Page 18 - Optim Orthopedics
P. 18
Strategic processes and tools
05 — Infolock is Lockton’s proprietary data warehouse and analytics 06 — GPS is a proprietary actuarial tool that utilizes client-speciic
tool. data, IDEAL Proile, organizational objectives, etc., to develop a
dynamic multiyear strategy with cost impact, employee friction, and
administrative effort.
Action through
insight YOUR DATA GPS
BIG DATA
Projected cost of plan: After three-year strategy
The big picture. $40M $37M
$35M
$35M $32M
Collect data from $30M $30M $32M
multiple, disparate CONSULTATIVE $30M $25M$25M $26M $28M $29M
$25M
PARTNERSHIP
sources. $25M $21M $25M $27M $28M
$21M$21M
$20M
Transform and enrich $15M
data to make it $10M
meaningful. INSIGHTS $5M
K
Skilled experts to 2014 2015 2016 2017 2018 2019
develop targeted Projected cost with trend
solutions. Purchasing efficiency, eligibility management, cost sharing
Key medical High-cost Utilization Gaps in Risk Add wellness
conditions claims patterns care stratification
1 1
Utilization trends summary
ZERO-DOLLAR MENTAL HEALTH EMERGENCY ROOM Sample Three-Year Strategic Plan
CLAIMANTS
2020 (current) 2021 2022 2022
17.3% 1,524 200 Purchasing Medical self-insured Assessand recalibrate stop- loss Implement co-pay / MandateCOE facilities and
risk transfer strategy
providers for designated
coinsurance differentials
Rx self-insured
and designated high
Members had $0 in allowed claims Behavioral Health visits/1,000 ER visits/1,000 Efficiency Stop loss reinsurance Reassessself-insured TPA/PBM for using COE facilities services
terms and provider network(s)
24.7% norm 417 norm 223 norm quality providers
These members should be looked at more 265.4% higher than norm; 10.3% lower than norm; Broad national PPO Implement telemedicine service Adopt local narrow Consider ACO
closely for potential care avoidance 8.5% below prior year 9.8% above prior year network network options where plans/networks by market
Healthcare Validate effectiveness of Rx available where proven cost effective
Delivery Mandatory Rx mail-order mandatory mail-order and
for maintenance
adjust as needed
HOSPITALIZATION OFFICE VISITS ADVANCED medications Continue biometric testing Continue biometric Continue biometric testing
EE annual discounts:
IMAGING
Health and $40 per month for Add spouses to biometric testing testing Continueoutcomes-based
completing health
Implement outcomes-
contribution differentials
Risk
evaluation and
based contribution
based on health risk factors
58 4,343 111 Improvement biometric screening differentials based on
73% employee
health risk factors
Admissions/1,000 Ofice visits/1,000 CT scans/1,000 participation
61 norm 3,463 norm 110 norm 1.38 covered dependents Amnesty dependent audit Engage third party for
per covered employee
dependent eligibility
Assessand recalibrate employee
Eligibility
4.2 25.4% higher than norm; 2.6% below prior year 0.1% higher than norm; 4.8% above prior year Management 300 estimated covered contributions for adding spouses audit
as needed to mitigate risk
spouses
Average day stay 717 87 4-tier contributions exposure
4.0 norm Preventive/1,000 MRIs/1,000 HDHP / HSA option Eliminated HSA seed and require Reduce dental plan Only offer one medical plan
employee contributions to
78% coverage value
option that is HSA qualified
subsidy to 50%
$4,728 558 norm 67 norm Participant PPP option receive any XYZ Company match Reinvest savings into Make dental plan 100%
80% coverage value
medical plan
employee paid
Start process of implementing a
Allowed/day 28.4% higher than norm; 0.1% above prior year 29.9% higher than norm; Experience ABC Company total defined contribution strategy;
13.6% below prior year
$4,324 norm medical plan premium cost neutral to XYZ Company
subsidy at 70%; total cost regardless of plan elected by
The high severity of conditions resulted in subsidy at 57% employee
an average allowed per admission charge of
$20,023 which is 15.3% above norm and 1.8%
higher than prior year 37
Lockton Companies
Optim Orthopedics — Lockton Beneits Practice overview 18 Lockton Companies
05 — Infolock is Lockton’s proprietary data warehouse and analytics 06 — GPS is a proprietary actuarial tool that utilizes client-speciic
tool. data, IDEAL Proile, organizational objectives, etc., to develop a
dynamic multiyear strategy with cost impact, employee friction, and
administrative effort.
