state of idaho benefit strategy development · • manage health care costs through greater focus...

S TAT E O F I D A H O

B E N E F I T S T R AT E G Y

D E V E L O P M E N T

M E E T I N G # 2 :

S T R A T E G I Z E A N D

A N A L Y Z E

J U L Y 3 1 , 2 0 1 7

2 Copyright © 2017 Mercer Health & Benefits LLC. All rights reserved.

A G E N D A

Draft Guiding Principles

Leveraging Innovation

Excise Tax Commentary

ACO Visioning

Next Steps

Appendix

• Employee surveys

• Innovation solutions by condition/service type

• ACO critical elements


DRAFT GUIDING

PRINCIPLES

OPTIONAL SUB-TITLE


D R A F T G U I D I N G P R I N C I P L E S

I N T R O D U C T I O N

• In our meeting on June 2, 2017, we discussed the current state and desired future

state of the State of Idaho employee healthcare benefit program

• Based on that discussion, we have developed draft guiding principles

– These principles are the basis for developing the proposed strategy

– Used to test whether the strategy still ―fits‖ as decisions and adjustments are

made in the future

– Guiding principles often address the following:

- Needs indicated by the business environment

- Goals of offering the benefits program

- Comfort with being on the leading edge

- Desired positioning relative to peer groups

- Split of employer and employee responsibility

- Absolute ―musts‖ of ―must not‖ be touched/ jeopardized (―sacred cows‖)



C U R R E N T V S . D E S I R E D F U T U R E S TAT E

GUIDING

PRINCIPLES CURRENT STATE OBJECTIVES/FUTURE STATE

Market Position • Current medical plans are generally more generous

than market

• Company is not an early adopter of new strategies

• Benefits targeted at market median with a

paramount focus on affordability both for employees

and for taxpayers, who fund the program

• Open to early adoption of new programs/strategies

but proof of concept is required – future strategies

need to be evidence-based

Company Budget

(Cost-sharing

Approach)

• No set strategy; decisions are based upon year-

over-year cost increase and budget

• Company cost growth to be managed proactively

• More cost shift through plan design while

maintaining protection for catastrophic events

• Manage health care costs through greater focus on

health improvement and appropriate use of health

care services

Program Eligibility • Programs provide a safety net for all employees

• Company subsidy does not vary based on pay or

job level

• Modest differences in employee contribution

requirements between plans

• Dependents are subsidized at a slightly lower level

than employees

• Continue to provide a safety net for all employees

• Address affordability for lower paid employees via

contributions that vary by salary and/or through

employer account funding and through greater

differentiation between plan options

• Maintain commitment to employees, but reduce

subsidies for dependents, including limiting or

charging more for coverage for spouses with other

coverage


GUIDING

PRINCIPLES CURRENT STATE OBJECTIVES/FUTURE STATE

Employee Choice

And Responsibility

(Plan Design)

• Offer a choice of medical plans with modest

differentiation in terms of plan design and minimal

employee financial risk

• No incentives for managing own health or choosing

more effective providers

• Offer meaningful plan choices, including high

deductible option(s) with significant employee

accountability

• Provide tools and employee-paid supplemental

coverages to support individual employee decision

making

• Incent employees to manage their own health and

choose effective providers

Program

Management

• Offer basic care management programs through

medical insurer aimed at helping sickest employees

and their families

• Offer the widest provider networks to support

employee choice

• Review budgets on an annual basis

• Offer evidence-based care management programs

that serve the entire family

• Offer wide provider networks, but encourage use of

the most effective providers with a focus on ―fee for

value‖ vs. ―fee for service‖

• Regularly evaluate program metrics

Culture Of Health • No set vision or philosophy regarding employee

health

• Little reporting on health care drivers or impact of

existing programs

• Create a culture of health with visible leadership

support

• Motivate employees to improve their health through

a variety of evidence-based programs and

incentives


C U R R E N T V S . D E S I R E D F U T U R E S TAT E


LEVERAGING

INNOVATION

OPTIONAL SUB-TITLE


M E R C E R H E A LT H I N N O VAT I O N L A B S

S TAY I N G A H E A D O F T H E M A R K E T

Top Goals

1. Evaluate emerging trends and solutions in a constantly evolving industry

2. Identify leading vendors that are driving change in health care

3. Develop marketplace perspective on best-in-class approaches and differentiators

4. Help our clients navigate a rapidly changing landscape in order to drive down

health care costs, increase engagement and improve population health

5. Bring industry-leading companies with innovative solutions to meet unique

challenges to our clients


I N V E S T M E N T I N I N N O VAT I O N

S TAY I N G A H E A D O F T H E M A R K E T W I T H M E R C E R

H E A LT H I N N O VAT I O N L A B S

Our Silicon Valley based team of consultants dedicated to:

Constantly, rigorously understanding and evaluating new products and services

emerging in the vendor community to identify true opportunities

• Reinventing how existing solutions are delivered to drive greater value and efficiency

(B2CB2B)

• Embedding new solutions in the services we deliver to clients on a daily basis

• Communications • Advocacy • Navigation • Incentives/Challenges

• Transparency • Smoking • Pregnancy/Fertility • Condition Specific

• Weight/Nutrition • Sleep • Financial Wellbeing • Resiliency/Mental Health

• 2nd Opinion • Pharmacy • On-site/Near-site • Physical Activity/Wellness

• Care Coordination • Telehealth • Narrow Networks • Centers Of Excellence

© MERCER 2017 10

Broad

10

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T H E H E A LT H C A R E M A R K E T T I P P I N G P O I N T

E X P L O S I O N O F T E C H N O L O G Y A N D D ATA

Sm

okin

g

Advocacy

Employer-Sponsored/Exchange

Communications

Incentives/Challenges

Navigation

M E M B E R

Assessments/Testing

Broad

Big Data Analytics

Pro

vid

er

Netw

ork

s


T H E H E A LT H C A R E M A R K E T T I P P I N G P O I N T

E X P L O S I O N O F T E C H N O L O G Y A N D D ATA

Sm

okin

g

Advocacy

Employer-Sponsored/Exchange

Communications

Incentives/Challenges

Navigation

M E M B E R

Assessments/Testing

Broad

Big Data Analytics

Pro

vid

er

Netw

ork

s

Healthy

Habits

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https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiB5e6M1r3UAhXmxYMKHQ_aD2EQjRwIBw&url=https://www.wellsteps.com/blog/2016/10/31/top-25-corporate-wellness-companies-2017/&psig=AFQjCNHaX0e4PwRamV2p2V6pr5zCS7fEaw&ust=1497541235202655

© MERCER 2017 13

Musculoskeletal 7%

Back 4%

Osteoarthritis 4%

Maternity 7%

Cancer 7% Heart 7%

Diabetes 3%

Hypertension 1%

Overweight/Obesity 1%

Mental Health 6%

Other Chronic 4%

COPD/Asthma 1%

Other 48%

T O P C O N D I T I O N S B Y S P E N D

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http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiy-efzpZzQAhXIQiYKHbvCDPQQjRwIBw&url=http://www.uh.edu/human-resources/wellness/&bvm=bv.138169073,d.eWE&psig=AFQjCNE1OSIxYu6WPApQ4qTjkfZVLAbHdA&ust=1478802265767591

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T H E I N N O VAT I O N A D O P T I O N C Y C L E

