The Economy, Health Costs and the Future 2002 National Health Policy Conference General Motors 2001 Health Care 1.2 million plan members ➣500,000 employees & family ➣700,000 retirees & family ■ $4.2 billion spend g 200 health plans (134 HMOs) g 30 million transactions ➣4,300 hospitals ➣36,000 pharmacies ➣241,000 physicians ■ Why Do Purchasers Care About Health Care? Inflation Index (1987 = 100) U.S. Medical Costs 135 125 Direct & Indirect Costs 115 X % GAP 105 95 Global Sales Price 20 00 19 98 19 96 19 94 19 92 19 90 19 88 85 Evolution of Employersí Management Community Health of Health Plans Employee Health Quality Leadership Value Purchasing Selection / Negotiation Pay Premiums GMís Key Health Care Initiatives Quality & Cost Drivers LifeSteps Managed Care Benefit Design Public Policy Value Purchasing Managed Indemnity Community Initiatives Process Improvement Workshops Safety Initiatives Prescription Drugs Delivery System Member Behavior & Health Disease Management Integrated Corporate Health Carrier Performance GMís Big Issues Driving patient safety and quality improvement efforts ➣ public disclosure/informed consumers g Reducing waste and inappropriate care in the delivery system ➣ decision support g Encouraging the appropriate use of prescription drugs g Preventable Deaths ì Personalizedî g Preventable deaths per year: 98,000 g U.S. Population: g GM covered lives: 1,210,000 g Preventable deaths per 100,000 per 250,000,000 year: 39 g General Motors preventable deaths ➣ per year: 468 ➣ per day: 1.3! Low High Degree of Management and Integration Managed Care Continuum Direct Contracting w/ delivery systems Group/Staff HMO Highly Integrated IPA (Benchmark plans) IPA HMO Managed PPO PPO Managed Indemnity Unmanaged Indemnity Low value High Managed Care g Quality initiatives reward performance ➣ influencing market share ñ Quality Report Card ñ financial incentives ➣ public recognition ñ benchmark status ➣ sharing best practices with top HMOs ñ disease management ñ Rx management ñ patient safety ñ referral process/service Managed CareÖ The Next Generation g Direct contracting with Integrated Health Systems ➣ g Aligns quality and financial incentives Activecare physician led plan ➣ organized, integrated delivery system ➣ offers broad access of Indemnity Plan with low cost sharing of HMO option ➣ in and out-of-network benefits ➣ consumer, purchaser, provider financial incentives align with best practices ➣ pilots in SE Michigan and Dayton, OH ➣ Prescription Drug Challenge GM spends $1billion+ on Rx drugs g Fastest growing cost component with 18-20% cost increases --no end in sight! g ➣ demographics, new drugs, DTC, high U.S. prices, inappropriate prescribing ➣ Do that many people need the purple pill? Prescription Drugs g GM initiatives pharmacy network ➣ generic vs. brand ➣ working with drug manufacturers ➣ educate enrollees and physicians ➣ dosing optimization ➣ cost sharing/plan design ➣ move to mail order ➣ internet-interactive voice system ➣ three auto company initiatives ➣ Rx legislation ➣ interactive point-of-care technology ➣ Community Initiatives g Joint GM-UAW Community Initiatives ➣ g launched in 1995 Expectations/objectives ➣ ➣ ➣ ➣ ➣ ➣ improve quality of outcomes 0 leads to enhanced cost effectiveness reduce duplicate services increase collaboration/cooperation address variation in provider practice patterns ó driving toward best practices that generate the best clinical outcomes resist unnecessary capacity expansion identify best providers and encourage enrollees to select them Legislative Issues Medicare + Choice ➣ CMS must reward good performers ➣ resurrect CPAC ➣ reduce plan reporting burden ➣ flexibility for the group market g Medicare Rx ➣ universal ➣ quality measures and reporting ➣ benefit design, $$ limits ➣ equitable financing g Legislative Issues Prescription Drugs ➣ continuing market exclusivity ➣ stifling generic competition ➣ DTC advertising ➣ U.S. pricing vs. other countries ➣ detailing practices g Flex Spending Accounts ➣ repeal ìuse-it-or-lose-itî rule ➣ allow non-taxed balance rollovers ➣ establish portability / allow purchase g Public/Private Partnerships QuIC ➣ Federal ➣ State opportunities g NHCPI g National Quality Forum g Leapfrog g NCQA / HEDIS g FACCT g CMS / APME g Federal Employees Health Benefits Plan g Summary GM believes the way to reduce health care cost is to improve qualityÖ i.e. preventing over use, under use and misuse of the health care system and provide people with the information on quality to make smart health care choices. In other words, get the WASTE out so the dollars can be put to better use!