Action through
insight YOUR DATA GPS
BIG DATA
Projected cost of plan: After three-year strategy
The big picture. $40M $37M
$35M
$35M $32M
Collect data from $30M $30M $32M
multiple, disparate CONSULTATIVE $30M $25M$25M $26M $28M $29M
$25M
PARTNERSHIP
sources. $25M $21M $25M $27M $28M
$21M$21M
$20M
Transform and enrich $15M
data to make it $10M
meaningful. INSIGHTS $5M
K
Skilled experts to 2014 2015 2016 2017 2018 2019
develop targeted Projected cost with trend
solutions. Purchasing efficiency, eligibility management, cost sharing
Key medical High-cost Utilization Gaps in Risk Add wellness
conditions claims patterns care stratification
1 1
Utilization trends summary
ZERO-DOLLAR MENTAL HEALTH EMERGENCY ROOM Sample Three-Year Strategic Plan
CLAIMANTS
2020 (current) 2021 2022 2022
17.3% 1,524 200 Purchasing Medical self-insured Assessand recalibrate stop- loss Implement co-pay / MandateCOE facilities and
risk transfer strategy
providers for designated
coinsurance differentials
Rx self-insured
and designated high
Members had $0 in allowed claims Behavioral Health visits/1,000 ER visits/1,000 Efficiency Stop loss reinsurance Reassessself-insured TPA/PBM for using COE facilities services
terms and provider network(s)
24.7% norm 417 norm 223 norm quality providers
These members should be looked at more 265.4% higher than norm; 10.3% lower than norm; Broad national PPO Implement telemedicine service Adopt local narrow Consider ACO
closely for potential care avoidance 8.5% below prior year 9.8% above prior year network network options where plans/networks by market
Healthcare Validate effectiveness of Rx available where proven cost effective
Delivery Mandatory Rx mail-order mandatory mail-order and
for maintenance
adjust as needed
HOSPITALIZATION OFFICE VISITS ADVANCED medications Continue biometric testing Continue biometric Continue biometric testing
EE annual discounts:
IMAGING
Health and $40 per month for Add spouses to biometric testing testing Continueoutcomes-based
completing health
Implement outcomes-
contribution differentials
Risk
evaluation and
based contribution
based on health risk factors
58 4,343 111 Improvement biometric screening differentials based on
73% employee
health risk factors
Admissions/1,000 Ofice visits/1,000 CT scans/1,000 participation
61 norm 3,463 norm 110 norm 1.38 covered dependents Amnesty dependent audit Engage third party for
per covered employee
dependent eligibility
Assessand recalibrate employee
Eligibility
4.2 25.4% higher than norm; 2.6% below prior year 0.1% higher than norm; 4.8% above prior year Management 300 estimated covered contributions for adding spouses audit
as needed to mitigate risk
spouses
Average day stay 717 87 4-tier contributions exposure
4.0 norm Preventive/1,000 MRIs/1,000 HDHP / HSA option Eliminated HSA seed and require Reduce dental plan Only offer one medical plan
employee contributions to
78% coverage value
option that is HSA qualified
subsidy to 50%
$4,728 558 norm 67 norm Participant PPP option receive any XYZ Company match Reinvest savings into Make dental plan 100%
80% coverage value
medical plan
employee paid
Start process of implementing a
Allowed/day 28.4% higher than norm; 0.1% above prior year 29.9% higher than norm; Experience ABC Company total defined contribution strategy;
13.6% below prior year
$4,324 norm medical plan premium cost neutral to XYZ Company
subsidy at 70%; total cost regardless of plan elected by
The high severity of conditions resulted in subsidy at 57% employee
an average allowed per admission charge of
$20,023 which is 15.3% above norm and 1.8%
higher than prior year 37
Lockton Companies
Optim Orthopedics — Lockton Beneits Practice overview 18 Lockton Companies
