MedCost Benefit Services (MBS) held it’s 2nd Annual Client Meeting on September 19, 2007 at the Grandover Resort and Conference Center in Greensboro, NC. There were over 100 attendees present to hear presentations from a number of MBS strategic partners about various health care topics and products and services available through MedCost Benefit Services. Nancy Travalia from OptumHealth started the day discussing the impact of trend on stop-loss renewal. John Zevzavadjian from CVS/Caremark then gave a presentation on pharmacy benefit trends. Melva Fager Okun from North Carolina Prevention Partners shared with the audience how healthy employees contribute to healthy businesses. Following a delicious buffet lunch, Kevin Wildenhaus from HealthMedia presented information about the science based online health risk assessment and wellness programs and interventions that are able to positively impact cost, health and productivity of members. The meeting ended with a presentation from MedCost on the Personal Care Management (PCM) nurse coaching program that highlighted program success stories showing the effectiveness of PCM and how PCM can integrate with HealthMedia to use on-line wellness programs to supplement nurse coach interventions for effective behavior change outcomes. Presentation summaries are available below.

Trend: The Stop-Loss Point of View
Nancy Travalia
Regional Underwriting Manager, Optum Health

At the recent Client Symposium, Nancy Travalia, the Regional Underwriting Director for OptumHealth (formerly NBR) made an informative presentation on trend and how it is applied to a specific stop-loss renewal.

What Trend is OptumHealth using to underwrite stop-loss renewals?
	OptumHealth Block	MBS Block
First Dollar Trend (aggregate)	8-9%	6-7%
Leveraged Trend (specific)	19.5%	15%

First dollar trend is used in calculating aggregate attachment factors. Leveraged trend is used when setting the specific premium. One method of mitigating the year-to-year specific premium increases is for an employer to assume more of the risk by increasing the specific stop-loss deductible. While this introduces the potential for increased funding costs, it also offsets increases in stop-loss premiums.

Impact of Quality PPO & Health Management Networks
Like most stop-loss underwriters, OptumHealth applies discounts when certain networks and health management programs are in place. OptumHealth uses network classes 1-4 and X. The “X” discount is reserved for relationships with a proven track record of exceptional PPO arrangements AND integrated health management programs that produce loss ratios well below the average. MedCost Benefit Services has achieved the “X” discount with OptumHealth.

Source of Jumbo Claims
Finally, Nancy discussed the primary diagnosis groups that are producing the highest claim dollars. Not surprising, cancer & leukemia topped the list. Premature births were the second highest category. MedCost Case Management employees a dedicated team of oncology nurses to manage cancer claimants, assuring the most appropriate treatment in the most cost effective environment. We also offer the SmartStarts Prenatal Program, which focuses on helping high risk mothers-to-be extend their pregnancy, thereby reducing the risk of a low birth weight baby.

If you have questions about Nancy’s presentation or would like to discuss leveraged trend, please contact Jeff Thornburg, Underwriting Manager or your Marketing Representative.

Understanding Pharmacy Benefit Trends
John Zevzavadjian, Vice President TPA Sales
CVS/Caremark

During the MedCost Benefit Services Annual Client Meeting, John Zevzavadjian, VP Sales and Account Services from CVS Caremark shared a presentation titled, “Understanding Pharmacy Benefit Trends.” John’s presentation highlighted the following:

• Examine trends in the marketplace
• Understand drivers of pharmacy trend
• Showcase Caremark innovative successes
• Forecast and explore the future
• Provide actionable trend management recommendations

For the 4th straight year, pharmacy trend continues to grow at single digits as opposed to what we saw back in the late 90's of double digit trends. The 2006 gross trend of 5.2% Per Member Per Month is well over 2 percentage points lower than last year’s trend of 7.9%. Reasons are, but not limited to: pharmaceutical industry trends such as few new block buster brands entering the market place; increased availability of generics in highly utilized classes such as the cholesterol lowering agents and Antidepressants, e.g. simvastatin and fluoxetine; over-the-counter (OTC) alternatives especially in the antihistamine and ulcer category, e.g. Claritin and Prilosec (over-the-counter) and clients implementing clinically sound and cost effective benefit design strategies.