S O L U T I O N E X A M P L E S

ALPHA GEEKS

Emerging

• Genetic,

molecular profile

• Physician home

visits

• Personalized

benefits

EARLY

ADOPTERS

Developing

• Metabolic

syndrome

• Wearables

• Narrow networks

FAST

FOLLOWERS

Establishing

• DPP,

Telemedicine

• Transparency

• Concierge

advocacy

LATE MAJORITY

Tested

• Consumer driven

health

• Health screenings

• Incentives/surchar

ges

LAGGARDS

Standardized

• Care management

• Utilization

management

Cumulative

representation


EXCISE TAX

COMMENTARY


$7,500

$10,000

$12,500

$15,000

$17,500

$20,000

$22,500

$25,000

$27,500

$30,000

$32,500

$35,000

$37,500

Employee Family

2016 Plan Cost 2020 Plan Cost

E X C I S E TA X O N H I G H - C O S T P L A N S

AT A G L A N C E

($35,600 − $28,950) × 40% = $2,660 per covered family

• Effective in 2020, a 40% excise tax (deductible) will apply to the total cost of an active or former employee‘s

health-related coverages exceeding the following estimated dollar levels: single, $10,750; other-than-self-only

(family), $28,950*

• Retiree coverage (ages 55–64) will be subject to a higher limit

• Includes medical coverage (employer and employee contributions), health FSAs, HRAs, HSAs (both

employer and employee pre-tax contributions), many on-site clinics, and EAPs

• Projected thresholds index 2018 baseline levels (CPI + 1% in 2019; CPI thereafter), and apply beginning in

2020

• There are many further details and regulatory uncertainties that impact the determination of the excise tax

P R O J E C T E D

S T A N D A R D

T H R E S H O L D

( 2 0 2 0 )

PROJECTED

STANDARD

THRESHOLD

(2020)

* Projected assuming CPI of 2.15%

2020 Family Tax Calculation

• In this example, 2016 costs already

exceed the 2020 thresholds, and the

tax burden grows significantly by

2020.


SUBSCRIBER

SUBSCRIBER

& SPOUSE

SUBSCRIBER

& CHILD

SUBSCRIBER

& CHILDREN

SUBSCRIBER,

SPOUSE &

CHILD

SUBSCRIBER,

SPOUSE &

CHILD

2017 Premiums Annualized

High Deductible Plan $6,176 $12,365 $8,647 $12,365 $14,835 $18,553

PPO Plan $7,212 $14,435 $10,106 $14,435 $17,318 $21,659

Traditional Plan $7,906 $15,824 $11,082 $15,824 $19,000 $23,741

2020 Premiums Annualized, projected at 6% per year

High Deductible Plan $7,356 $14,727 $10,299 $14,727 $17,669 $22,097

PPO Plan $8,589 $17,193 $12,036 $17,193 $20,626 $25,796

Traditional Plan $9,416 $18,846 $13,199 $18,846 $22,629 $28,276

2020 Excise Tax Thresholds

All plans $10,750 $28,950 $28,950 $28,950 $28,950 $28,950

E X C I S E TA X O N H I G H - C O S T P L A N S

S TAT E O F I D A H O

Note: this comparison is based on medical premiums only, which were developed by removing the 2% load from 2017 COBRA rates. The

comparison does not include other costs that may be included for excise tax liability calculation purposes. See the next page for more detail.


INCLUDE

• Employee and employer share of major medical cost/premium

(for example, PPO, HMO, HDHP, Rx)

– Including executive medical/physical benefits and some

expatriate coverage

• Health FSA

• HRA

• ―Employer contributions‖ to an HSA, including employee pre-tax

contributions made through a cafeteria plan

• On-site medical clinics offering more than ―de minimis‖ medical care

• Medigap, TRICARE supplemental insurance, and other ―similar

supplemental coverage‖

• Specified disease or illness coverage, or hospital or other fixed

indemnity insurance, if payment for coverage is excluded from

employee‘s gross income (for example, employee pays for coverage

with pre-tax salary reduction contributions and/or employer-paid

without imputed income)

EXCLUDE

• Employee HSA contributions made on an after-tax basis

• Insured limited-scope dental and vision plans

• Specified disease or illness coverage, or hospital or other fixed

indemnity insurance, if payment for coverage is included in

employee‘s gross income (for example, employee-pay-all on an

after-tax basis and/or employer-paid with imputed income)

• Long-term care insurance

• Some expatriate coverage

• Certain non-medical ―excepted benefits‖ including:

– Accident-only (including AD&D)

– Disability income insurance

– Liability insurance, including any automobile or supplemental

liability insurance

– Workers‘ compensation

– Automobile medical payment insurance

– Credit-only insurance

– Other ―similar‖ insurance coverage

• Limited-purpose dental/vision-only FSAs or HRAs

• Employee assistance programs, if HIPAA-excepted benefit2

• Self-insured limited-scope dental and vision plans, if HIPAA-

excepted benefit2

W H AT T Y P E S O F C O V E R A G E S A R E

I N C L U D E D / E X C L U D E D F R O M T H E E X C I S E TA X ? 1

1 This description is largely based on Mercer's current interpretation, as official regulatory guidance is not yet available 2 Although ACA‘s statutory language appears to include self-insured dental/vision plans and EAPs, the IRS is considering excluding such plans if they qualify as HIPAA-excepted benefits

[IRS Notice 2015–2016].


ACO VISIONING

OPTIONAL SUB-TITLE


I N T R O D U C T I O N

• SESSION PURPOSE: To develop a vision of how Accountable Care Organizations will

make improvements in achieving the State of Idaho‘s goals and priorities for its medical

plan performance

• VISIONING SESSION is a technique used to support a group of stakeholders in

developing a shared vision of the future

– Involves asking participants to appraise where they are now and where they can

realistically expect to be in the future

– A Vision of Success is a clear and succinct description of what the organization should

look like after it successfully implements its strategies and achieves its full potential

• EXPECTED DELIVERABLE is a vision statement for ACOs with the following elements:

– Include desired outcomes and benefits

– Based on experience of past decisions and actions as much as possible

– Be inspirational

– Be widely disseminated and used to help guide organizational decisions and actions


C H A R A C T E R I S T I C S O F A S U C C E S S F U L A C O

• Vision/leadership — defining the ACO culture, setting direction, guiding decisions, bringing partners together, embracing change

• Provider and staff engagement — ensuring providers and staff are ready to adopt a team-based approach to care vs. performing in silos; willingness to change status quo delivery of care

• Patient engagement/education — creating a compelling experience that gains and retains members, improving patient health

• Care model — proactively identifying, managing and activating high risk patients to participate in high touch care programs

• Data/analytics — developing a data management system that transforms integrated data into meaningful and timely action

• Standardization — establishing protocols and processes for key care services that are consistent throughout the health system and across partners

• Infrastructure — investing in systems and processes that connect providers to patients, and providers to providers


A C O

Patients are cared for in a Patient Centered Medical Home by a multi disciplinary team. A Care Manager

engages the patient, assesses health risks, and develops a an integrated Care Plan. Self-care management is

enabled through tools, processes, and benefit design

PROCESS

• Medical Home Team: Multidisciplinary team including

participants such as Health Coach, Primary Care

Physician, Nurse Practitioners, Dietician, Social Worker

(provides integrated behavioral health clinical services

and linkage to other community-based services), Physical

Therapist, etc.

• Care Manager: Supports Medical Home Team

PEOPLE TOOLS/SYSTEMS/ENABLERS

• Health Risk Assessment Tool: Used to identify health risks

• Patient Self-Care & Education Tools: Multiple channels such as 24x7

care line staffed by RNs, online/ interactive tools, etc.

