BHCG 2019 UnitedHealthcare® Results
Highlights of the 2019 results[i] for BHCG employers using UnitedHealthcare’s network include:
- BHCG member employers have seen a 1.2 percent aggregate increase in per member per month (PMPM) costs from 2015 through 2019.
- Employees and spouses of all BHCG employers that are highly engaged with Premium providers showed 6.4 percent lower spend in 2019 when compared to adults with low utilization of Premium providers (after adjusting for high cost claimants and claim risk differences)[ii].
- Risk adjusted PMPM is 19 percent lower for employees and spouses of all BHCG employers that are highly engaged with Premium providers in consecutive years vs. adults with low utilization of Premium providers in consecutive years.
- Medical trend on a PMPM basis for BHCG’s total population in 2019 was only 2.9 percent higher than 2018; for covered lives in eastern Wisconsin in 2019 the increase was 2.8 percent higher than 2018.
- Utilization of network providers for BHCG’s total population in 2019 stood at 98.2 percent, an increase of .2 percent from 2018; for covered lives in eastern Wisconsin network utilization came in at 99.2 percent, an increase of .1 percent from 2018.
- Admissions per 1,000 for BHCG’s total population in 2019 was 44.6, a 2.0 percent drop from 2018; for covered lives in eastern Wisconsin, admissions per 1,000 was 43.8, a decrease of 3.5 percent compared to 2018.
- Employers with a plan design that supports greater use of Premium physicians have higher utilization of those providers than employers who do not – 42.4 percent vs. 36.1 percent.
BHCG’s Informed Decision Making Vendor Best Doctors Reports 2019 Results for BHCG Member Employers
With access to more than 50,000 world-renowned medical experts, Best Doctors offers consumers facing difficult medical decisions access to expert medical consultations (in addition to a range of other tools and resources) so they have the confidence to make informed decisions about their care. Key BHCG case statistics in 2019 included:
- 90 percent of respondents gave Best Doctors the highest customer satisfaction rating possible
- Diagnoses clarifications or changes occurred in 48 percent of the cases
- Treatment clarifications or changes occurred in 77 percent of the cases
- Total realized cost savings resulting in a return on investment of 3.2:1
In addition to core services, Best Doctors offers additional services available to BHCG member employers at significantly reduced rates including:
- Oncology Insight with Watson – combines expert medical review with cognitive technology to revolutionize oncology
- Virtual Care Optimization - Data Analytics – intervenes with employees with the greatest need using population data
- Global Expert Medical Opinion – InterConsultation, Critical Care Support and Ask the Expert services in over 100 countries
- Extended Family Coverage – Coverage for family members beyond those covered by the employer’s health plan
BHCG Member Employers See Significant Savings in Transition to Navitus Health Solutions
Navitus Health Solutions, BHCG’s best in class strategic partner for pharmacy benefit management, is proving to be a game changer for four member employers who implemented Navitus in 2019. Using its administrative fee only model featuring complete transparency and lowest net cost, Navitus has produced outstanding cost savings for Baird, City of Kenosha, Masters Gallery Foods and Paragon Development Systems.
Pharmacy Spend - 2019 vs. 2018
|City of Kenosha||Paragon Development Systems|
|Masters Gallery Foods||Baird*|
*Represents 2nd half of 2019 savings only
Several other BHCG member employers made the transition to Navitus as of January 1, 2020. Their results will be reported in the upcoming months.
[i] Dates of Service 1/1/2019-12/31/2019. Paid through 02/29.
[ii] Total BHCG population. Limited to subscribers and spouses only (Excludes dependents). Excludes Catastrophic Claimants >$100,000 in medical spend, Highly Engaged members have 75% or more of their Premium spend at Premium Tier 1 providers (Quality & Efficient). Low engagement is <75% of the Premium eligible spend. Savings is based on Covered spend (before member cost share) on a per member basis after adjusting for claim risk score.