As we talk about pharmacy trend, it is important to balance drug spending increases through appropriate utilization and coverage options. “Good Trend” or good utilization can be viewed as pharmaceutical investments in medications that are life-saving or medically necessary, e.g. Diabetes medications. Management of these categories should focus on strategies that drive adherence to treatment guidelines and medications to improve total health and prevent disease progression. “Bad trend” or over-utilization of drug classes are generally considered in the healthcare industry as either non-essential to our health status or have potential for over-utilization, e.g. treatment for male pattern baldness. Management of these therapies should focus on tools that ensure that the right person gets the right drug for the appropriate duration of therapy. The trend impact of each contributes to CVS Caremark’s overall trend of 5.2%. It is exciting to see that therapies for the management of conditions that are critical for sustaining life had the greatest impact on our overall trend (a total of 4% or over 75% of total trend is driven by medications associated with good utilization).

Unlike non-specialty drug trend, which was at 5.2%, specialty trend for 2006 was 16.1%. Specialty medications are expensive ($10,000-$1,000,000 per year), infused or self-injected and require special handling. The trend was driven by increased utilization of 7.6%, a robust pipeline, and expanded indications for existing therapies. A very small percentage of the population of about 1% is utilizing specialty pharmaceuticals but drive almost 10% of total drug spend.

John highlighted plan designs that can promote consumerism and impact member behavior to make cost-effective choices and thus lower an employer’s overall drug costs. Some examples include:

• Three tier plan designs encourage the participant to choose the right drug such as generics and preferred brands.
• The larger the spread between co-pays, the more likely the participant will encourage the physician to prescribe a generic or formulary drug
• DAW penalties on brand drugs that have an FDA approved generic help influence decision to choose the generic
• Programs that drive mail utilization increases the likelihood that a generic drug will be substituted
• Restrictive coverage on therapeutic classes commonly prescribed for lifestyle use can decrease utilization within these classes

Looking forward, to continue to manage trend, the industry will focus on measures that drive consumer awareness and impact member behavior towards selecting cost-effective medications and utilizing the most cost-effective delivery channel. As well, it is important to provide a balanced plan design that encourage trend within the categories that will promote health and wellness, and discourage utilization and trend for lifestyle medications or in classes with high abuse potential. Such strategies will help plan sponsor continue to manage overall pharmacy trend and sustain an affordable pharmacy benefit.

North Carolina Prevention Partners
Melva Fager Okun, Dr PH, Manager
Healthy Hospital Initiative

Healthy Employees Create Healthy Businesses
Obesity, poor nutrition, physical inactivity, and tobacco-related illness cost North Carolina over $15.85 billion each year. This translates into NC employers paying an average of $5,000 per employee per year. These costly, unhealthy behaviors can lead to chronic disease, which results in absenteeism, presenteeism, and escalating health care costs. NC Prevention Partners (NCPP) helps businesses assess their policies and identify ways to create a healthier work environment. The Prevention 1st Challenge, a program of NCPP, has web-based audit tools to help employers determine where to make changes to improve the health of their employees. Healthier employees are more productive and have lower health costs. NCPP has worked with NC hospitals to help them become 100% tobacco-free campus wide and to provide support for tobacco users to quit with access to cessation medications and counseling. NC hospitals lead the nation in this effort. MedCost is to be congratulated for making its properties tobacco-free and for supporting all employees who want to quit. (For more information about assistance for businesses, contact Kristy Lowther at Kristy@ncpreventionpartners.org and 919 969-7022 ext 1#.)

In January, NCPP will release the 2008 NC Prevention Report Card. The Report Card helps businesses and government leaders determine the strategic actions needed to improve the health of the citizens of the state.

Wellness/Health Risk Management
Kevin Wildenhaus, Ph.D., Director of Science
HealthMedia, Inc.

MedCost Benefit Services was privileged to have Dr. Kevin Wildenhaus from HealthMedia, Inc. present at our Annual client meeting in Greensboro, North Carolina.

HealthMedia (HMI) is an industry leader in providing science based, highly tailored and efficacious web based health & wellness interventions. HealthMedia's interventions have proven themselves in numerous clinical trials and studies to provide superior outcomes. The HMI solutions help organizations lower health care costs and improve the health and productivity of their populations. This is achieved by:

1. Unique Tailoring Technology: Expert Tailored Counseling (ETC) is an expert system technology that combines the knowledge, skill and capabilities of a comprehensive group of health professionals and scientists into a powerful tailoring engine that produces highly individualized, easy-to-implement, actionable health behavior improvement interventions. The end result is a unique technology-based counseling interventions that fully incorporates the individual's personal characteristics and focuses on their specific needs and concerns regardless of where "they fall" on the health care continuum.
   