• Benefit designs that promote self-care: e.g., no co-pays for office

visits

• Rewards for activities such as joining a smoking cessation program

• EMR / Personal Health Record (medical history, medications, recent

hospitalizations, emergency or urgent care visits, health maintenance)

• Advance directives

• Patient registries, referral protocols, medication adherence guidelines

• Community resources

• Health Planning: Periodic assessment of a patient‘s specific health risks and development of a customized Health Plan. The Health

Plan incorporates age/sex-appropriate wellness monitoring and interventions (e.g., mammograms, immunizations).

• Health Management: Monitoring the patient‘s health (e.g., hospitalizations), updating the Health Plan, monitoring compliance, and

initiating reminders based on triggers to ensure patients stay on track with physician‘s orders. Includes coordinating care across the

continuum (e.g., referral specialists, emergency care, hospital admissions, therapeutic care, skilled nursing facilities, home care).

Includes medication reconciliation. Self-care management is supported and patients are provided with tools to proactively manage

their health.

• Health Education: Providing patient self-management information about managing existing health conditions as well as preventive

care


A C O M E A S U R E M E N T S

M E M B E R

H E AL T H

✓ Clinical outcomes

✓ Specialized care for

complex patients

C O S T

✓ Financial trend

✓ Reduced unnecessary

healthcare services

PAT I E N T

E X P E R I E N C E

✓ Member satisfaction

and engagement

✓ Timely and appropriate

access to healthcare

services


D U T I E S O F T H E A C O A N D H E A LT H P L A N

S E PA R AT E A N D S H A R E D

ACO Duties Health Plan Duties Commonly

Shared and

Integrated Duties

• Proactive population health

management

• Care management and care

coordination

• Team-based care

• Patient-centered care, including

engagement and activation

• Enhanced access to care

• Claims administration

• Eligibility administration

• Provider contracting

• Provider Credentialing

• Utilization management

• Complex case management

• Appeals processing

• Data sharing

• Quality

Management

improvement

• Member & patient

experience

• Evidence-based

guidelines

• Coordinated

messaging


D ATA I N T E G R AT I O N

DATA

INTERMEDIARY

• Gap analysis

• Reporting

• Ad hoc queries

ACOs are typically

responsible for

contracting with a

data intermediary

ADMINISTRATIVE

• Medical claims

• Pharmacy claims

• Behavioral Health

Monthly claims feeds

CLINICAL

• EHR

• Registries

• Population health

management

• Clinical guidelines

Daily inpatient census reports are sent directly to the ACOs


K E Y I S S U E S FA C I N G A C O G R O W T H

• Need sufficient enrollment or attributed patients to create the economies of scale to

achieve desired goals

• Care management systems and tools for high-cost/high-risk patients for proactive

identification and management

• EHR systems and information exchanges to exchange information across the

continuum of care

• Focused set of cost and quality measures and their calculations

• Alliances with behavioral health, post-acute care, and community-based health and

social providers

• Expanded role of patients and their families in their care

• Roles for transparency and consumerism in the new model


W H AT I S W O R K I N G W E L L A N D W H AT N E E D S

I M P R O V E M E N T ?

• What is working well and what needs improvement with the State of Idaho‘s current

medical plan from the following perspectives:

– Patient experience/engagement and customer service

– Data and reporting

– Healthcare quality

– Financials/costs

– Supplier integration

– Communications

– Benefit plan design

– Benefit administration

– Unions

– Leadership

– HR


H O W W I L L A C O S P O S I T I V E LY I M PA C T Y O U R M E D I C A L

P L A N ?

• In an ideal scenario, describe how the ACOs will positively impact the State‘s

medical plan from the same perspectives:






– Communications



– Unions

– Leadership

– HR


W H AT W I L L Y O U N E E D TO A C H I E V E T H E O P T I M A L A C O

P L A N ?

• In an ideal scenario, describe what the State will need from the following in order to

achieve the optimal ACO plan

– Administrator

– Delivery system

– Patients/members

– State of Idaho

– Other benefit suppliers/vendors


D E S C R I B E H O W Y O U W I L L K N O W T H AT T H E A C O I S

A C H I E V I N G D E S I R E D G O A L S

• Describe how the State of Idaho will know (typically from data) that the ACO is

achieving your goals






– Communications



– Unions

– Leadership

– HR


NEXT STEPS


N E X T S T E P S

• Mercer to develop and send first draft of strategic roadmap for review

• Schedule meeting #3, agenda to include:

– Self-funding review and feasibility (or hold as a separate meeting)

– Prepare straw-model design scenario incorporating changes to plans and

programs based on earlier discussions

– Conduct financial analysis to estimate the cost impact of changes and strategies

under consideration

– Conduct self-funded analysis including commentary on current Idaho State

requirements for governmental self-insured groups as compared to other State

requirements and any recommendations for exemption or changes

• Other?


APPENDIX

OPTIONAL SUB-TITLE


EMPLOYEE SURVEYS

OPTIONAL SUB-TITLE


S U RV E Y S TO D AY

• ‗Percent satisfied‘ statistics, e.g., the top two boxes on a 5-point scale

• Normative comparisons, i.e., how do I compare to ―peers‖

• Grouping data into themes based on judgment, not based on facts

• Focus on cuts and comparisons over time, but not as much on outcomes

• Obsession with ―engagement‖ as opposed to the actual desired result, e.g.,

retention, performance, client service

• Administered annually or bi-annually, as opposed to when a question needs

to be answered


P R I N C I P L E 1 : “ S AY – D O ”

C O N N E C T W H AT E M P L O Y E E S S AY ( S U RV E Y S ) W I T H

W H AT T H E Y D O ( O U T C O M E S )

What employees say, as

measured through:

• Focus groups

• Senior leadership

and HR

interviews

• Conjoint surveys

• Climate surveys

• Exit surveys

How employees

actually behave, as

measured through:

• HRIS / payroll

• Employee turnover

• Performance /

productivity


P R I N C I P L E 2 : F R O M “ W H AT ” TO “ W H Y ”

T H R E E C O N D I T I O N S M U S T B E M E T TO S H O W O N E

FA C TO R D R I V E S A N O T H E R

1. CORRELATION

The factors are related

2. TIME (directionality)

One precedes the other

3. ISOLATION (controls)

Other factors are ruled out

The key is to analyze multiple variables, then

isolate those that directly impact the outcome

Engagement Profit

YES

Time 1

Engagement Profit

YES

Time 2

Engagement Profit

YES

Span of

Control Tenure

Labor

Market


B A S E L I N E

S AT I S FA C T I O N A N D E N G A G E M E N T Q U E S T I O N S

These are traditional survey questions in which subjects indicate their perceived satisfaction with certain

aspects of their work experience by responding to a set of statements typically using a 5-point Likert scale

ranging from very satisfied to very dissatisfied. These types of questions are typically evaluated an absolute

basis as well as relative to benchmarks from similar organizations and/or similar employee groups.

Engagement is defined as ―an employee‘s involvement with, commitment to and satisfaction with work‖ and is

widely regarded as a key positive outcome of a mutually favorable relationship between an organization and its

employees or contractors. The theory is that engaged employees will stay with the organization, walk the extra

mile for the organization and do what is right for the organization. However, traditional surveys don‘t link what

employees say with what they do.

An example of satisfaction and engagement questions are show below:

HOW SATISFIED ARE YOU WITH THE FOLLOWING?

