direct Contracting ? Large employers with significant market presence ? May be able to achieve significant savings by contracting directly with health care providers ? May need group of regional employers to achieve critical mass 31 Mercer Human Resource Consulting Promote Consumer Accountability Help patients be better consumers of health care ? Background – If half of cost is due to lifestyle and half of chronic patients do not follow treatment plan, what can we do? ? Get members’ attentio
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