Trustees Finance & Audit Committee, April 2012

– April 2012
17,300 FT Employees; 16,150 enrolled in medical
37,000 plus covered lives
4 medical plans: PPO networks, with member cost sharing
Salary-based premiums, with credit for non-use of tobacco
HDHP & HSA with 8,100 employee enrollments
PPACA compliant
No post-65 Retiree Healthcare liability
FY 2011/12 IU Budget for Healthcare = $186.6 m
FY 2012/13 IU Budget = $197.8 m or $11,433 per eligible employee

(as of April 2012)
Same or lower number of covered employees
Same medical plan options as 2012 increase enrollment in the HDHP & HSA plan
Moderate increase in total premiums small or no increase in HDHP plan premiums
PPACA: new “Summary of Benefits and Coverage” annual limit of $2,500 for health FSA contribution, starting 2013
Form W-2 reporting for 2012 health coverage
Cost Increases: 1) provider fees and 2) medical utilization

“Disease and Injury” Classifications
(by $s paid for 2011)
Supplemental Classifications (e.g. pregnancy, dialysis)
Musculoskeletal system & connective tissue
Neoplasms
Circulatory system
Symptoms, signs and ill-defined conditions (e.g. ER)
Digestive system
Genitourinary system
Nervous system & sense organs
Injury & poisoning
Complications of pregnancy and childbirth
% Difference w/2010
.6%
+ 29.4%
+ 22.9%
+ 4.7%
+ .4%
- 10.3%
+ 5.9%
+ 30.0%
- 9.5%
+ 11.6%

Therapeutic Class (by $s paid for 2011) % of Total # Rxs
Miscellaneous (e.g. transplant, MS)
Anti-depressants
Lipotropics
Diabetic therapy
Anti-arthritics
Bronchial dilators
Anti-ulcer
Antivirals
Anti-neoplastics (cancer)
Other hypotensives (blood pressure)
2.5%
9.8%
7.8%
4.1%
2.7%
3.2%
3.7%
0.9%
0.5%
7.4%

IU’s Employee Medical Plans
Relationship Between Members and Plan Costs
1%
12%
15%
29%
43%
37%
8% of members = 58% of costs
28% of members = 87% of costs
71% of members = <14% of costs
14% of members with no costs
1%
20%
7%
Members
21%
Plan Costs

IU’s Employee Medical Plans
Relationship Between Members and Plan Costs for 2011
14% 5,180 mbrs
$ Per Member
$ 0.0 --- $ 0 / yr
15%
5,550 mbrs
29%
$ 1.9 m --- $ 342 /yr
43% 15,910 mbrs $ 22.8 m --- $ 1,433 / yr
1%
20%
7%
Members
7,400 mbrs
2,590 mbrs
370 mbrs
$ 55.1 m --- $ 7,446 / yr
$ 70.3 m --- $27,143 / yr
$ 39.9 m --- $107,838 / yr

Major Medical Program Initiatives
Initiatives that
Are applicable across all medical plan options
Complement or supplement provider and member activities
Integrated Clinical Care Services -details to follow
Personal Health Record (PHR)
Personal web-based access to medical records, such as: contact info, medications, immunizations, illnesses, medical history, allergies, biometric tracking, legal documents, etc.
Data integration with Medco, Anthem, and IU Health/HealthSmart
Support for Clinical Care Services program (clinical portal)
Transparency
Member web-based access to: location of PPO providers; “price” for services by provider; “cost” for episodes of care by provider group/healthcare system; and quality measures & patient satisfaction

Integrated Clinical Care Services
Improve access to primary care providers, for routine and urgent care
Dedicated care management team, for patients with chronic and/or complex medical conditions
Connectivity of medical records

Integrated Clinical Care Services
Virtual patient centered medical home
Essential components:
1.
2.
3.
4.
Primary care provider group(s)
Dedicated team of nurse care-managers
Electronic medical records system (EMR)
IU-based resources
Promotion to plan members
Expansion opportunities

Integrated Clinical Care Services
1.
Primary Care Provider Groups
Physicians, nurse practitioners, physician assistants
Walk in care, same day appointments
After hours access: telephone, e-visits
Electronic Medical Records (EMR) system
Quality Health First program measures
Participate in care management activities

Integrated Clinical Care Services
1.
Primary Care Provider Groups
Proposed initial rollout in Bloomington
East of the IU Bloomington campus
Sare Rd. – Premier Healthcare
Clarizz Blvd. – IU Health Southern IN Physicians
West of the IU Bloomington campus
Landmark Ave. – Premier Healthcare
Rogers St. – IU Health Southern IN Physicians

Integrated Clinical Care Services
Primary Care Provider Groups -- Proposed

Integrated Clinical Care Services
2.
Nurse Care-Managers
(including pt pharmacist)
Care transitions: hospital home, p-care specialty care
Medication management for chronic conditions
Registries for diabetes, high blood pressure, high cholesterol, asthma, heart failure, COPD
Outreach to patients with a chronic condition
Support self-management by patients
Triage agent

Integrated Clinical Care Services
3.
Electronic Medical Records (EMR) System
Connectivity across all providers
Meet NCQA medical home standards
Includes e-prescriptions
Additional features:
Order & retrieval of lab and imaging tests
Patient portal for medical records, scheduling appointments, prescription refills, referrals
Connected with IU Health and IU Health Physicians

Integrated Clinical Care Services
4.
IU-based Resources
Membership data: employees, retirees, graduate assistants and their families, who are covered by IU medical plans
Coordinate with existing care-management programs
Anthem, Aetna, Medco
Interface with existing programs: 24-hour nurse line, tobacco cessation, nutrition & weight management, Employee
Assistance
Written and website communications

Integrated Clinical Care Services
Promotion to Employee/Retirees/Graduate Assistants
Greater access to primary care
Nurse care-manager for consultation
Enhanced medical plan coverage
Enhanced dental plan coverage
Electronic connectivity
Electronic Medical Record (EMR)
Personal Health Record (PHR)

Integrated Clinical Care Services
Expansion Considerations
Pediatrics in Bloomington
Adults in
Ellettsville
Bedford
Spencer
Nashville
Adults and pediatrics at other Indiana regions, especially where meaningful numbers of plan members reside

IU Health Southern Indiana Pediatrics Clarizz
Blvd.

IU Health Southern Indiana Pediatrics
Landmark Ave.

IU Health Southern Indiana Pediatrics
Arlington Rd.

IU Health Southern Indiana Physicians
Clarizz Blvd

IU Health Southern Indiana Physicians
Rogers Rd.

IU Health Urgent Care East
Woodcrest Dr.

IU Health Urgent Care West
Third St.

Premier Healthcare Medical Center
Landmark Ave.

Premier Healthcare Family Practice
Landmark Ave.

Premier Healthcare Family Practice
Sare Rd.