The Pursuit of Coverage and Quality Health Care Presented by

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The Pursuit of Coverage and Quality Health Care

  • Presented by

  • Lynn Zehnder

  • Director, Benefits Strategy

  • Sears, Roebuck and Co.

  • June, 2004

Employer – Based Health Care Initiatives

  • Affordable Solutions Coalition Sears has joined forces with more than 50 Fortune 500 Companies to create an easier entry point to a range of health plans for their combined uninsured populations. Individuals will be responsible for paying their own premiums, but the Coalition aims to provide lower cost coverage than is available to an individual

  • Care Focused Purchasing Sears and 28 other large employers are working to provide consumers with quality and efficiency data for individual hospitals and physicians to help them make better decisions when choosing providers

Why Do We Care? Another Year of Double Digit Health Care Cost Increases

Why Do We Care? Employers Can Gain From Insuring the Uninsured

  • Reduction of Uncompensated Care Cost Shifting $3B - $16B

  • Reduction in Turnover $3.8B - $8.6B

  • Reduction of Absenteeism $1B - 1.2B

  • Productivity Gains $87B - $126B

  • Total $95.1B - $151.8B

Care Focused Purchasing

Care Focused Purchasing Concept, Purpose, and Participation

  • Concept:

    • Acting together, employers – can make a market that rewards better physicians, better hospitals, and better treatment options
    • Standardized information on provider quality and efficiency will create performance sensitive buyers of care
    • This will result in a more transparent, rational market for health care
  • Purpose:

    • Speed up underlying marketplace trends
    • Yield significant reductions in cost trend and improvements in quality and patient safety
  • Current participation:

    • 28 national employers
    • Collectively represent more than 2 million enrolled health plan members

Participating CFP Employers

  • 3M Company

  • Adecco

  • Analog Devices, Inc.

  • Assurant (formerly Fortis, Inc.)

  • BellSouth Corporation

  • The Boeing Company

  • Capital One Financial Corporation

  • Corning Incorporated

  • Edward Jones

  • Hannaford Bros. Co.

  • J.C. Penney Company, Inc.

  • Lowe’s Companies, Inc.

  • Marsh & McLennan Companies, Inc

Activating the Vision

  • Governance Structure addresses:

  • Technical Streams:

    • Performance, Cost, and Quality Measures
    • Data Disclosure and Management
    • Program Design, Pricing, and Management
    • Public Policy
    • Communications
  • Data Stewardship and Management

  • Outreach to Other Initiatives

CFP Data Management Roles

CFP Data Management Process Flow

Activating the Vision Integrating CFP with Other Initiatives

Activating the Vision Technical Stream Objectives

  • Measures: Develop a standardized set of quality and efficiency measures that will be used to create scorecards for physician and hospital performance.

  • Data: Create a consumer data repository by combining data from several sources (self-insured employers, carrier book of business, Medicare). The repository will be used to generate standardized provider scorecards.

  • Design: Develop an overall program design that integrates the key features of the “End State.” The design will address both the ultimate End State and an interim structure for 2005. Once the program design is established, we will identify and negotiate with suppliers who will align service offerings with CFP principles.

  • Public Policy: Create and advance a public policy agenda that supports the vision of the CFP, especially making valid provider performance information more available. A specific objective is liberation of physician identifiers in Medicare data.

  • Communications: Develop, deliver, and implement a strategy for communication of CFP vision, actions, and results to key constituents, including a series of concise messages for management, employees, providers, vendors, other employers, and the public/media.

Affordable Solutions

Affordable Solutions – Objective

  • Reduce the number of uninsured by providing access to affordable health care for ineligible actives and retirees

    • Ineligible part-time employees or employees in waiting period
    • Contract workers
    • Pre-65 retirees
    • Terminated employees or those coming off COBRA
    • Ineligible dependents

Affordable – Concept Overview

  • Develop unsubsidized, separately administered health care and benefit options with:

    • open enrollment
    • national focus
    • exclusive contracting
    • limited first dollar coverage
    • standardized designs with variations in limited areas
    • interactive selection tools including provider
    • lower administration fees
    • reduced commissions
    • economics of scale

Affordable Solutions – Coverage Options

Participating Companies An estimated 4,000,000 eligible

  • ACS Ford Motor Corporation McDonald’s Corporation

  • Aerojet FPL Group Inc. Motorola, Inc

  • ALCOA Inc. Gap Inc. Parker Hannifin Corporation

  • Allstate Insurance Company General Dynamics Payless Shoe Source

  • Anheuser-Busch General Electric Company Prudential Financial

  • Avon Products, Inc. General Mills Sears, Roebuck and Company

  • Caterpillar Inc. The Home Depot Starbucks Corporation

  • Church Pension Group Honeywell Starwood Hotels and Resorts

  • Circuit City Stores, Inc. IBM Corporation SYSCO

  • Cox Enterprises, Inc. International Paper Target, Inc.

  • DTE Energy Company Johnson Controls, Inc. Temple-Inland

  • Eaton Corporation Limited Brands Textron Inc.

  • EMC Corporation Lockheed Martin Corporation Toys “R” Us, Inc.

  • Emerson Electric Company Maersk United Parcel Service

  • The Episcopal Church Manpower Incorporated United Technologies

  • Federal-Mogul Corporation Marathon Ashland Verizon Communications

  • First Data Corporation Marriott Verizon Wireless

Creating a New Health Care Marketplace

  • Imagine a health care marketplace in which

    • Consumers are free to choose providers, but are sensitive to cost and quality, and are engaged in their health
    • Doctors and hospitals compete based on the cost and quality of services and are rewarded for better performance
    • Purchasers reward plans for their ability to create innovative plan designs that align provider-patient-purchaser incentives and are supported by cutting edge tools, resources and technology
  • Affordable Solutions and Care Focused Purchasing, while two separate initiatives with distinctly different goals, have the potential to positively impact the current health care delivery model

Why Do We Care?

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