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 Trust Matters, February 2015 

Wellness saves lives

BIG DATA and MIT

Did you know?

Ron Tilton retiring

RMS Spring Meetings

New website launched

From the Board Room

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Wellness Saves Lives

Effective for the 2014 plan year, members were required to complete their annual physical, age appropriate cancer screening per the American Cancer Society guidelines, and participate in our Personal Care Management program if invited. Failure to meet these requirements results in a 10% penalty applied to the monthly premium of the non-compliant employee or dependent. Our statistics show that many of our high claims could be tied to failure to get the screenings completed.

Now that this is in place, we have seen a significant increase in the number of exams completed. For instance, screening colonoscopies increased from 159 in 2013 to 714 in 2014 -- a 350% increase! However, the really good news is that these requirements have saved at least two lives!

One person who complained that we should not have required the colonoscopy learned following her procedure that she had malignant polyps and she was on the verge of developing colon cancer that was dangerously close to spreading to her internal organs. The test was done in the nick of time, and the polyps' removal solved the problem.

Another person went for his routine physical as a result of these requirements and was taken immediately to the emergency room as he was a heart attack waiting to happen. Again, the intervention was in the nick of time, and heart surgery repaired the problem.

In both cases, these employees are now very thankful we instituted these requirements!

It is gratifying to know that we are accomplishing what we hoped:

  1. Saving lives through early detection (even if its just in the nick of time)
  2. Improving the health of our members
  3. Enabling members to begin a relationship with a doctor for long term health benefits and
  4. Saving money through the avoidance of costly, long-term treatments.

BIG DATA and MIT

Big Data is a term we often hear lately. Wikipedia defines big data as an all-encompassing term for any collection of data sets so large or complex that it becomes difficult to process using traditional data processing applications. We believe data analytics, or predictive modeling, could provide a significant advantage as we manage your health benefits pool.

This fall we had a preliminary analysis done of our claims -- the results were not great, but the opportunities to better manage our costs are. For example, our overall costs are consistent with groups that are “loosely managed.” If we can bring these costs down to the “moderately managed” benchmark, we will save $4.8 million in claims (almost 10%). Additionally, these analytics will allow us to answer the question, “How are the ones we are tracking doing?” In 2013-14 we had more than $9 million in claims from modifiable conditions. Targeted interventions that bring down costs by 10% would save us $900,000. This is accomplished by avoiding ER visits and inpatient hospital stays as individuals better manage their health.

These tools use medical and pharmacy claims data to identify individuals with the highest probability of high-cost medical claims as well as those folks who are about to develop a chronic condition such as diabetes or hypertension or those who have already been diagnosed but are not managing their conditions. Once we know who those folks are, the obvious next step is to engage these individuals in a wellness program, including a recommendation to participate in the Personal Care Management program provided through MedCost.

We are excited about the possibilities that predictive analytics bring to the table:

  1. Allow us to focus our wellness resources to the specific areas of need,
  2. Take a major step forward in helping our members positively manage their health,
  3. Improve the accuracy of our rates, and
  4. Provide insight into plan designs that incent healthy choices.

Did you Know?

We mentioned above we are planning to employ Big Data in managing the health benefits trust. A preliminary analysis has revealed some interesting facts:

  • More than $9 million in costs were incurred from modifiable conditions. Interventions that reduce costs by 10% will result in savings of over $900,000
  • Last year 10% of our population with medical costs above $10,000 accounted for 70% of our costs
  • We have identified 76 members that have a high likelihood of a hospital admission representing $900,000 in avoidable costs

We are excited to begin using the analytics tool; we believe it will save lives, improve member health and save $!

Ron Tilton Retiring

Please join us in congratulating Ron Tilton, Risk Management Consultant for Central North Carolina, on his upcoming retirement on March 31.  Ron joined the League staff Jan. 2, 1997, and made significant contributions to our success during his tenure. Ron’s background in safety practices, experience as a volunteer firefighter and the utilities industry and creative thinking enabled him to provide practical solutions for our members. While we will surely miss Ron, we wish him the very best as he enters this next phase of life. Michael Young, who joined the staff last June to work special assignments will fill Ron’s territory; allowing us to continue without a break in service. We know you will enjoy working with Michael and find him to be very knowledgeable and helpful.

2015 RMS Spring Meetings

Our spring meeting schedule is set:

April 1: Raleigh, Quorum Center, 308 West Jones St

April 2:  Wilmington, New Hanover County Office Complex, 230 Government Center Drive

April 7:  Winston-Salem, Historic Brookstown Inn, 200 Brookstown Avenue

April 8:  Hickory, Western Piedmont COG, 1880 Second Avenue NW

April 9: Asheville, Double Tree by Hilton, 115 Hendersonville Road

April 14: Greenville, Hilton Greenville, 207 SW Greenville Blvd

April 15: Edenton, Town Council Chambers, 504 South Broad Street

Plan to attend to learn the latest on rates, incentive credits, initiatives to help you reduce losses, etc. In addition, we will have a 90-minute session dedicated to employment liability issues such as best practices for hiring, disciplinary action, managing workers' compensation claims for employees out of work and not likely to return, and other employment liability land mines. To learn more about the meetings and to register, click here.

New website has launched!

We launched the revised RMS Website last month, and our online claims reporting application will be available soon. Our new site will allow access to all the resources available to our participants with just one login. These resources include:

  • the Learning Center, where you can access our online safety training, Safety Catch; 
  • My Claims Data to see your Workers’ Compensation and Property/Liability losses (updated nightly); 
  • the Cyber Liability E-Risk Hub, which provides a wealth of tools and information to navigate through the cyber security maze (available only to property/liability participants);
  • access your coverage documents;
  • request changes to your property coverage and request certificates of insurance.

In addition, you can access a long list of links and resources to aid you in your risk management efforts. We encourage you visit the site, see what’s there and take full advantage of the resources available.

From the Board Room

The Board of Trustees affirmed several initiatives during its annual strategic planning workshop that will further solidify our objective to be “MORE THAN INSURANCE” for our membership. We are excited about several of these that will improve our communications (see new website), internal operations, and member benefits by providing additional value-added features. Below are just a few of items you can look forward to in the coming months:

  • Dashboard Report Tool-This tool will allow our loss control field staff to quickly ascertain whether a member’s loss experience is deteriorating. This will be designed for our larger members and will provide departmental breakdown and benchmarking. Our grants have been underutilized over the years, and we continue to gauge the impact of our wellness efforts. We have engaged an internal focus group of members to develop a business plan that we believe will engage more employers and their employees in the worksite wellness programs. We anticipate we will utilize more local vendors for bio metric assessments and employee education. Stay tuned as we expect to announce specific plans during the spring meetings.
  • Online Distribution of Health Rates-In 2015 your health rates will be accessible through the website just like other insurance documents.
  • Develop improved TASER training for our police officers; we are aware of a program that our police chiefs have heartily endorsed, now we are working on how best to deliver.
  • Assist our members in adopting best practices in hiring-we will kick this off with training during our spring meetings and will be developing best practices and other resources to assist our members.