FROM INFORMATION TO ACTION State Worksite Wellness Conference

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FROM INFORMATION TO ACTION State Worksite Wellness Conference Ann S. Fuelberg, Employees Retirement System

FROM INFORMATION TO ACTION State Worksite Wellness Conference Ann S. Fuelberg, Employees Retirement System of Texas October 12 -13, 2009

WHAT IS THE GROUP BENEFITS PROGRAM? 2 2009 State Worksite Wellness Conference

WHAT IS THE GROUP BENEFITS PROGRAM? 2 2009 State Worksite Wellness Conference

The GBP covers 1 in 46 Texans through its health plans GBP = “GROUP”

The GBP covers 1 in 46 Texans through its health plans GBP = “GROUP” Benefits Program 527, 792 Participants 3 • One advantage of joining a large self-funded plan like the GBP is that each member of the group shares the risk for the plan’s health claims equally. • Managing health care effectively for the entire “group” is how ERS can offer employees and retirees a range of high quality, affordable benefits at a uniform rate. 2009 State Worksite Wellness Conference

HOW MUCH DOES THE GBP COST AND WHO PAYS FOR IT? 4 2009 State

HOW MUCH DOES THE GBP COST AND WHO PAYS FOR IT? 4 2009 State Worksite Wellness Conference

The State of Texas Pays Most of the Cost 59 cents of every dollar

The State of Texas Pays Most of the Cost 59 cents of every dollar Member Copays Contributions and Coinsurance 13¢ 19¢ 5 Other Sources (such as the Reserve Fund) 9¢ State Contribution 59¢ 2009 State Worksite Wellness Conference

Potential Funding Gap Based on Emerging 9% Cost Trend Contributions will pay 6. 5%

Potential Funding Gap Based on Emerging 9% Cost Trend Contributions will pay 6. 5% of the increase Reserve fund may pay $179 million of the increased cost 6 Contributions will pay 6. 8% of the increase Smaller reserve fund can only cover $97 million of increased cost Potential funding gap is $154 million or 6. 5% of the total plan expenses 2009 State Worksite Wellness Conference

WHAT DRIVES COSTS IN THE GBP? 7 2009 State Worksite Wellness Conference

WHAT DRIVES COSTS IN THE GBP? 7 2009 State Worksite Wellness Conference

COST DRIVER: Aging healthy members adds 1. 9% to the annual health cost trend

COST DRIVER: Aging healthy members adds 1. 9% to the annual health cost trend 50 and over Under 50 8 Under 50 50 and over 2009 State Worksite Wellness Conference

COST DRIVER: Hospital expenditures are rising faster than any other Health. Select category (Health.

COST DRIVER: Hospital expenditures are rising faster than any other Health. Select category (Health. Select expenditures over time, as a percentage of total plan costs) 50. 0 45. 0 Hospital Other medical expense Pharmacy External admin 40. 0 35. 0 30. 0 25. 0 20. 0 15. 0 10. 0 5. 0 0. 0 FY 05 9 FY 06 FY 07 FY 08 FY 09* FY 10* FY 11* 2009 State Worksite Wellness Conference

Millions Health. Select paid the most for these 5 types of hospital inpatient stays

Millions Health. Select paid the most for these 5 types of hospital inpatient stays (Active and Retirees) Source: Major Diagnostic Category Summary for All Claims, Health. Select Annual Statistical Report, 2008 10 2009 State Worksite Wellness Conference

COST DRIVER: Prescription drug trend GBP spends more than $1. 5 million/every day on

COST DRIVER: Prescription drug trend GBP spends more than $1. 5 million/every day on drugs Rank Drug Condition 1 Nexium Digestive Disorder 2 Lipitor 3 Rank Drug Condition 11 Lantus Diabetes High Cholesterol 12 Singulair Asthma/Bronchitis/Allergies Enbrel Musculoskeletal 13 Diovan High Blood Pressure 4 Plavix Heart Disease 14 Celebrex Musculoskeletal 5 Humira Musculoskeletal 15 Valtrex Neurological Disorders 6 Actos Diabetes 16 Lexapro Depression/Sleep Disorder 7 Advair Diskus Asthma/Bronchitis/Allergies 17 Provigil Depression/Sleep Disorder 8 Cymbalta Depression/Sleep Disorder 18 Lyrica Musculoskeletal 9 Crestor High Cholesterol 19 Tricor High Cholesterol 10 Effexor Depression/Sleep Disorder 20 Copaxone Musculoskeletal Source: Texas Employees GBP FY 2009 Health. Select PDP Experience, Rudd & Wisdom 11 2009 State Worksite Wellness Conference

COST DRIVER: Name brand drugs increase costs The GBP and its members could save

COST DRIVER: Name brand drugs increase costs The GBP and its members could save $5. 3 million/year if four recently approved generic drugs were used rather than the brand-name drugs 12 • 2, 098 users • $1. 4 million net spend Topamax Topiramate (for Migraine, Seizures) Prevacid Lansoprazole • 1, 830 users • $763, 000 net spend (for Gastric Reflux Disease, Ulcers) • 1, 789 users • $974, 000 net spend Adderall XR Amphetamine, Dextroamphetamine Mixed Salts (for ADHD) Valtrex Valacyclovir (for Cold Sores, Shingles) • 5, 359 users • $2. 2 million net 2009 State Worksite Wellness Conference spend

COST DRIVER: Percent of members suffering from top 5 chronic conditions Percent of Health.