   
2. Behavioral Science Expertise: The science of health behavior change is a dynamic and innovative field of study. HealthMedia's solutions leverage over 20 years of research from their Founder and Chief Science Officer, Victor Strecher Ph.D., MPH, and the company continues to be the beneficiary of research conducted at the Center for Health Communication Research at the University of Michigan.
   
   
3. Program Impact: HealthMedia interventions have been recognized by industry leaders and clients as a proven mechanism for obtaining results. Their ability to not only track, but leverage positive outcomes from participants has made HealthMedia one of the industry leaders in healthy behavior change interventions.

MedCost Benefit Services has contracted with HealthMedia to provide the following products:

Succeed: Health Risk Assessment
Balance: Weight Management
Nourish: Nutrition
Breathe: Smoking Cessation
Relax: Stress Management

The data from the Health Risk Assessment is exportable into our Personal Care Management data-mining module and will enable us to identify those ‘at risk’ patients prior to a claims encounter.

Contact your account manager if you would like to receive more information about these exciting new products.

Dr. Wildenhaus is a Clinical Psychologist specializing in health behavior change and practical, effective health intervention programs. Dr. Wildenhaus leads the Behavioral Science and Consulting Group at HealthMedia and is the Principal Investigator on a Robert Wood Johnson grant looking at internet based self-management interventions for weight control, goal setting and nutrition. He completed his doctorate from Wayne State University, with a major in Clinical Psychology and a minor in Industrial & Organizational Psychology. In addition, Dr. Wildenhaus also serves as the Team Psychologist for the 2006 Super Bowl Champion Pittsburgh Steelers.

Personal Care Management
Kathryn Showalter, VP Business Development
Becky Miller, RN, PCM Nurse Coach
MedCost, LLC

Kathryn Showalter, from MedCost, gave a presentation on the Personal Care Management program. Personal Care Management (PCM) is a nurse coaching program that uses claims data to identify individuals with certain conditions and/or utilization of services that may indicate health risks. A nurse coach assesses each individual to determine if they can benefit from personal nurse coaching and interventions that will support the individual in making behavior and lifestyle changes that will improve health status, reduce risks and ultimately lower cost of care. Nurse coaches are flexible in developing a personalized plan for each individual that are goal-oriented and can refer the patient to HealthMedia on-site lifestyle management programs, employer on-site programs or community resources to help provide education and support.

The PCM program is showing great success with 81% of participants showing positive health changes and 73% retention rate of enrollees. Financial analysis that compares the annual cost per PCM participant for 1 year prior to joining PCM and for 1 year after joining PCM shows an average reduction of $4,115 per participant.

Becky Miller, RN who is a personal health coach for MedCost expressed her enthusiasm and passion for the Personal Health Management program with the audience by sharing a more personal look at the program. She told about a 46 year old female patient that triggered to the program for emergency room visit utilization. The assessment revealed the patient experienced hypoglycemic events and a history of back problems due to weight issues. She learned the patient drank about six sodas a day and had unhealthy eating habits. She set weight loss and nutrition goals for the patient and asked her to join the YMCA and attend 4 times a week and wear a pedometer. Three weeks after enrolling in the PCM program the patient emailed Becky saying, “Just thought I’d drop you a line to know that I have already lost 10 pounds!! I stopped Mt. Dews and am working on my portion limits. I’m eating more fruits and veggies and trying to cook my meats better. I start my Weightloss Warriors program soon and will start going to the YMCA on Monday. Thanks for your support and we will win this battle.” Currently the patient has lost 27 pounds and is compliant with her dietary and exercise plan. There have been no further hypoglycemic events or emergency room visits reported.

Another 51 year old patient triggered into the PCM program with a diagnosis of diabetes and hypertension. The patient was on medication for hypertension and pain medication for short term relief of post-op pain. The patient had gained 50 pounds in two years and was engaged in limited exercise due to pain issues. Initially, the patient agreed to focus on diet and exercise and began a low fat diet and walking program 3-4 days a week. Within 3 months of these changes, the patient had lost 30 pounds. Post-op pain issues were not resolving and the client was getting limited rest due to disruption of sleep to take pain medicine during bedtime hours. He expressed exhaustion and irritability and personality changes. The patient agreed to let the nurse coach call his physician and discuss changing the pain medication regimen to provide more long-term relief that allowed a full night sleep. The patient sent this message to Becky after that intervention, “Hi Becky, I am working regularly without having to take time off for the pain. Thank you for being a blessing and assisting with a solution that has enabled me to sleep therefore to heal. I feel if this progress continues, I will be able to diminish the medication within the next short while….”

For more information about the Personal Care Management Program, contact your marketing representative.