Bermuda Country Update

10th Caribbean Conference on National Health Financing Initiatives

Progress, Challenges and

Preparing for the Next Decade

Oct. 28th – 30th, 2015, Turks & Caicos

Calvin C C White Sr

Objectives

Overview of Past 10 Years Current Landscape Future Plans

2

The Past 10 Years

3

Per Capita Health Expenditure / Standard Premium Rate (SPR)/ Standard Hospital Benefit

4

$ $ $ $ $ $ $

2014 2015

$$173 $187 $208

$271$325 $301

$236$252

Bermuda Health Council Health Accounts 2015

$2016

$338

Per Capita Spend

SHB $ SPR

Components of Health Expenditure (Bermuda Health Council Health Accounts 2015,)

5

Health Expenditure Growth

6

2007 2008 2009 2010 2011 2012 2013$0

$50

$100

$150

$200

$250

$300

$350

Bermuda Hospitals Board MOH Promotion/Prevention/Curative Care MOH Administration Overseas Local PractitionersPrescriptions Other Administration

The Current Landscape

7

LONG TERM CARE (HOSPITAL & SOME COMMUNITY)

Standard Health (Hospital) Benefit (& Mutual Reinsurance Fund)

SUPPLEMENTAL BENEFITS

Private Insurers (& Approved Schemes)

Ser

vice

s co

vere

d

Population covered

Fut

ure

Car

e

Propo

rtion

of

costs

cove

red

HIP

Adapted from WHO 2010

Dimensions of health coverage in Bermuda

Courtesy of BermudaHealth Council

9Bermuda 2015 National Health Accounts – Courtesy of Bermuda Health Council

Sigh…..

Bermuda Chronic disease burden(2010 census data)

10

65 yr. and older : 77% report long term health condition 14% disabled by health condition.

Under 65 yrs: 35% report long term health condition, 4% report disabled by health condition.

Bermuda Chronic disease burden(2010 census data)

Overweight /Obesity 67% Hypertension 36% High cholesterol, 34%, (never had it checked

25%) Disability 14% Diabetes 13% Asthma 9.8%

11

High Cost Participants

Top 250 participants (1%) accounted for 35% of all claims paid ($49,666,634 out of $142,939,803)

Aged Subsidy accounts for 76% of all Subsidy claims paid (excluding Geriatric)

October 26, 2015 BHB Subsidy Claims Analysis 12

Service Types DRG and Schedule 2-Per Diem account for 43% (19% and 24%, respectively) of all claims paid

Enhancements for

System Sustainability

13

System Sustainability Enhancements

14

Standard Hospital Benefit

Standard Health Benefit

• Inpatient, outpatient, home medical services and other benefits

• Directed Gov. funding to acute care setting

• Enhances old SHB• Expands funding use• Improves access to essential

services• Alternate care setting for certain

long-stay BHB patients• Pilot Enhanced Care program for

uninsured/indigent with predefined non-communicable chronic illness

Primary Care

Home (& Rx)

1000 Uninsured (Subsidy) &

Underinsured (FA)

$3.0 M

Program Funding (MRF Transfer)

Approved Provider Payments (Capitation) Return on Investment

Health Condition

Current Utilization

Participant Agreement

Eligibility RequirementsProgram

EvaluationProvider Participation (RFP)

SHB

Other Fringe

● Primary Care ● Rx ● SHB + Supplemental ● ● Provider

Comprehensive Chronic Disease

Management

Phased Program Outcomes

HIP/FC Sup

Community

Patient Satisfaction

Quality Measures

Utilization Changes

Health Status

System Innovation

Cost Savings

● Program Funding ● Insurance ● Self-funded

Courtesy of Bermuda Health Council

Enhanced Care Pilot

System Sustainability Enhancements

16

Post Acute Care

• BHB patients over 100 days (Long Stays)

• Allows Government Subsidy funding to support long term care in the community.

• Allows persons with limited financing and lack of benefit coverage who require long-term care to a more cost-effective and appropriate care setting.

System Sustainability Enhancements

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Home Medical Services

• Provides for medical services in home setting

• Appropriate care in appropriate setting at a better price

• IV infusions, wound care, other medical services as defined by the Bermuda Health Council

HID Sustainability Enhancements

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Personal Home Care

Benefits

• Care management services by a HID Nurse Practitioner• **Personal caretaking, companion or homemaking services at $15

an hour (max 40 hours per week) • **Nursing Aide Services at $25/ hr (max 14 hours per week)• **Adult day care services at $50/day (max $200 for 7 days)• **$60,000 max annual benefit per year, per policyholder

** (Specific qualifications must be met)

• Supports Aging in place; • more cost effective than

institutionalizing at early age. • Addresses gap in continuity of care.