VERY

DISSATISFIED DISSATISFIED NEUTRAL SATISFIED

VERY

SATISFIED N/A

1. Opportunities to participate in training

2. The teamwork within my team / unit

HOW DO YOU FEEL ABOUT THE FOLLOWING?

STRONGLY

DISAGREE DISAGREE NEUTRAL AGREE

STRONGLY

AGREE N/A

1. I feel like I have a future at this organization

2. I am not seriously considering leaving the function

3. I am not seriously considering leaving the company

Illustration


B A S E L I N E + C O N J O I N T

C O N J O I N T A N A LY S I S R E V E A L S P R E F E R E N C E S

Conjoint questions are used to provide an assessment of the relative importance of different work and reward

elements by asking respondents to express which element they would trade off and which they would not

Conjoint analysis is the most prevalent method for understanding customer choice and preferences in

marketing. Only very few large organizations today would design and launch a new product without testing it

first using data and some form of conjoint analysis. HR began to use this method about a decade ago as a

quick and cost-effective tool for understanding employee choice and preferences, especially related to

compensation & benefits.

Below is an example of a set of conjoint questions (an employee would select one most important, and one

least important for each question block)

Illustration Question 1

Most Important Least Important

0 The recognition I receive for my individual performance and contributions (praise, interesting job assignments, etc.) 0

0 Being informed by senior management about our goals and direction 0

0 The level of my bonus / commissions 0

0 Working in an exciting field

0

Question 2

Most Important Least Important

0 My benefits (medical, dental, vision, 401(k 0

0 The recognition I receive for my individual performance and contributions (praise, interesting job assignments, etc.) 0

0 Having sufficient career opportunities 0

0 The level of my base salary 0


B A S E L I N E + C O N J O I N T

C O M B I N I N G S AT I S FA C T I O N W I T H I M P O R TA N C E A L L O W S

A C T I O N S TO B E P R I O R I T I Z E D

Wellness

Employee Assistance Program

Vision Plan

Short term disabilityDental Plan

Company MeetingEducation Benefits

401(K)

Time off

Medical PlanBonus

Bench Policy

Base PayR

ela

tive

Imp

ort

ance

Relative Variation from Average Satisfaction

High Importance

High Satisfaction

Maintain

High Importance

Low Satisfaction

Target for action

Low Importance

Low Satisfaction

Low Importance

High Satisfaction

Despite its

importance: Base

pay is not a primary

target due to high

satisfaction levels

Three potential targets but

neither one has ―alarming‖

dissatisfaction scores.

Illustration


B A S E L I N E + C O N J O I N T + D R I V E R A N A LY S I S

C R E AT I N G S TAT I S T I C A L C O M P O S I T E S W H I C H M E A N

S O M E T H I N G The driver analysis creates a composite score around areas such as engagement, retention, and

motivation, based on employee survey questions. These scores are then run through a

multivariate regression model to determine which satisfaction elements have a statistically

significant impact. This allows the organization to determine the degree to which a change in a

certain satisfaction element impacts engagement, retention, or motivation.

In short, this analysis quantifies the relative impact of changing an aspect of am employee‘s value

proposition compared to another.

Below is an example of a driver output:

LINKAGES ENGAGEMENT RETENTION MOTIVATION

Leadership & Support .59 .44

Careers & Development .19 .44

Colleagues .12

Job Security .12

The biggest driver of engagement is

leadership & support

Illustration


B A S E L I N E + C O N J O I N T + D R I V E R A N A LY S I S

D R I V E R A N A LY S I S Q U A N T I F I E S T H E R E L AT I O N S H I P

B E T W E E N S U R V E Y S C O R E S A N D A C T U A L

O U T C O M E S ( E . G . , R E T E N T I O N )

Illustration

I have confidence in leadership

Treated with dignity and respect .20

.16 / .51

Career opportunities .19

Engagement

Index

Extra Mile

Engagement

Index

Only significant relationships are shown, i.e., P<0.05

Reported numbers are standardized regression coefficient and can be interpreted like correlations


C A S E S T U D Y: A S S E S S I N G H E A LT H B E N E F I T S

C O N J O I N T A N A LY S I S I D E N T I F I E D C O S T A S K E Y L E V E R

TO I M P R O V E VA L U E TO E M P L O Y E E S

Doctor quality

Low payment at service

Contribution cost

Collaborative doctors

Ease of scheduling

Variety of doctors

Billing and administration

Sa

tis

fac

tio

n

Importance



FA C TO R A N A LY S I S & D R I V E R A N A LY S I S C O N F I R M E D

T H E I M P O R TA N C E O F C O S T

Quality of doctors

Ease of understanding plan features

Choice of doctors

Ease of using plan

Cost of plan

Overall theme driving employee

satisfaction with health benefits

Particular question driving employee

satisfaction with health benefits

My out-of-pocket payments at time of

service are affordable

It is easy to use, or easy to get

authorization to use, my plan

The number and variety of doctors to

choose from

I understand the health care benefits

that are available to me at my company

I‘m able to find specialists within covered

by my plan



TO T E L L T H E S TO RY W E A L S O L O O K E D AT E M P L O Y E E

E VA L U AT I O N S B Y P L A N • Once relative importance to employees was established, simple approaches

like cutting data by provider was used to interpret the data

• In the example below, we looked at the three most important items:

– Doctor quality

– Contribution cost

– Payment at service cost

• By focusing on what was most important to employees, we identified

―Managed Care Plan‖ as an option to consider

Question

InsCo 1 High

Deductible

InsCo 1 Low

Deductible

InsCo 1 Mid

Deductible

State

Medicine

Managed

Care Plan All

The overall quality of the

doctors in my network 78% 78% 75% 81% 74% 77%

Low weekly payroll

contributions 63% 68% 65% 91% 82% 74%

Low out-of-pocket payments

for health care services 54% 66% 62% 85% 75% 68%


S A M P L E O U T C O M E S

S E G M E N TAT I O N W I L L R E V E A L W H AT D I F F E R E N T

G R O U P S P R E F E R M O R E O R L E S S

Salary Range Tenure

Element All $0 - $60k $60k - $80k $80k - $120k $120k+ <1 yr. 1 to 3 > 3 yrs.

Working for an organization with a mission 49% 35% 50% 41% 69% 45% 50% 52%

Work / life balance 49% 40% 40% 50% 58% 58% 39% 53%

Base pay 45% 45% 45% 52% 38% 43% 53% 39%

Job security 36% 40% 50% 36% 27% 30% 34% 41%

Career opportunities 34% 40% 50% 41% 15% 43% 36% 27%

Bonus 24% 35% 5% 36% 10% 20% 30% 20%

Paid time off 21% 40% 35% 9% 13% 15% 28% 17%

Flexible work schedule 18% 13% 10% 16% 29% 18% 16% 22%

Casual office attire 13% 8% 20% 16% 10% 13% 17% 8%

Benefits 11% 18% 10% 7% 10% 13% 14% 6%

Restricted stock 10% 0% 0% 13% 17% 20% 5% 8%

Office environment 9% 5% 0% 5% 19% 3% 2% 20%

401(k) Savings Plan 7% 8% 10% 4% 10% 8% 2% 13%

Preference for restricted stock increases with compensation

Overall, the mission matters more than most pay elements

Preference for restricted stock decreases with tenure

Illustration


S A M P L E O U T C O M E S

C O M PA R I N G R E L AT I V E P R E F E R E N C E TO R E L AT I V E

S AT I S FA C T I O N H E L P S F O C U S

Base pay

Bonus

Restricted stock

Paid time offBenefits

401(k) Savings Plan

Career opportunities

Working for an organization with a

mission

Work / life balance

Casual office attire

Rela

tive S

ati

sfa

cti

on

Relative Importance

All Respondents

High ImportanceLow Satisfaction

Low ImportanceHigh Satisfaction

High ImportanceHigh Satisfaction

Low ImportanceLow Satisfaction

Base pay should be first priority for review

Illustration


INNOVATION SOLUTIONS

BY CONDITION/

SERVICE TYPE

OPTIONAL SUB-TITLE


Highlights Personal assistant to help take

care of daily tasks such as getting

event tickets, finding a plumber,

planning a vacation, etc.

