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6. 6. Discussion and possible action regarding the
following opportunities for Plan Year 2017
beginning July 1, 2016 (For Possible Action):
6.1. New reduced cost CDHP national network
access for members living outside of
Nevada;
6.2. Utilizing existing Third Party Administrator
(HealthSCOPE Benefits), contract with a
telemedicine vendor for virtual visits.
(Mary Catherine Person, HSB)
Cost Containment Strategies
1
NATIONAL PROVIDER NETWORK For Members Outside Nevada
2
DISRUPTION ANALYSIS/SAVINGS Outs ide Nevada
NETWORK DISRUPTION
Eligible Charges Analyzed ** $12,129,737
Incumbent * Aetna Cigna PPO
Total Charges In-Network: $10,982,659 $11,402,230 $11,803,184
Facility Charges In-Network: $7,563,206 $7,532,841 $7,897,755
Physician Charges In-Network: $3,419,454 $3,869,389 $3,905,428
% of Charges In-Network: 90.5% 94.0% 97.3%
3
*Incumbent Network ** Charges sampled represent 100% of facility & physician charges for ee’s outside NV from January – December 2015 Additional Utilization Review and Case Management fees may apply. Please consult your account manager.
DISRUPTION ANALYSIS/SAVINGS Outs ide Nevada
DISCOUNTS & SAVINGSSavings are calculated by applying facility & physician discounts to the respective in-network dollars.
Incumbent * Aetna Cigna PPO
Facility Charges In-Network: $7,563,206 $7,532,841 $7,897,755
Facility Discount: 23.8% 43.4% 43.5%
Facility Savings: $1,798,404 $3,270,613 $3,439,317
Physician Charges In-Network: $3,419,454 $3,869,389 $3,905,428
Physician Discount: 38.6% 49.5% 44.9%
Physician Savings: $1,319,056 $1,916,089 $1,755,220
Facility & Physician Charges In-Network: $10,982,659 $11,402,230 $11,803,184
Facility & Physician Discount: 28.4% 45.5% 44.0%
Facility & Physician Savings: $3,117,459 $5,186,703 $5,194,537
4
*Incumbent Network
DISRUPTION ANALYSIS/SAVINGS Outs ide Nevada
ACCESS FEES & OVERALL SAVINGS
Employee Count 810
Months in Period (claims timeframe) 12
Incumbent * Aetna Cigna PPO
Fee PEPM $5.50 $12.50 $10.00
Fee Per Period $53,460.00 $121,500.00 $97,200.00
TOTAL OVERALL SAVINGS: $3,063,999 $5,065,203 $5,097,337
5
*Incumbent Network
TELEMEDICINE
6
EMERGENCY ROOM / URGENT CARE SUMMARY
46.9% of Overall ER/UC
Spending is considered
Non-Emergent per HSB
PEBP HSB Index
Emergency
RoomUgent Care Total
Emergency
RoomUgent Care Total
Number of Visits 4,556 7,412 11,968
Number of Admits 746 1 747
Visits Per Member* 0.16 0.25 0.41 0.17 0.24 0.41
Visits/1000 Members* 157 255 412 174 242 415
Average Paid Per Visit $1,897 $46 $751 $1,684 $74 $749
% of Visits w/ HSB ER Dx 51.5% 29.8% 38.1%
Total Paid $8,642,901 $342,993 $8,985,894
53.9%
31.6%
53.1%
46.1%
68.4%
46.9%
ER UC Total
% of ER/UC Paid
HSB Emergency Dx Non-Emergent Dx
51.5%
29.8%38.1%
48.5%
70.2%61.9%
ER UC Total
% of ER/UC Visits
HSB Emergency Dx Non-Emergent Dx
7
EMERGENCY VS NON -EMERGENCY VISIT BREAKDOWN
371
352
307
353
303 311349
307
362
315 311302
292
321
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Emergency Room by Day of Week
ER Non-Er
# Visits Total Paid Paid per Visit
PY15 3Q PY16 PY15 3Q PY16 PY15 3Q PY16
Emergent Visits
Emergency Room 2,189 2,346 $4,695,174 $4,660,963 $2,145 $1,987
Urgent Care 1,829 2,212 $68,262 $108,224 $37 $49
Overall 4,018 4,558 $4,763,436 $4,769,187 $1,186 $1,046
Non-Emergent Visits
Emergency Room 2,528 2,210 $4,315,199 $3,981,939 $1,707 $1,802
Urgent Care 5,756 5,200 $198,099 $234,769 $34 $45
Overall 8,284 7,410 $4,513,298 $4,216,708 $545 $569
284
404
304 306 294331
289
566
893830
786771
712642
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Urgent Care by Day of Week
ER Non-Er
Top 10 Non-Emergent Diagnoses
Diagnosis Description Total Paid
HEADACHE $203,631
UNSPECIFIED ABDOMINAL PAIN $112,402
ABDOMINAL PAIN, OTHER SPECIFIED SITE $79,672
SUICIDAL IDEATIONS $71,217
ABSCESS OF LUNG $65,271
FEVER, UNSPECIFIED $62,576
MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED $57,374
POSTPARTUM COAG DEFECTS, POSTPARTUM COND OR COMPLICATION $54,892
ALTERED MENTAL STATUS $53,817
RIGHT LOWER QUADRANT PAIN $51,822
8
9
Doctor On Demand is Telemedicine That Works
Top-Rated Patient Experience • 3x more 5-start reviews than competitors combined
Highest Clinical Standards • Board certified doctors – 100% dedicated to DOD
• NCQA, HITRUST and ATA Accredited
Comprehensive Support • Custom implementation and engagement marketing
• HealthSCOPE Benefits has existing contracts with Doctor on Demand to eliminate
unnecessary administrative burden
• Real-time eligibility checks and claims filing
Employer-Friendly Business Model • No start-up costs and No PEPM fees
10
• Doctor On Demand has received
multiple accreditations for
rigorous credentialing, quality
care, and industry-leading data
security
HIGHEST STANDARDS FOR QUALITY AND DATA SECURITY
11
1. Doctor On Demand quantitative research
(N=2400)
2. Updated 2/16/16
3. American Well, MDLIVE, and Teladoc.
More 5-star reviews
than all other
telemedicine
companies
combined2,3
3X
87%
Recommended
Doctor On
Demand
to a friend or
colleague1 Average Rating
2,416 Ratings
4.8
Average Rating
8,267 Ratings
4.6
#1 IN PATIENT SATISFACTION
12
Understand your needs
and goals for
telemedicine
Detailed project
management to ensure
seamless integration
with any health plan
Real-time eligibility
checks and claim filing
Based on quantitative
research about who is most
likely to use Doctor On
Demand and why
Leverages behavioral
economics-based playbook
to incentivize use
Continuous monitoring and
refinement of all marketing
programs and tactics
Customized
engagement plans for
each HR customer to
achieve awareness,
registration, and
utilization goals
Detailed employee
utilization reports
87% of our patients
have referred friends
and colleagues
Straightforward
Implementation
Best-in-Class
Engagement Intelligent Marketing
ENGAGING YOUR TELEMEDICINE SUCCESS
13
Total Cost Savings
14
TOTAL COST SAVINGS
• National Medical Network Change - $2 Million • Addition of Telemedicine – Approximately $500,000
Total = Estimated Savings of $2.5 Million