Bermuda Country Update
10th Caribbean Conference on National Health Financing Initiatives
Progress, Challenges and
Preparing for the Next Decade
Oct. 28th – 30th, 2015, Turks & Caicos
Calvin C C White Sr
Objectives
Overview of Past 10 Years Current Landscape Future Plans
2
The Past 10 Years
3
Per Capita Health Expenditure / Standard Premium Rate (SPR)/ Standard Hospital Benefit
4
$ $ $ $ $ $ $
2014 2015
$$173 $187 $208
$271$325 $301
$236$252
Bermuda Health Council Health Accounts 2015
$2016
$338
Per Capita Spend
SHB $ SPR
Components of Health Expenditure (Bermuda Health Council Health Accounts 2015,)
5
Health Expenditure Growth
6
2007 2008 2009 2010 2011 2012 2013$0
$50
$100
$150
$200
$250
$300
$350
Bermuda Hospitals Board MOH Promotion/Prevention/Curative Care MOH Administration Overseas Local PractitionersPrescriptions Other Administration
The Current Landscape
7
LONG TERM CARE (HOSPITAL & SOME COMMUNITY)
Standard Health (Hospital) Benefit (& Mutual Reinsurance Fund)
SUPPLEMENTAL BENEFITS
Private Insurers (& Approved Schemes)
Ser
vice
s co
vere
d
Population covered
Fut
ure
Car
e
Propo
rtion
of
costs
cove
red
HIP
Adapted from WHO 2010
Dimensions of health coverage in Bermuda
Courtesy of BermudaHealth Council
9Bermuda 2015 National Health Accounts – Courtesy of Bermuda Health Council
Sigh…..
Bermuda Chronic disease burden(2010 census data)
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65 yr. and older : 77% report long term health condition 14% disabled by health condition.
Under 65 yrs: 35% report long term health condition, 4% report disabled by health condition.
Bermuda Chronic disease burden(2010 census data)
Overweight /Obesity 67% Hypertension 36% High cholesterol, 34%, (never had it checked
25%) Disability 14% Diabetes 13% Asthma 9.8%
11
High Cost Participants
Top 250 participants (1%) accounted for 35% of all claims paid ($49,666,634 out of $142,939,803)
Aged Subsidy accounts for 76% of all Subsidy claims paid (excluding Geriatric)
October 26, 2015 BHB Subsidy Claims Analysis 12
Service Types DRG and Schedule 2-Per Diem account for 43% (19% and 24%, respectively) of all claims paid
Enhancements for
System Sustainability
13
System Sustainability Enhancements
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Standard Hospital Benefit
Standard Health Benefit
• Inpatient, outpatient, home medical services and other benefits
• Directed Gov. funding to acute care setting
• Enhances old SHB• Expands funding use• Improves access to essential
services• Alternate care setting for certain
long-stay BHB patients• Pilot Enhanced Care program for
uninsured/indigent with predefined non-communicable chronic illness
Primary Care
Home (& Rx)
1000 Uninsured (Subsidy) &
Underinsured (FA)
$3.0 M
Program Funding (MRF Transfer)
Approved Provider Payments (Capitation) Return on Investment
Health Condition
Current Utilization
Participant Agreement
Eligibility RequirementsProgram
EvaluationProvider Participation (RFP)
SHB
Other Fringe
● Primary Care ● Rx ● SHB + Supplemental ● ● Provider
Comprehensive Chronic Disease
Management
Phased Program Outcomes
HIP/FC Sup
Community
Patient Satisfaction
Quality Measures
Utilization Changes
Health Status
System Innovation
Cost Savings
● Program Funding ● Insurance ● Self-funded
Courtesy of Bermuda Health Council
Enhanced Care Pilot
System Sustainability Enhancements
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Post Acute Care
• BHB patients over 100 days (Long Stays)
• Allows Government Subsidy funding to support long term care in the community.
• Allows persons with limited financing and lack of benefit coverage who require long-term care to a more cost-effective and appropriate care setting.
System Sustainability Enhancements
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Home Medical Services
• Provides for medical services in home setting
• Appropriate care in appropriate setting at a better price
• IV infusions, wound care, other medical services as defined by the Bermuda Health Council
HID Sustainability Enhancements
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Personal Home Care
Benefits
• Care management services by a HID Nurse Practitioner• **Personal caretaking, companion or homemaking services at $15
an hour (max 40 hours per week) • **Nursing Aide Services at $25/ hr (max 14 hours per week)• **Adult day care services at $50/day (max $200 for 7 days)• **$60,000 max annual benefit per year, per policyholder
** (Specific qualifications must be met)
• Supports Aging in place; • more cost effective than
institutionalizing at early age. • Addresses gap in continuity of care.