HID Sustainability Enhancements

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Preferred Overseas

Network for Tertiary Care

• Reimburse at 60% for HIP and 75% for FutureCare in network

• 10% penalty for out of network services• Treatment must be medically necessary• Treatment must not be available in Bermuda

• Promotion of diagnosis based treatment

• Reduction of claims costs and client co-pays

HID Sustainability Enhancements

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WellnessBenefit

• Counseling for smoking cessation, asthma, nutrition, diabetes, lifestyle counselling and fall prevention

• Max $35/visit for max 6 visits per year• Must have chronic illness• Programme must be HID approved

• Incentive for self management• Promotes health• Reduces risk of chronic illness

Unfinished Business

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Health Spending

Health Investment

• Home Medical Services• Personal Home Care Services• Post Acute Care Programme

Unfinished Business

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Acute Care Delivery Model

Primary Care Delivery Model

• Enhanced Care Pilot• Personal Home Care Services

The Not So Invisible

Elephant

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Unfinished Business

Unfinished Business

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Complex FinancingStructure

Simple Financing Structure

• System Financing Restructure

PROVIDERS

INSURERS

Bermuda Health System Financing

Employers

Individuals

Government Consolidated Fund

Patient Care Subsidies

Argus

BF&M

Colonial

Mutual Reinsurance Fund

Local ProvidersOverseas

Hospitals

KEMH / Some Community

MWI

LCCA

FutureCare

HIP

Taxes

Tran

sfer

Out

of p

ocke

t pay

men

ts (e

.g .

copa

ys)

Clai

ms

Clai

ms

Claims

Claims

Veterans Fund

Premiums

Financial Assistance

Fund

ing

Funding

Gra

nt

Gra

nt

Fund

ing

Fund

ing

Prem

ium

Repayments

NOTES: 1. Insurers light = SHB dark = supplemental benefits.2. Excludes Public Health Services and Residential Care Homes

Claims & Out of pocket payments

GEHI

BNTB

HSBC

Version 2.0(anim) 12Nov12

Premium

DOHStandard Premium Rate

Clai

ms

Reim

b.

Claims Reimb.

Claims Reimb.

Clai

ms

Reim

b.Reinsurance

RESIDENTS

Bermuda Health System Long Term Objective

Provide the Appropriate CareDelivered in Appropriate SettingAt an Appropriate Cost

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Q&A27

Annex

28

Bermuda Health Insurance Department Objectives

Mission Statement: To provide accessible health benefits for the residents of Bermuda.

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# Objectives

1 To adjudicate and pay claims correctly in accordance with Health Insurance Department policies, procedures and legislation

2To provide quality customer service by providing accurate responses to queries in accordance with Health Insurance Department policies and procedures

3 To reduce health care expenditures for Health Insurance Department managed Funds

4 To improve the timing and frequency of our operational, management and financial reporting to better assist in business decisions

HID Administrative Structure

Permanent Secretary of

Health & Seniors

Director Health

Insurance

Customer Relationship Management

Provider Management

Finance & Risk

Management

Clinical Case

Management

Outsourced Operations

Project & Change

Management

Health Insurance Committee

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Scope of Operations:Four Products

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Product Description Health Insurance Plan

(HIP) Basic Insurance Plan for individuals & groups Continuous enrollment for persons 19+ Covers Hospital I/P & O/P + Supplemental

Benefits + Dental

FutureCare Plan (FCP) Like HIP but more comprehensive For persons 65+

Mutual Reinsurance Fund (MRF)

Funds programmes for long term care and chronic disease management

Premium-funded by all public & private insurers

Government Subsidy Entitlement

Hospital Subsidies for Youth (100%), Indigent (100%), Aged (70% or 80% for 75 and older)

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Claims Claimed by Product 2014/15

Subsidy109.0

HIP26.2

MRF0.0

FutureCare22.1

Other2.3

in millions ($)

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Claims Paid by Product 2014/15

Sub-sidy102.3

HIP23.4

MRF0.0

FutureCare17.2

in millions ($)

Dialysis claims

Fiscal Year # of participants Claims paid

2011/12 150 $21,037,582.50

2012/13 153 $24,124,270.50

2013/14 173 $27,294,413.70

PROVIDERS

INSURERS

Bermuda Health System Financing

Employers

Individuals

Government Consolidated Fund

Patient Care Subsidies

Argus

BF&M

Colonial

Mutual Reinsurance Fund

Local ProvidersOverseas

Hospitals

KEMH / Some Community

MWI

LCCA

FutureCare

HIP

Taxes

Tran

sfer

Out

of p

ocke

t pay

men

ts (e

.g .

copa

ys)

Clai

ms

Clai

ms

Claims

Claims

Veterans Fund

Premiums

Financial Assistance

Fund

ing

Funding

Gra

nt

Gra

nt

Fund

ing

Fund

ing

Prem

ium

Repayments

NOTES: 1. Insurers light = SHB dark = supplemental benefits.2. Excludes Public Health Services and Residential Care Homes

Claims & Out of pocket payments

GEHI

BNTB

HSBC

Version 2.0(anim) 12Nov12

Premium

DOHStandard Premium Rate

Clai

ms

Reim

b.

Claims Reimb.

Claims Reimb.

Clai

ms

Reim

b.Reinsurance

RESIDENTS

36

Current Initiatives

Post Acute Care Programme Enhanced Care Pilot

Collaborative Case Management Personal Home Care Services

Incentives for Healthy Lifestyles System Financing Restructure

October 26, 2015 37

Calvin C C White Sr

Acting Director

Health Insurance Department

Government of Bermuda

Tel:  (441) 278-8200

e-mail:  ccwhite@gov.bm

website:  www.hip.gov.bm

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Thank You!!!