美世mercer-美国保险公司人力资源方案(ppt56)-保险策划(编辑修改稿)

美世mercer-美国保险公司人力资源方案(ppt56)-保险策划(编辑修改稿)内容摘要：

is a very difficult proposition – Opportunities exist to change eligibility, design , etc. for future retirees  If we don’t take cost out of the system, either the employer or the employees/retirees will pay the increases Mercer Human Resource Consulting 24 Agenda  The Environment  The Catch22  Paths Away from Traditional Delivery: Two Camps  Opportunities Along Path 2  The Answer  Additional Topics Mercer Human Resource Consulting 25 Paths Away from Traditional Delivery: Two Camps  Employers that bee more involved in – Changing employee behavior – Changing provider behavior – Changing providers that they work with – Changing the laws  Employers that reduce their involvement by – Increasing employee responsibility – Limiting employer cost – Limiting employer risk Mercer Human Resource Consulting 26 Employers Being More Involved  Collective Purchasing  High Performance Networks  Direct Contracting  Consumer Accountability  Leap Frog  Lobbying  Disease Management/Preventive Care  What these approaches share is an eye toward reducing cost from the employer’s system, and in some cases, the entire health care system. Mercer Human Resource Consulting 27 Collective Purchasing Use employer and plan manager clout to negotiate favorable payment arrangements  Background – Traditional work negotiations are volume driven  Approaches to achieve lower costs include – Aggregated purchasing to improve negotiating strength  Coalitions  Formal alliances  Informal alliances – Directing care to most costeffective source of quality care – Reviewing effectiveness, efficiency and “fit” of current vendor relationships。 changing as appropriate Mercer Human Resource Consulting 28 What is a HPN? High Performance Network: A health plan performance improvement method that steers care to providers that meet specific efficiency and quality criteria Mercer Human Resource Consulting 29 Rationale for HPNs  New management approaches are needed in this era of cost acceleration  Patients and physicians are the key drivers of health care costs – But they have limited or no incentive to care about costs  The heart of the High Performance Network concept is to change the provider selection behavior of patients and/or physicians Mercer Human Resource Consulting 30 High Performance Networks Network models  Limited Network – A subset of an existing provider work prised of high performing providers  Tiered Network – Employee copay/coinsurance differentials to encourage use of high performing providers  Physician Partnering – An arrangement with (typically) primary care physicians to enhance efficiency  Consumer Driven – Deployment of performance information to consumers to improve provider selection Mercer Human Resource Consulting 31 Direct Contracting  Large employers with significant market presence  May be able to achieve significant savings by contracting directly with health care providers  May need group of regional employers to achieve critical mass Mercer Human Resource Consulting 32 Promote Consumer Accountability Help patients be better consumers of health care  Background – If half of cost is due to lifestyle and half of chronic patients do not follow treatment plan, what can we do?  Get members’ attention – make them aware of consequences  Approaches to encourage consumer involvement include – Coordinated health promotion, disease prevention and educational programs – Tying employee cost increase to trend – “Defined contribution” health plans – Consumer directed health care – Reintroduction of coinsurance Mercer Human Resource Consulting 33 Efforts to Improve Quality of Care in Hospitals Leapfrog initiative  The Leapfrog Group: Background – Formed in response to Institute of Medicine study of errors in health care – Goal: Major gains in patient safety, customer service and health care affordability – Sponsored by Business Roundtable – Employers in Leapfrog Group use purchasing power to encourage health care providers to adopt patient safety standards  Leapfrog standards include: – Computerized systems in hospitals to improve the accuracy of physicians’ prescriptions and minimize medication errors – Staffing of intensive care units by physicians trained in critical care medicine – Referral of patients requiring certain plex procedures to hospitals offering the best results Mercer Human Resource Consulting 34 Lobbying  Some employers making presence felt on Capitol Hill  Many have been active for years and are recognized as important voices  Some large associations have similar goals and represent large voting populations Mercer Human Resource Consulting 35 Preventive Care and Disease Management Across the Health Care Continuum Programs should be tailored to the needs – Prevention – Screenings – Health Risk Assessment – Targeted Risk Reduction Programs – Risk Modeling – Nurse Advice Line – Web Tools – Consumer Directed Health Plan – Disease Management – Incentive Design – Self Management Training – Case Management – Decision Support – Predictive Modeling Well No Disease At Risk Obesity High Cholesterol Acute Illness/ Discretionary Care Doctor Visits Emergency Visits Chronic Illness Diabetes Coronary Heart Disease Catastrophic Head Injury Cancer 85% members = 15% cost 15% members = 85% cost Mercer Human Resource Consulting 36 Employers Being More Involved Summary  Typically the larger employers  “Fighting” to change the way health care delivered to own employees – Goal is to produce better outes…… – And lower cost Mercer Human Resource Consulting 37 Employers Being Less Involved (Camp 2)  Employers desir。