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Affordability Is Our Goal

CDPHP understands that delivering high-quality health care services is only part of the equation for improving the health of our community. Our services cannot be effective unless our members – regardless of their age, work status, or income – can access and afford the care that is available. Unfortunately, over the past decade, the cost of health care in America has surged seven times faster than wages and consumes 32 percent of the average household budget. We feel it is time for affordability, and to help our members and employers manage that trend, CDPHP instituted several strategies to rein in costs.

cost of careProduct Choice
CDPHP offers a broad product portfolio designed to allow consumers and businesses of all sizes to tailor their health plan to their budget and their needs. Our health plan offers innovative programs like Embrace Health and Shared Health, along with a range of copayment and deductible levels, health funding arrangements, and wellness resources to help employers and members manage their health care costs. We also participate in government programs that provide health care for children and lower-income families, including Child Health Plus, Medicaid managed care, and HARP.

Health Savings Accounts. In 2016, CDPHP partnered with HealthEquity to offer a new fully integrated health savings account (HSA), thereby strengthening its position in the consumer-directed care market and giving employers and employees another way to manage their health care spend. Available to eligible members with a high-deductible plan, the HSA is a fully portable, interest-bearing, tax-free savings account that can be used for qualified medical expenses.

The HSA offers simplified account management, complete with easy enrollment, reduced paperwork, and hassle-free claims, as well as online tools, resources, and education. By enrolling in claims integration, members allow CDPHP to share medical and prescription claim information with HealthEquity so their medical expenses can easily be tracked and paid for on the member portal. In addition, HealthEquity HSA members can redeem Life Points® for additional HSA dollars. To date, we’ve created HSAs for 854 of our members, who together have an account balance of $1,148,595.

Education
At CDPHP, serving our members is our top priority, and that begins with making sure that they get the education they need to make informed health care decisions.

  • Our Consumer-Directed Health site helps our clients decipher their benefit options, addressing topics such as high-deductible plans, health funding accounts, prescription drug coverage, and more.

  • If you’re shopping for health insurance or choosing between plans offered by your employer, CDPHP is poised to help with online tools and expert guidance for decision-making. We offer an open-enrollment checklist to help individuals sort through their options and arrive at a plan that works for them and/or their families.

  • The web is rife with conflicting and inaccurate information on health care issues, disease conditions, drug treatment, immunizations, and the like. Through our blog, The Daily Dose, and our podcasts and videos, CDPHP tries to help consumers separate fact from fiction and keeps them up-to-date on current health care trends, strategies for maintaining a healthy lifestyle, and treatment options.

  • In 2016, we launched CDPHP Price Check, a cost estimator service that we are testing with our employees and selected employers. The program can be used to compare prices and plan for expenses relating to common surgeries and treatment regimens.

Preventive Care
Recognizing that disease prevention is a cost-effective strategy for combating rising costs, CDPHP offers a host of preventive care services for members at any age and stage of life. These include annual physicals, well-woman and well-child exams, mammograms, essential immunizations, and screenings for a number of diseases.

Prescription Drug Costs and Price Transparency
According to a recent report by America’s Health Insurance Plans (AHIP), consumers pay more than 22 percent of every premium dollar on prescription drug costs, an amount that outstrips what they pay for physician, inpatient, or outpatient hospital services. In the face of rapidly escalating costs for prescription drugs, patients are often in the difficult position of having to sacrifice meeting other needs so they can afford their medication. The situation is worse in the case of specialty drugs, which can end up costing more than the average American’s annual salary. For more information on this troubling trend, listen to Dr. Bennett’s podcast on the subject.

CDPHP – on behalf of its members – is strongly advocating for drug price transparency, urging pharmaceutical companies to unveil how much they spend on marketing, research, lobbying, and administrative costs. We are also taking pains to educate our members on steps they can take to lower their prescription drug costs, and we’ve instituted other measures to help them manage the cost of their medications:

  • Rx for Less allows our customers to purchase certain generic drugs at sharply reduced prices.

  • A Caremark website allows members to learn up front how much their medication will cost.

  • A CDPHP Preventive Drug List identifies medications for which members enrolled in certain high-deductible plans pay only the lower, tier-based cost-share.

Additional Cost-Containment Strategies
CDPHP has implemented several other programs that have been successful in lowering health care costs without sacrificing quality. Listed below are just two of the initiatives that have yielded positive results.

  • Our medical necessity review program, eviCore, is designed to reduce or eliminate unwarranted outpatient high-tech medical imaging, such as CT scans, MRIs, MRAs, and PET scans. In 2016, this radiology review process produced $3,934,183 in savings across all lines of business.

  • Practitioners who order sleep studies for their patients are now encouraged to conduct those studies in the home. In 2016, this approach was applied to 57 percent of the cases, and not only was it more convenient for our customers, the cost was found to be one-third that of a sleep lab study.

Health Care Reform and the Affordable Care Act
Much debate and controversy surround national health care reform and the efforts of the new administration and Congress to repeal and replace the Affordable Care Act (ACA). The economics, quality, and effectiveness of current modes of health care delivery have been called into question and are once again in the forefront of public discourse and debate.

CDPHP has been an active and vocal participant in shaping health care policy at the local, state, and national level. Our focus is, and always has been, on the essential elements of the Triple Aim: quality care, improved access and experience of care, and reduced costs. Whatever changes arise from the most recent reform efforts, our stakeholders can rely on CDPHP to maintain that focus in this era of uncertainty, and we will continue to help them understand and adjust to any reforms that impact New York’s health care system.