Online/digital tools seek to provide

personalized, timely health and

benefits information via portal/app;

new entrants emerging with great

frequency: existing wellness and EAP

vendors are rapidly retooling to serve

this function as well

Generally focused on helping members

navigate the health care system by

carving out/replacing a number of

health plan customer service functions.

For example, can help members with

claim issues, interpret EOBs, find a

provider, etc.

Models capitalize on inbound

customer service inquiries from

members to engage the member in the

underlying health issue; aims to

simplify and improve the member‘s

health and healthcare experience

Pro Can free up employees for more

important, more complex activities

(e.g., leading to more productivity,

more time with loved ones which

can improve happiness/reduce

stress, more healthy activities, etc.)

Lower cost tools that offer the ability to

steer users to other programs and

benefits, utilizing personalization

recommendation engines to filter

suggestions

Help employees navigate a complex

healthcare system and provide users

with knowledge and skills to make

rationale decisions

Basic customer service inquiries may

often be triggered by a medical need –

advocates can transition the trust built

around transactional needs to improve

health decisions, behaviors and

increase engagement with other

available programs

Con Service can get lost within other

discount or work/life programs;

some EAPs are getting in this

space, but may be tainted by low

utilization/poor brand

The ―intelligence‖ driving these digital experiences still is lacking

Valued by employees, but generally

underutilized by the workforce; more

limited in scope and operates more as

an episodic experience

Higher disruption for employers to

implement; can be difficult to measure

the impact of changed health

decisions and increased engagement

in other programs

Concierge Care

Advocate Digi ta l

Navigator Adminis t ra t i ve

Advocate

I N N O VAT I O N S TA R G E T I N G A D V O C A C Y / C O N C I E R G E

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi2ipbYze_QAhUGx2MKHeoECr8QjRwIBw&url=http://www.hubga.com/tag-press-release/sharecare-wins-five-digital-health-awards/&psig=AFQjCNEExn-_bdCY9ovBsdg5gaD0v8kvyQ&ust=1481664806527164

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwihhbLWvejTAhUiw4MKHeMmBAIQjRwIBw&url=http://www.talentstrategyinstitute.com/index.php?option=com_content&view=article&id=90:wpa15&catid=2:uncategorised&psig=AFQjCNEf7U-Q1iKCnR_cDCavvdvu8_sVJQ&ust=1494614132822899

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiixbSn9IbUAhXq54MKHYNdCBAQjRwIBw&url=http://www.tec.vc/&psig=AFQjCNGGl36ZpLTnDpHL57R87WzvJsHTHA&ust=1495659590553179


Performance

Training I N N O VAT I O N S TA R G E T I N G

B E H AV I O R A L H E A LT H

RESILIENCY/

STRESS MGMT.

IN-PERSON/

STEERAGE

CBT/SELF GUIDED

THERAPY

DIGITAL

MESSAGING

Highlights Simple self-help tools

that help members

build skills to cope

with stress

Provides easy access to CBT

interventions on demand;

may have light coaching

On demand messaging with

coach or behavioral health

specialist

Improves access to licensed

behavioral health

professionals by utilizing

traditional telemedicine

channels

Helps guide members to

higher quality INN

physicians to improve the

level of care received

Pro Simple engagement

mechanism through

promotion of brain

training

Low barrier to entry for

members struggling with

behavioral health challenges

Provides members access

to interventions in an

anonymous environment

Removes barriers to seeking

care by allowing members to

speak with therapists on their

own time

Helps guide members

through the complex

behavioral health system

and facilitates appointment

scheduling

Con Requires continued

engagement to reap

preventive effects

Limited in the scope of

conditions that each

company can treat

Diagnosis of serious mental

illness isn‘t possible without

a clinician on the back end –

potential for improper

treatment

Limited ability to establish a

true long term member and

therapist relationship

Limited provider quality

data available calling into

question the ability to steer

members to quality

providers

TELETHERAPY R e s i l i e n c y /

S t r e s s M g m t .

I n - P e r s o n /

S t e e r a g e

C B T / S e l f -

G u i d e d T h e r a p y

D i g i t a l

M e s s a g i n g Te l e t h e r a p y

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjHusi-6NvSAhUM7IMKHc3ZBeAQjRwIBw&url=https://www.crunchbase.com/organization/ginger-io&psig=AFQjCNEViANSOj4n4Ovwk4Wc-MUjuNpP_A&ust=1489780883714022


I N N O VAT I O N S TA R G E T I N G P R E G N A N C Y

Fer t i l i ty Parent ing Pregnancy

Apps

Pregnancy

Coaching

Highlights Fertility and pregnancy monitoring

through mobile apps

Access to coaches/providers specializing in

women‘s health, access to breastfeeding

coaches

Online and mobile resources

for new parents

Breast milk delivery for

working moms

Pro Engaging tools for moms-to-be;

supports future/family planning

Easy, instant access for an often overwhelmed

parent

Closed social network for

sharing pictures, updates

Simple solution to deploy

Con Member must be willing to share data

with employer

Similar services may be provided by local

hospitals

Many free parenting resources

avail. in the market

Small segment of workforce

will benefit

Highlights Improved infertility treatment pricing and clinical quality, plus support for adoption/surrogacy resources; fertility preservation/egg-freezing

Pro Can reduce multiple births and improve patient experience

Con Carve-out from health plan network; integration with HSAs

Breast Mi lk

De l ivery

Risk

Ident i f icat ion

Highlights Inherited gene screening/ counseling

Pro High quality testing to identify risk with education

and guidance w/ genetic counselors

Con Requires working with health plans to redefine

testing eligibility; still high cost

I n f e r t i l i t y /

P r e s e r va t ion

Ad o p t i o n /

S u r r o g a cy

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiqtPbW1ujTAhUl9IMKHUu7DhoQjRwIBw&url=https://techdayhq.com/community/startups/baby-doctor&psig=AFQjCNG7Qn5k1AAUh72ZQ5bvgEZONyY7Zg&ust=1494620842260971


I N N O VAT I O N S TA R G E T I N G C A N C E R

Risk

Ident i f ica t ion

Research /

C l in ica l Tr ia ls

Management /

Navigat ion

Workplace

Tools

Highlights Hereditary cancer-risk gene

screening or liquid biopsy early

cancer indicator testing

Advocacy and navigation through

cancer journey; both clinical and for

lifestyle decisions

Tools to help employees

struggling to deal with cancer

treatment and work-related

issues

Guidance and access to

collective knowledge and

resources for difficult cancer

cases

Pro High quality, low-cost testing to

identify risk with education and

guidance through on-staff

genetic counselors

High touch and concierge level

guidance and support for individuals

managing cancer diagnosis and

treatment; high cost reductions if

able to avoid unnecessary ER visits

/ complications

Includes multimedia online

education on cancer treatment

and the employer‘s benefits

Access to clinical trials, case

studies and investigational

therapies specific to individuals‘

genetic pathology and cancer

Con Requires working with health

plans to redefine testing

eligibility or going outside of

the plan; liquid biopsies are still

very early stage

High cost Requires employee to engage

with another point solution—

though the solution provides the

employee great value

Risk of unproven treatments

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjHxvOL3dnTAhXB7IMKHaauBloQjRwIBw&url=https://jobs.lever.co/freenome&psig=AFQjCNGqxpMwF2CPZYbar4ABKU--mNl4AA&ust=1494107170943910

