Maximizing Employer Partnerships“Make New Friends, but Keep the Old”Jeffrey Carr, Corporate & Consumer Services Growth Officer,Inova

Key Customers/Stakeholders

• Physicians

• Patients/Consumers

• How is your health system or hospital meeting the needs of each?• How are you messaging and marketing to each?• Does your company view each stakeholder with equal or some with

greater importance?• Where does the majority of your revenue originate today and 5 to 10

years out?• How are you leveraging each stakeholder for growth, strategic planning,

philanthropy, service, etc.?• Do your operations, sales, marketing, and relationship teams and

resources mirror the above customer segments? Are these teams inter-connected and able to share information and opportunities?

• Employers

• Brokers

• Insurers

• Employees

How do employers see things?

Narrow Networks

Business CommunityProblem Statement

Increased Quality Lower Cost

Seeing the employer as the payor/customer…“through their lens…”

The way our hospital businessworks

The way employers view it…

More utilization = the morerevenue we make…

More healthcare utilization they have= less money to grow, hire, invest,develop, shareholders, etc.

Less we spend on claims & healthcare = more we can invest to grow, hire,profit, etc.

Fewer procedures and testingwe perform = increased losses,cut backs, lower bond rating,etc.

vs.

Move to shift awayfrom employer to“employee.”

Moving away from oldrich PPO toConsumer DirectedHealth Plan.

Is your hospital readyfor growth to be drivenby value?

How is the organization insured (and whydoes this matter)?

Two-thirds of employees in the U.S. who arecovered under an employer-sponsored healthplan are covered by some form of self-fundedhealth plan.

Fully-insured

• The most common way employers fund theirhealth care plan

• Fully-insured funding arrangements offerpredictable monthly premiums, guaranteedprotection for all covered claims andsimplicity with no additional costs

• Company pays a fixed monthly premium tothe insurance company, regardless of theplan’s claim costs.

• Insurance company assumes the financialand legal risk of loss if claims exceedprojections.

Self-funding

• Employers retain the risk of paying for theiremployees’ health care themselves, eitherfrom a trust or directly from corporate funds.

• When employees have few claims and fewexpensive illnesses, the employer realizesan immediate positive impact on overallhealth care costs.

• If the employee group has unfavorableclaims experience, employer would incur animmediate expense beyond what wasexpected.

We are in still in two businesses...

InovaBrand

IntegratedIT

InovaCulture

•PopulationHealthManagement•CapitationPayment

•HealthServicesDelivery

11

22

The Employer - Focused Approach

What are employersshopping for? Whatproblems do theyhave? Whichsolutions will meetthose needs?

Determine whichservices and solutionshave biggest potentialto drive growth

How do employersshop? Whatinformation do theyuse to makedecisions? Where dothey look and turn tohelp? Trustedsource?

Create “Go to Market”strategy to deliverservices to market

“Works for the consumer as a customer too.”

“New World” Healthcare Sources ofGrowth & Profitability

2015 2018 2020Traditional Health

Care/Hospital Services

Population HealthManagement

Other / Premium/ Self Pay

90%

5%

5%

65%

25%+

10%+

40%

40%+

20%+

Business

Could originate from employer as payor

Could originate from employer as payor

Who are the top employers in your market & howwell do you know them? How do they view you?

• How would you rate your organization’s relationships withemployers?

• How knowledgeable are your strategic planning, marketing, andcommunications departments with the employers (and brokers) inyour markets? Are they using data and employer relationships toleverage when contracting, mapping out and messaging yourinitiatives, government relations, etc.?

• What sources are you using, how do you store it and maximizecross-boundary teamwork?

Leveraging Vendors?

• Hospitals/health systems are massive buyers of supplies, services,materials, consulting and labor

• How are these vendors “giving back” and contributing to yourorganization?

• Who is doing the asking?

• Are your contracts written to benefit your occupational healthservice line?

• How aligned are your marketing, corporate health services, sales,foundation, and communications teams back to purchasingdepartment?

• Vendors are employers too

Role Brokers Play in Healthcare

How do most employers (and theiremployees) access your health system?

Brokerseeks bids

fromcarriers

Broker reviewsbids with

employer &makes

recommendations

Health plan &benefitdesign

selected byemployers

Members of planhave access &

financialincentive to use

providers innetwork

Can your hospital/health system influence alongthis process?

Do you have meaningful relationships with brokersand employers?

How employers (and their employees) willselect their benefits using technology

FOREMPLOYEES

FOREMPLOYERS

Employers look to you as “best practice”for wellness, prevention, occupationalhealth, care management, sustainability,behavioral health, managing costs, etc.

What is your health system/hospitaldoing?

What are you doing as best practice andcan it be shared and delivered to openmarket?

On-site wellness clinic

WellAware

Be a Leader and Trusted Source

C-suite

• Welcome opportunities to community

• Practically everyone needs PCP, OB/GYN, Peds, etc.