COST DRIVER: Percent of members suffering from top 5 chronic conditions Percent of Health. Select Participants with condition 18% 15% 16% 15% 12% 9% 6% 5% 4% 3% 2% 0% Diabetes and High Cholesterol Hypertension Asthma Degenerative Back Disorder Heart Disease Source: Blue. Cross Blue. Shield Texas, Expense Report, FY 2009 13 2009 State Worksite Wellness Conference

WHAT ARE THE CURRENT WELLNESS OFFERINGS WITH THE GBP? 14 2009 State Worksite Wellness

WHAT ARE THE CURRENT WELLNESS OFFERINGS WITH THE GBP? 14 2009 State Worksite Wellness Conference

GBP Wellness Benefits for State Employees GBP participants have access to: • Health Risk

GBP Wellness Benefits for State Employees GBP participants have access to: • Health Risk Assessments • Coaching programs for tobacco cessation and weight loss • Disease management programs for those with chronic conditions • Mother and baby programs for pre- and post-natal care • A 24 -hour Nurseline • Personal Health Manager • Discounts to gyms, eyewear, etc. • Flu Shots and Health Screening Reminders • Youth Fitness Program Health. Select participants can earn up to $600 per year for using the Personal Health Manager. 15 2009 State Worksite Wellness Conference

Your personal health information is always protected HIPAA ensures that your personal health information

Your personal health information is always protected HIPAA ensures that your personal health information is always protected • Personal health information will not be released to anyone (including your employer ) without your written consent. • HRA results may not be used to discriminate against you when applying for health insurance or for another job if you leave state employment. • HRA results are only used for outreach for Blue Care Connection® programs, which are designed to assist you with managing chronic conditions or helping participants achieve a healthy lifestyle. 16 2009 State Worksite Wellness Conference

Help us promote wellness participation Statewide participation rates are very low Program Health Risk

Help us promote wellness participation Statewide participation rates are very low Program Health Risk Assessment # of Participants 6, 555 This is 1. 4% of total Health. Select membership of 468, 977 (as of 08/31/2009) 17 Disease Management 8, 361 Nurseline 4, 599 Weight Management 1, 531 Tobacco Management 40 2009 State Worksite Wellness Conference

MOVING AGENCIES INTO ACTION: RESOURCES TO HELP YOU PROMOTE WELLNESS 18 2009 State Worksite

MOVING AGENCIES INTO ACTION: RESOURCES TO HELP YOU PROMOTE WELLNESS 18 2009 State Worksite Wellness Conference

Regional Health Indicators Map NEW online at ERS. STATE. TX. US • Now you

Regional Health Indicators Map NEW online at ERS. STATE. TX. US • Now you can go to the ERS website to analyze Health. Select data specific to 8 regions of the state • Total number of active state employees and their dependents per region 19 2009 State Worksite Wellness Conference

Regional Health Indicators Map View the top conditions in your region • Link to

Regional Health Indicators Map View the top conditions in your region • Link to BCBS Wellness presentations about that condition • Coming soon are participation rates in disease management programs for each region 20 2009 State Worksite Wellness Conference

Blue. Resource materials 21 2009 State Worksite Wellness Conference

Blue. Resource materials 21 2009 State Worksite Wellness Conference

Click here: New Health. Select Wellness Icon 22 2009 State Worksite Wellness Conference

Click here: New Health. Select Wellness Icon 22 2009 State Worksite Wellness Conference

New Health. Select Wellness website 23 2009 State Worksite Wellness Conference

New Health. Select Wellness website 23 2009 State Worksite Wellness Conference

Resources for you and your employees Regional Health Indicator Map Shows you top chronic

Resources for you and your employees Regional Health Indicator Map Shows you top chronic conditions for your region with links to… 24 Wellness Presentations Aimed at Top 5 Chronic Conditions ready for you to use New Health. Select Wellness Logo for you to add to your website that takes your employees directly to… Blue Care Connection offering a full suite of wellness and disease prevention programs 2009 State Worksite Wellness Conference

Thank You www. ers. state. tx. us

Thank You www. ers. state. tx. us