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwip0vXH3dnTAhWJg1QKHb2lAnUQjRwIBw&url=https://www.linkedin.com/company/grail-inc.&psig=AFQjCNGzlFci3c3iXAx7M5MtRJ8f_r0yWw&ust=1494107296975081


I N N O VAT I O N S TA R G E T I N G M U S C U L O S K E L E TA L

Prevent ive /

Coaching

Post -

Surg ica l

Therapy/

Rehab Pre-Surg ica l

Highlights On-demand physical

therapy for specific

MSK conditions

Collaborative with PCP and

specialty to increase clinical

availability and value

Expert decision support

and guided second opinion

to ensure right diagnosis

and treatment

Narrow networks or COE

models steer to high quality

physicians

Intense precertification

and/or post-operative audit

Pro Access to coaches,

peer-to-peer

support, self-guided

content from home

Drastic reductions in

recovery times for members

Prevents high-cost,

unnecessary treatment or

surgeries

Bundled payment models

can generate meaningful

savings

Manages financial

risk/payment integrity,

provider networks and

clinical care

Con Limited

programming

For digital services,

member compliance with

exercise routines may be

less rigorous. For in-person

services, requires

significant associate volume

in one location

Challenging to identify

when individuals will need

support

Steerage and/or health plan

integration can be challenge

Integration with plan

required; high

implementation cost

Surgica l

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I N N O VAT I O N S TA R G E T I N G C H R O N I C D I S E A S E

Diabetes Heart Disease Substance

Abuse

Ongoing Management/ Intense Comorbid Management

Highlights Digital intervention covering

addictions from drinking, drugs,

and eating disorders, to

gambling and spending

Targeted outreach to address

highest risk population for pre-

diabetes or metabolic syndrome

Connected glucometer or app

with real-time diabetic

educator outreach

Apps that track CHF, weight, BP to

monitor health and influence positive

behavior change

Pro Access to professional

counseling from a social worker

Pay for outcomes models to

ensure engagement and results

Real-time outreach reduces

high-highs and low-lows for

testing

Regular use can lead to reduced

blood pressure and heart attack /

stroke risk

Con Not fully- integrated with

treatment plans

Weight-based outcomes msmt.

could be improved

PBMs may evaluate potential

rebate impact

Require sustained behavior change

over long periods of time

Highlights Weekly engagement with personality-matched coach Behavioral health program for those undergoing treatment for a

medical condition

Pro Meets members where they want coaching, on their mobile device Focus on cardiac, diabetes, chronic pain, temporal substance

issues, respiratory, depression, postpartum, bereavement,

caregiver issues

Con High price High price

We i gh t Los s /

P r e D i a b e t e s

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjU7LCQ8LjRAhXF64MKHZiYC4gQjRwIBw&url=http://soleranetwork.com/&psig=AFQjCNHfSd7-TwTRIGVXwGjlPSaUo2OWWQ&ust=1484182313505017

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwidzJzY3tnTAhVG0FQKHQRVCDsQjRwIBw&url=http://digitalhealthaccelerator.com/portfolio/&psig=AFQjCNGw6xJaQ0WL_4Pem77gSrFljWZqYQ&ust=1494107598663989

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiy-efzpZzQAhXIQiYKHbvCDPQQjRwIBw&url=http://www.uh.edu/human-resources/wellness/&bvm=bv.138169073,d.eWE&psig=AFQjCNE1OSIxYu6WPApQ4qTjkfZVLAbHdA&ust=1478802265767591


I N N O VAT I O N S TA R G E T I N G O T H E R C H R O N I C D I S E A S E S

A N D A S T H M A

RESILIENCY/

STRESS MGMT.

IN-PERSON/

STEERAGE

CBT/SELF GUIDED

THERAPY

DIGITAL

MESSAGING

Highlights Tools from CPAP to CBT to sleep

hygiene

Use technology to track adherence to

medications, diet, and use of scales and blood

pressure sensors

Inhaler-attachable device that reminds users to

be compliant with daily dosing and tracks

adherence

Pro Sleep health correlates directly to other

aspects of health, including weight and

mental health

These platforms often use reminders or

incentives to promote adherence to a routine

preventative behavior, avoiding catastrophic

costs like ER visits or heart attacks

Lessens the number of adverse asthmatic

reactions and digression of COPD symptoms

Con The savings are typically downstream, in

avoided costs in other disease

categories, not an immediate hard dollar

ROI

Previous models have involved expensive

hardware and have demonstrated low

continued engagement over time

The device does not work with all inhalers

TELETHERAPY S l e e p Ad h e r e n c e As t h m a / C O P D


I N N O VAT I O N S TA R G E T I N G D I A B E T E S

F r e e C o n t e n t D i a b e tes

R e ve r s a l

M e tab o l i c

S yn d r o m e

C o n n e c ted

G l u c om e te r s C o n t i n u o u s

G l u c o s e M e t e r s

Highlights Free educational content

aimed at helping patients

understand their disease

and treatment plan

Targeted weight

management programs

aimed at members with

MetS or pre-diabetes that

aim to drive at least 5%

body weight loss which

reduces future disease risk

Cloud based diabetes

management program that

provides employees with

free BG testing supplies

and real time CDE

interventions when

adverse test results are

detected

Targeted at insulin

dependent diabetics this

wearable device measures

BG every few seconds and

communicates with

wearable insulin dispenser

Intervention platform that

utilizes a low carb diet and

remote monitoring by a

physician and care team to

aggressively bring down

patients BG and HbA1c

Pro Free resource with strong

brand association that can

help employees upon

diagnosis

Per engaged user cost

model paired with wireless

scales enables tracking of

program effectiveness

Enables CDE‘s to reach

out to members any time

there is a BG test result

out of a normal range

helping reduce potential

ER visits/hospitalizations

By actively monitoring a

patients BG they are able

to better manage their

condition by administering

insulin in real time based

upon need

Produces significant

improvements in patients

BG and HbA1c numbers

which reduces their

medication needs and long

term effects of disease

Con Limited mechanism for

driving engagement to

these resources

Not applicable to the entire

population and requires

successful communication

to those eligible

Requires members to

learn how to use a new BG

monitor and to enroll in the

program

Very expensive device to

distribute to a large

population

Requires members to

adapt to a new eating style

and diet that is outside of

the traditional American

diet

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj3henU77jRAhXM34MKHZEtDi4QjRwIBw&url=http://www.aberford.info/american-diabetes-association.htm&psig=AFQjCNHHGiRq-1aongVW8ha_DzHOreJEDg&ust=1484182177502753

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjIno7m77jRAhWl8YMKHSEtBX8QjRwIBw&url=http://logo-load.com/5397-novo-nordisk-logo.html&bvm=bv.143423383,d.amc&psig=AFQjCNGP2hE9ESjFgtnQwFaZ0MM3_x3mQg&ust=1484182218287293

