1. La Crosse County Healthcare Update October 2011 Presented by: Bill Heinz Benefits Consultant Diane Deters Account Manager

2. Health Insurance Formula Premium = Claims + Administration

3. Stop Loss Premium (Equalized Enrollment)

4. Premium Change History (2007-2011)

5. 2012 Renewal Reserve Balance has enough to pay 3 months of claims

6. Changes / Improvements • Marketed for Health Insurance to all available markets • Fully Insured: Gundersen, Health Tradition, • State Plan • SUGGESTIONS for 2012 and beyond • To control costs and employee contributions • Neighborhood Clinics / Express Care / Wal-Mart • Higher Deductibles • Add Copays for Physician visits / Hospital • Change Emergency Copay to $100

7. Other Long Range ChangesOnly for Discussion at this time • Integrated Disease Management • HRA adjusted deductibles and contributions • Bio-Metrics for Contributions • Medical Tourism • Milliman Study to avoid 2018 Cadillac Tax and other issues related to HCR

8. State Plan Comparison

9. La Crosse County Benefits La Crosse County General Marketplace Increases 9% - 12% avg. Increasing Deductibles Increasing Out of Pocket Expenses Ever Increasing Employee Contribution Cost Shifting to Employee • Zero Increase • Low Deductible $100/$300 • Very low Out of Pocket Expenses • Low employee premium (10% share by employees) Avg. Comparable Counties: 12% Premium share by Employees $375 Single/$843 Family Deductible

10. Benchmarks of Health Insurance (Western WI)

11. Annual Cost Per Employee

12. Claim Dollars from Unhealthy Behaviors

13. Claims that Could Have Been Positively Affected by Early Detection

14. Dollars Spent on Chronic Disease

15. Chronic Disease Claims Impact

16. 5 Year Average

17. There is no “SIMPLE SOLUTION” but there is help…………..! Health Assessments Wellness Programs Education Employee Involvement

18. La Crosse County Needs Wellness • La Crosse County claims ($1.1M) are related to unhealthy behavior • Physical Inactivity • Poor nutrition • Tobacco use // Alcohol and Drug • 12% of La Crosse County claims ($1.24M) could have been POSITIVELY affected by early detection and disease management programs • Education and Early detection are critical components (HRAs are a good resource)

19. Final Thoughts • Federal Healthcare Reform is going to be expensive • Health costs will continue to rise • Real solutions will be found in changing behaviors, not cost shifting tactics • CDHP plans do work with lots of options • Cost savings is dependent on design

20. Summary of Suggested Changes • Add Neighborhood Clinics to Coverage • Covered at 100% = No charge to the employee • Includes Neighborhood Clinic, Express Clinic, Wal-Mart Clinic • Add $25 Office Visit • Currently you pay your deductible then coinsurance • Change Emergency Room charge to $100 • Currently $25 • The new charge is waived if you are admitted to hospital • $0 Increase in healthcare premium for 2012 Instead of raising premiums by 5%