• Happy spouse and family = happy life

• Loyalty from start. Trusted resource/partner. Support from thetop.

• Time is Precious

• Potential Donors

Does your health system/hospital have theserelationships?

Who is responsible for messaging to C-suite audienceand/or building/managing relationships?

OccupationalHealth

OccupationalHealth

DirectContracting

DirectContracting

ConciergeServices

ConciergeServices

EAP &Work Life

EAP &Work Life

InsuranceDivision

InsuranceDivision

CareManagement

CareManagement

WellnessWellness

TravelMedicine

TravelMedicine

ExecutiveHealth

Services

ExecutiveHealth

Services

Tele-medicine

Tele-medicine

OnsiteClinicsOnsiteClinics

CorpHealthSvcs

CorpHealthSvcs

Inova – More than just hospitals…

Delivers Health Services to 2,000 +employers

Executive Health Services

• Continuity of care subscription program.

• Half day complete health and wellnessassessment.

Innovation Health – Transforming Healthcare

Aetna’s health plan administrationexperience:

• Aetna’s national provider network*

• Plan sponsor reporting

• Actuarial and underwriting

• Sales and marketing

• Employer, member and provider services

• Claims and medical management

• Regulatory and compliance services

• Pharmacy services

• Billing and collections

Inova’s clinically integrated health deliverysystem:• Inova’s nationally recognized centers of excellence,

care delivery programs, and wellness programs

• Inova-developed provider network to driveimprovements for efficiency, quality and patientsatisfaction

• Premium/costs below market resulting from significantunit cost reductions; additional value to be generatedfrom network efficiencies over time

• Health Information Technology and Health InformationExchange services to play a key role in enablingclinical integration to measure and improveperformance through shared electronic health records,data analytic systems and evidenced-based guidelines

Direct to Employer ContractingKey Drivers for Employers – Cost and Quality

Lower Cost & Better Outcomes• Cost savings to plan sponsor/employer and potentially employee• Less financial risk for the employer and employee• Fewer readmissions & complications• Shorter length of stay

• Less likely to get hospital based infections• Less time away from work

• Better continuity of care (dietician, physical therapist, etc.)

Local Market Assessment• Narrowed List of Procedures for

Evaluation

Evaluation Criteria• Predictable Costs• Predictable Outcomes• Volume• Quality Metrics

National & LocalTrends

Procedure Evaluation Process

Direct to Employer ContractingTarget Employer Characteristics

• Self Insured• 500+ employers (Middle & Large Market)• Geo Target based on current health plan carrier/plans offered &

new potential to your hospital/health system• New markets and new growth• Clinically at-risk employers & employee population (i.e., aging,

overweight depending on bundled procedure)• Offer as retiree benefit(s)• Consider employers offering generous benefit plans / wellness

focus

Direct to Employer ContractingFuture Interest?

Employee Assistance

• 95 % cases reachresolution within EAP

• Reduction in healthinsurance claims.

Value in Serving Public Safety

Occupational Health

Sample Employer Segments & PotentialOpportunities to Deliver Service(s)….

Public & Labor• Self Insured• Likely largest employers in your

market• Potential Big Users of healthcare• Open to public/private

partnerships• Potential services include;

occupational health, wellness,insurance, narrow networks,clinics

• Huge upside to fosteringrelationships; especially servingPublic Safety

• RFP- Competitive Bids

Small Business• Limited knowledge, resources

to understand, and navigateoptions for service

• Don’t always have separate HRDepartment

• Big opportunities to helpnavigate

• Exchange Users

Mid Size Companies• Headquarters can be local• Mix of Self Insured• Onsite Clinics• Wellness• Insurance/Narrow

Networks• Direct Contracting

Large Private Employers• Executive Health• Self Funded• Wellness, EAP, On site clinics,

Direct Contracting, NarrowNetworks, Occupational Health

• Separate Benefits Team, HRTeam, Risk Management

• May seek contract at NationalLevel – TPA’s

• Looking for partners at locallevel

• Opportunity to retirees

Leverage Employer Relationships to GrowTraditional Provider & Hospital Services

Health Education• Spine, Sleep,

Cardiac, PCP, etc.

Biometrics & Screenings• Tie back to care

management

View wellness as revenue streamand marketing vehicle as growthengine for economic drivers ofyour health system.

Provide ortho/PT/athletictrainers & resources back tohigh schools & professionalteams

Six “Low Effort/High Reward”Take-a-ways

1. Send congratulations letter (or phone call) to newly promoted leadersin your market. Same for new CEO’s & companies relocating to yourcommunities.

2. Be a sub contractor to insurance companies for wellness services

3. Host employer symposium for your business community (regardlessof having corporate health program)

4. Begin to message to employers and brokers in your market onaccess, affordability, primary care, ambulatory care, prevention, etc.

5. Lead by example & consider “peer to peer” strategy. HR to HR orCEO to CEO.

6. Leverage vendor relationships and message accordingly.

Questions ?