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Devices

Highlights Content and

education around

end-of-life planning

Specialized services to

help mitigate dependent

adult financial abuse

Communication/Coordination

platforms across care team

Assistance navigating the

elder care space and

guidance on finding the right

options

Finding caretakers for in-

home care

Pro Support for often

complicated topic

Can help users resolve

existing issues and

provide suggestions for

proactive measures to

protect the estate

Provides technology for care

team to collaborate

Support for often complicated

and stressful things

• Education

• Create care plans, care

teams

• Fraud and Estate Issues

• Placement services

• Medicare assistance

• Team coordination

More personalized and

affordable alternative to

finding in-home caretaker

vs. traditional care agency

referral services

Con Variability in

regulations across

states

Narrow service that should

be connected to other

products along the

spectrum

One more app/platform for

people to use on their phone

and computer

Variability in services and

regulations across states and

can be expensive

Can be expensive and most

companies are very local

E d u c a t i o n / E n d -

o f - L i f e P l a n n i n g I n - H o m e C a r e

F r a u d & E s t a t e

I s s u e s

C o m m u n i c a t i o n /

C o o r d i n a t i o n

C a r e g i v e r

A d v o c a c y

I N N O VAT I O N S TA R G E T I N G S E N I O R C A R E

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjjsIqevujTAhWp6YMKHeyeC6MQjRwIBw&url=http://corporate.amplifon.com/&psig=AFQjCNEwieXKmPlAoWp8zw8HGHE1M3bdbg&ust=1494614282000364


I N N O VAT I O N S TA R G E T I N G D I A G N O S I S A N D T R E AT M E N T

O F C O M P L E X O R R A R E C O N D I T I O N S

EXPERT MEDICAL

OPINION CROWDSOURCING

Highlight

s

Multidisciplinary team approach

for disease-based medical

management of chronic-type

conditions by a hospital or health

system

Confirms right diagnosis and

directs patients to the most

effective treatment plan

Harnessing ‗the wisdom of crowds‘

to help solve difficult medical cases

quickly and accurately online

Machine learning. single, secure

database that could read symptoms

and run through thousands of

clinical studies, medical records,

and medical textbooks to present a

risk-matched list of potential

diseases

Pro COE designation is generally

based on different quality, safety,

efficiency, and/or outcome

measures

Access to clinical consultations

with world-leading experts on rare

and complex conditions

Challenging for doctor(s) to parse

out which symptoms are caused by

which obscure diseases in order to

treat them

Outperforms doctors 98% of the

time for complex cases

Con Often self-designated status with

varying metrics Often rating

quality is across physician groups

not individual physician quality

Requires employers to offer an

additional vendor and teach

employees to use this service; may

be higher cost

The ―medical detectives‖ are mostly

physicians, but there are a number

of them with no medical background

who are interested in helping

Results are only as good as the

data inputs

C e n t e r s o f

E x c e l l e n c e

Ar t i f i c i a l

I n t e l l i g e n c e

E x p e r t M e d i c a l

O p i n i o n C r o w d s o u r c i n g


I N N O VAT I O N S TA R G E T I N G P R O V I D E R S T R AT E G I E S

High light Confirms right diagnosis and directs

patients to the most effective treatment

plan

Providers include patients in the decision

making process, laying out all potential care

paths and their risks/rewards

Multidisciplinary team approach for disease-

based medical management by a hospital or

health system

Mercer‘s clinical team works with identifies regional hospitals

that are ―best-in-class‖ to implement change in specific high

cost clinical areas

Pro Access to clinical consultations with

world-leading experts on rare and

complex conditions

Patients are empowered to take charge of

their care paths, patients feel their

interactions with their provider are more

transparent

COE designation is generally based on

different quality, safety, efficiency, and/or

outcome measures

Can be a first step toward a ―supply side‖ strategy for

employers moving toward value based purchasing and ACO

development planning

Con Requires employers to offer an

additional vendor and teach employees

to use this service; may be higher cost

Patients may urge providers to take a

decision path that is not clinically in the

patient‘s best interest

Often rating quality is across physician groups

not individual physician quality

Only targets hospital systems in select geographies currently.

E x p e r t O p i n i o n S h a r e d D e c i s i o n

M a k i n g

C e n t e r s o f

E x c e l l e n c e

C u s t o m i z e d N e t w o r k s O n s i t e C l i n i c C a r r i e r H i g h -

P e r f o r m i n g N e t w o r k s A C O S t r a t e g i e s

Highlight On or near site of employment clinics that can

offer primary care, occupational health and

physical therapy, or pharmacy services.

Narrow Networks steer to high quality

physicians

Delivers integrated care to the patient by

bringing together groups of doctors, hospitals,

and other health care providers, with providers

taking responsibility

for results

Build out networks of high quality, high value

providers for each geography the employer

operates in.

Pro Convenient location can lead to increased

Physical Therapy and Pharmaceutical

adherence.

Bundled payment models can generate

meaningful savings

Incentives are aligned between providers and

payers. All aspects of care are integrated and

centrally managed.

All providers in the network are vetted and

preapproved by the employer

Con Employees may have a preferred PCP or

pharmacy in a different location. Cost.

Steerage and/or health plan integration can be

challenge

Geographic variability in access and quality

indicators.

Time and cost intensive. Must be done for

each geography.

Q u a l i t y I m p r o v e m e n t

C o l l a b o r a t i v e

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj7-d6a2KnRAhVB04MKHUTtA4UQjRwIBw&url=https://www.marketbeat.com/stocks/NYSE/EVH/&psig=AFQjCNFgDDSursg5BidoaG8AA9Vj6UzLjQ&ust=1483660486961443

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjeyY7i16nRAhXj6IMKHSHhByYQjRwIBw&url=https://en.wikipedia.org/wiki/File:Mayo-clinic-logo.png&bvm=bv.142059868,d.amc&psig=AFQjCNHV0yMdrPOaE6ymUEf8OBe2fb5q7Q&ust=1483660372518140

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiTkcr916nRAhVD5YMKHYpGBMwQjRwIBw&url=http://logonoid.com/cleveland-clinic-logo/&psig=AFQjCNHX7zRH-kzUkS6pPsR8q2wbu58Lpw&ust=1483660434411508


I N N O VAT I O N S TA R G E T I N G P R O V I D E R Q U A L I T Y

C o n s u m e r

R e s o u r ce s

C O E / N a r r ow

N e tw or ks

Ca r r i e r

D i s t i n c t i o n

P r o g r a m s

Th i r d P a r t y

P r i c e

Tr a n s par en cy

Highlights Mostly free resources

for employers and

members to find local

physicians/hospitals

Designations within the

broad PPO network for

providers that have shown

quality and cost control

Transparency tools centered

around helping members

shop for commodity services

(MRIs)

Transparency tools focused

on quality across many

different provider specialties

Narrow networks or COE

models steer to high quality

physicians

Pro Some provide a level

of quality information

where previously

there was none

Simple tool for members to

follow that may or may not

have a meaningful impact

on quality, possible to steer

employees with cost share

differential

Members may be familiar

with shopping for care using

these tools and it does not

require members to utilize a

separate tool for quality

Produce much more

sophisticated quality

measures because of

advances in data analytics

Bundled payment models

can generate meaningful

savings

Con No incentive for

employees to utilize

the program and

many use patient

satisfaction as a key

measurement

Relies on members to

search for a provider with

this designation and

carriers often are rating

quality across physician

groups not individuals

Vendors are repurposing

quality data from multiple

consumer resources and as

a result data displayed is

limited in its sophistication

level

Requires employers to offer

an additional vendor and

teach employees to use this

service for physician quality

Steerage and/or health plan

integration can be challenge

Th i r d P a r t y

Q u a l i t y

Tr a n s par en cy

+Carrier Options


M E R C E R H E A LT H I N N O VAT I O N L A B S A L L I A N C E S

Overview Key Terms Target Market Pricing

Cellular glucometer that provides

members with an easy way to track

blood glucose

• Best-in-class market pricing;