HID Sustainability Enhancements
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Preferred Overseas
Network for Tertiary Care
• Reimburse at 60% for HIP and 75% for FutureCare in network
• 10% penalty for out of network services• Treatment must be medically necessary• Treatment must not be available in Bermuda
• Promotion of diagnosis based treatment
• Reduction of claims costs and client co-pays
HID Sustainability Enhancements
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WellnessBenefit
• Counseling for smoking cessation, asthma, nutrition, diabetes, lifestyle counselling and fall prevention
• Max $35/visit for max 6 visits per year• Must have chronic illness• Programme must be HID approved
• Incentive for self management• Promotes health• Reduces risk of chronic illness
Unfinished Business
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Health Spending
Health Investment
• Home Medical Services• Personal Home Care Services• Post Acute Care Programme
Unfinished Business
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Acute Care Delivery Model
Primary Care Delivery Model
• Enhanced Care Pilot• Personal Home Care Services
The Not So Invisible
Elephant
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Unfinished Business
Unfinished Business
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Complex FinancingStructure
Simple Financing Structure
• System Financing Restructure
PROVIDERS
INSURERS
Bermuda Health System Financing
Employers
Individuals
Government Consolidated Fund
Patient Care Subsidies
Argus
BF&M
Colonial
Mutual Reinsurance Fund
Local ProvidersOverseas
Hospitals
KEMH / Some Community
MWI
LCCA
FutureCare
HIP
Taxes
Tran
sfer
Out
of p
ocke
t pay
men
ts (e
.g .
copa
ys)
Clai
ms
Clai
ms
Claims
Claims
Veterans Fund
Premiums
Financial Assistance
Fund
ing
Funding
Gra
nt
Gra
nt
Fund
ing
Fund
ing
Prem
ium
Repayments
NOTES: 1. Insurers light = SHB dark = supplemental benefits.2. Excludes Public Health Services and Residential Care Homes
Claims & Out of pocket payments
GEHI
BNTB
HSBC
Version 2.0(anim) 12Nov12
Premium
DOHStandard Premium Rate
Clai
ms
Reim
b.
Claims Reimb.
Claims Reimb.
Clai
ms
Reim
b.Reinsurance
RESIDENTS
Bermuda Health System Long Term Objective
Provide the Appropriate CareDelivered in Appropriate SettingAt an Appropriate Cost
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Q&A27
Annex
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Bermuda Health Insurance Department Objectives
Mission Statement: To provide accessible health benefits for the residents of Bermuda.
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# Objectives
1 To adjudicate and pay claims correctly in accordance with Health Insurance Department policies, procedures and legislation
2To provide quality customer service by providing accurate responses to queries in accordance with Health Insurance Department policies and procedures
3 To reduce health care expenditures for Health Insurance Department managed Funds
4 To improve the timing and frequency of our operational, management and financial reporting to better assist in business decisions
HID Administrative Structure
Permanent Secretary of
Health & Seniors
Director Health
Insurance
Customer Relationship Management
Provider Management
Finance & Risk
Management
Clinical Case
Management
Outsourced Operations
Project & Change
Management
Health Insurance Committee
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Scope of Operations:Four Products
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Product Description Health Insurance Plan
(HIP) Basic Insurance Plan for individuals & groups Continuous enrollment for persons 19+ Covers Hospital I/P & O/P + Supplemental
Benefits + Dental
FutureCare Plan (FCP) Like HIP but more comprehensive For persons 65+
Mutual Reinsurance Fund (MRF)
Funds programmes for long term care and chronic disease management
Premium-funded by all public & private insurers
Government Subsidy Entitlement
Hospital Subsidies for Youth (100%), Indigent (100%), Aged (70% or 80% for 75 and older)
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Claims Claimed by Product 2014/15
Subsidy109.0
HIP26.2
MRF0.0
FutureCare22.1
Other2.3
in millions ($)
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Claims Paid by Product 2014/15
Sub-sidy102.3
HIP23.4
MRF0.0
FutureCare17.2
in millions ($)
Dialysis claims
Fiscal Year # of participants Claims paid
2011/12 150 $21,037,582.50
2012/13 153 $24,124,270.50
2013/14 173 $27,294,413.70
PROVIDERS
INSURERS
Bermuda Health System Financing
Employers
Individuals
Government Consolidated Fund
Patient Care Subsidies
Argus
BF&M
Colonial
Mutual Reinsurance Fund
Local ProvidersOverseas
Hospitals
KEMH / Some Community
MWI
LCCA
FutureCare
HIP
Taxes
Tran
sfer
Out
of p
ocke
t pay
men
ts (e
.g .
copa
ys)
Clai
ms
Clai
ms
Claims
Claims
Veterans Fund
Premiums
Financial Assistance
Fund
ing
Funding
Gra
nt
Gra
nt
Fund
ing
Fund
ing
Prem
ium
Repayments
NOTES: 1. Insurers light = SHB dark = supplemental benefits.2. Excludes Public Health Services and Residential Care Homes
Claims & Out of pocket payments
GEHI
BNTB
HSBC
Version 2.0(anim) 12Nov12
Premium
DOHStandard Premium Rate
Clai
ms
Reim
b.
Claims Reimb.
Claims Reimb.
Clai
ms
Reim
b.Reinsurance
RESIDENTS
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Current Initiatives
Post Acute Care Programme Enhanced Care Pilot
Collaborative Case Management Personal Home Care Services
Incentives for Healthy Lifestyles System Financing Restructure
October 26, 2015 37
Calvin C C White Sr
Acting Director
Health Insurance Department
Government of Bermuda
Tel: (441) 278-8200
e-mail: [email protected]
website: www.hip.gov.bm
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Thank You!!!