Manatee County Government Employee Health Benefits Rx Benefits: Key Component of Fully Integrated Health Management Problem Identification Employer health care expenses have skyrocketed not only because of higher price tags for drug and medical services, but also higher utilization. The increased incidence of chronic health conditions, such as diabetes, hypertension, high cholesterol, heart disease, depression and other mood disorders, has significantly escalated health care benefit costs and decreased workforce productivity. This trend must be reversed if employer-based drug and medical benefit programs are to be sustainable. Rebuilding a fit workforce with a willingness to change lifestyle habits is essential for corporate American to compete in a global economy. Objectives The Manatee County Employee Health Benefits Office sought to create a value-based benefit culture in which healthy lifestyle behaviors and active health management are expected, nurtured and rewarded.  By empowering and incentivizing employees to take charge of their health, Manatee County aimed to improve workforce health and curb its drug and medical cost trends. Target Audience The County’s 7,400 active and retired employees and their dependents are the target audience. Solution Since 2005, Manatee County has been building an integrated health management program with a benefit plan requiring member accountability for healthy behaviors. Key components are: Your Choice Drug and Medical Benefits Designs: The medical benefit features strong financial incentives for healthy behaviors. Cost sharing is linked to health management activities such as participation in health risk assessments, biometric lab tests, wellness exams, age-based screenings and targeted health improvement programs (e.g. diabetes management, weight management, tobacco cessation). Employees who qualify for Best cost sharing options pay no deductible, no co-insurance, and $25 co-pay on all office visits. The drug benefit cost sharing structure encourages cost-effective purchasing when medically appropriate and helps ensure medications are affordable. The County negotiated a preferred retail pharmacy network with a local chain, resulting in favorable discounts. Members get free generics when obtained from network pharmacies. Prescribed over-the-counter drugs for allergies and gastrointestinal problems are covered with no copayment. Diabetic test strips and meters are free. A partnership with Bayer Corporation enables the County to purchase these supplies at cost. Your Choice Center for Health and Lifestyle Management: The Center provides a continuum of education, fitness, counseling and coaching programs. It includes preventive health management, chronic condition management, lifestyle assistance for managing stress/depression, and a no-fee fitness center. Professional resources include registered nurses, clinical pharmacist, three behavioral health professionals, exercise kinesiologist, exercise coach, and licensed nutritionist. Full-time, Onsite Clinical Pharmacist: The onsite pharmacist assuring that pharmacy expertise integrated into every aspect of County’s health management program. In addition to being a certified asthma educator, the pharmacy advocate also consults with the staff diabetes educator.Pharmacy Advocate interventions include: Face-to-face Medication Therapy Management (MTM) by referral or request Phone consultations providing disease education and cost-saving opportunities Worksite Pharmacy Benefit Education sessions, followed by individual appointments Education through multiple employee media Clinical interventions such as an Asthma Education Program Integrated Utilization Data: Drug utilization data are integrated into a health program database that includes medical claims, lab results, health risk assessment (HRA) and wellness exam results, and EAP/behavioral health utilization data to create a complete and totally integrated patient profile. This 360 degree view of health status, care in progress, and gaps in care guides the County’s in-house disease management, case management, EAP, wellness coaching, and pharmacy advocate. Results This sustained effort has produced solid results over multiple years: 93% of members are engaged in all the health management activities necessary to quality for the medical plan’s Best cost-sharing option The County’s current drug trend is -3.8% Generic utilization rate is 69%, an increase of 26% over three years Utilization of preferred drug list is 86%,an increase of 6% over three years Average patient cost share per Rx has decreased 15% over three years without any changes in plan design because of increasing generic use and increasing formulary adherence Combined medical and pharmacy program costs are currently at 2006 levels. High risk for chronic disease is 6% below the national average Diabetes hospitalization costs have decreased from $500,000 in 2005 to $70,000 in two subsequent years Severe diabetes cases with complications decreased from 28 cases totaling $2.3 million in 12 months down to 10 cases totaling $559,000 in two years later 8% decrease in pharmacy claims for antidepressants in first year of County’s Lifestyle Assistance and Management Program (LAMP) 32% decrease in per member per year (PMPY) total health care costs related to depression in first year of LAMP