• Exclusive partnership w/ Mercer

• Clinical audit by Mercer clinicians

annually

• Pre-negotiated service level

agreements

1,000+

• $67 PPPM, for minimum 6 months per enrolled

individual OR

• One-time fee of $199 for Starter Kit with

reduced $59 PPPM, no minimum term

Network of infertility clinics that

combines bundled payments and

best practices to reduce multiple

birth rates experienced by

employers and improve outcomes

• Best-in-class market pricing

• $0.40 PEPM admin fee for Mercer

clients

• Pre-negotiated Performance

Guarantees

1,000+ • Employers will pay a discounted rate on a per

cycle basis

• For employers without an infertility benefit,

employees will be able to directly access the

Progyny network; this also applies to employees

who have exhausted their employer benefit.

Tele-advice solution that will enable

Spanish speaking members to talk

with a doctor, mental health

professional or dietitian in their

native language



• Pre-negotiated Performance

Guarantees

All sizes • $99 per participating employee/year; 12 month

subscription triggered upon first call/text

• $199 per participating family/year (up to 5

members, as defined by the employee)

Mobile app and coaching for children

and families to lose weight and eat

healthy



• Special 4 month Mercer Program

(vs. 3 month standard)

• Pre-negotiated Perf. Guarantees

All sizes; preference

for 5,000+

• 4 months for $200 per child

• $10,000 implementation fee for employers less

than 5,000 lives

Supporting working parents caring

for children with developmental

disabilities



• Special Mercer Program


agreements

All sizes • 7 visit package at pricing of 6 visit ($.334

PEPM) or

• 14 visit package at price of 12 ($0.584 PEPM)

Concierge program that helps guide

members to high quality physicians

in their local market by utilizing

advanced data algorithms

• Standalone Office Visits Program

exclusive to Mercer clients



agreements

1,500+ self-insured • Base tier- $1.50-$1.65 PEPM

• Integration tier- $2.38-$2.61 PEPM

• Incentives tier- $4.05-$4.46 PEPM

• No implementation fees

Note: Any administrative fees associated will be disclosed via SOW


ACO CRITICAL

ELEMENTS

OPTIONAL SUB-TITLE


PAT I E N T C R I T I C A L E L E M E N T S

• Clear relationship with the care team and the delivery system

• Receives concierge services

• Experiences low hassle factor with administrative (e.g., eligibility, benefits, etc.) and

clinical (e.g., accessing care, interacting with the care team, etc.)

• Feels ―delighted‖ with the delivery system

• Has accessible multiple channels to care (e.g., telemedicine, nurse line, emailing,

texting, app, etc.)

• Receives education and support from care team that is understandable and

actionable

• Uses tools and resources for self-care (e.g., patient decision aids)


D E L I V E RY S Y S T E M C R I T I C A L E L E M E N T S

• Leadership commitment with the dedication of appropriate resources

• Consolidated, curated, and distributed data

• Primary care teams with the appropriate staff qualifications and infrastructure to

perform proactive population health management

• Empowered electronic health record (EHR) that provides efficient communication,

information sharing, and incorporates evidence-based guidelines

• Control of care delivery pathways and protocols

• Commitment to the meet the needs of the patient, including service delivery and

clinical delivery

• Rigorous and transparent quality commitment, including reporting and improvement

activities


P L A N S P O N S O R C R I T I C A L E L E M E N T S

• Create a plan design that facilitates enrollment into the ACO

• Communicates and reinforces the model to its population

• Supports supplier integration and collaboration

• Ensures timely and accurate information and data sharing routinely occurs

• Negotiates meaningful clinical and administrative performance guarantees


A D M I N I S T R ATO R C R I T I C A L E L E M E N T S

• Ability to administer value based payment methodologies

• Ability to provide timely and accurate data between suppliers

• Vetting of high quality provider groups

• Establish clear administrative processes for the ACO plan design

• Reinforces the communication regarding the ACO value proposition

• Ability to ―carve out‖ certain functions that the administrator usually performs when

the delivery system proves it has the capabilities (e.g., catastrophic case

management and utilization management)

• Ability to adhere to clinical and administrative performance guarantees


D E L I V E RY S Y S T E M G A P A N A LY S I S

• How and where can the ACO delivery system make improvements to reduce costs,

improve quality, and support positive patient experience?

• Ask carrier if they have conducted a gap analysis of each ACO group in order to

understand the gaps in care and the opportunities for improvement in care delivery

and outcomes


P O P U L AT I O N H E A LT H M A N A G E M E N T C A PA B I L I T I E S

• How do we know that the delivery system can perform as an ACO and a patient-

centered medical home (PCMH)? We would like to know that the delivery system will

be a highly functioning ACO with the requisite population health management

capabilities with the necessary tools, resources, staff, methodologies, etc. in place in

order to achieve the desired goals

• Ask carrier if they have completed a readiness assessment of the delivery system

and have information regarding accreditation/recognition obtained by the delivery

system


PAT I E N T- C E N T E R E D C A R E A N D C O M M U N I C AT I O N S

• ACO needs to be patient-centered with tailored and customized communications in

order to support patient enrollment and engagement with the ACO, including open

enrollment, standardized messaging, concierge call center, patient decision aids, etc.

• How are the communication and engagement strategies from ACOs and carrier

being deployed that will result in increased enrollment and engagement?


Q U A L I T Y M A N A G E M E N T A N D I M P R O V E M E N T

• The ACO delivery system needs to clearly articulate how it is engaged in an on-

going, systematic quality management and improvement program that delivers

improved outcomes and better patient satisfaction/engagement, including key quality

measures that are a part of the program evaluation and financial reconciliation

process

• How is healthcare quality (including clinical processes and outcomes as well as

patient satisfaction and engagement) factored into the program evaluation and

financial reconciliation process?


I N F O R M AT I O N S H A R I N G A N D R E P O R T I N G

• The ACO needs timely, accurate, meaningful, standardized, and actionable

information and data in order to support proactive population health management

• How will information sharing and reporting be done in order to provide the necessary

information the ACO needs to succeed?


S U P P L I E R C O L L A B O R AT I O N

• There are usually a number of services and vendors involved with an employer‘s

overall benefit plan. There needs to be awareness and collaboration between all of

the vendors when an ACO is launched.

• How will the vendors interact and collaborate in order to support a highly functional,

integrated system?


B E N E F I T P L A N D E S I G N

• The benefit design needs to be modified to demonstrate the value to the patient in

enrolling in the ACO, including such things as eliminating co-pays and co-insurance,

process for obtaining a waiver to go outside the ACO, primary care physician (PCP)

designation requirement, employee premium reduction for the ACO, etc.

• How will the benefit plan encourage enrollment into the ACO?


F I N A N C I A L R E C O N C I L I AT I O N M E T H O D O L O G Y

• The financial reconciliation methodology needs to be clearly articulated in order for

all parties to understand how this will be performed, including such items as upside

and downside risk, outlier exclusions (if any), attribution methodology, risk corridors

(if any), etc.

• What is the process for calculating the financial penalties and rewards?

state of idaho benefit strategy development · • manage health care costs through greater focus...

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