Premium Growth Management
Per Admission Copay Vs. Deductible Plans
Services Offered
Educational Services
Local, Onsite Services
Plan Design

Premium Growth Management
The current renewal premium is important, but much more important is a plan to manage premium growth over the next 5-10 years. With 15% medical inflation, premiums will double in five years. FirstCarolinaCare Insurance Company, Inc. (FCCIC) is the only carrier addressing this strategic issue with employers. We can help them slow premium growth through employee education, wellness programs, disease management, plan design, and cost sharing alternatives. The key issue is finding employers that recognize the problem and are willing to develop a five-year target for their health plan premium. See chart below.

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Per Admission Copay Vs. Deductible Plans
When comparing FCCIC copay plans with competitor deductible plans, the objective is to establish the copay plan as a richer or superior benefit plan. On average, only 6% of a plan’s members will have a hospital admission during a plan year. Therefore, only 6% of members will “incur” the per admission copay. A large number of the 94% of members who will not experience an admission will access the health care system in ways that are usually subject to a deductible. This means that most members will feel that their health plan is of little benefit when they incur routine health care costs that are subject to a deductible. Seek employer buy-in to the concept that the majority of employees should see tangible benefits from their health plan and that those who use the plan the most should pay a larger share of the claims cost. See Exhibit B.

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Services Offered
As a community based, locally owned and managed insurer, we are able to provide an array of on-site, personalized services that no other statewide or national carrier can match. Our services are not only included in our premium rate, but they will help reduce or slow growth in the cost of claims (medical inflation + utilization + technology cost).

Our service offerings include:

• Health screening
• Health Fairs
• Wellness Programs
• FirstHealth Fitness Center discounts
• Chronic condition management
• Educational seminars, videos, etc. targeted for group members
• 800 Nurse help line
• Analysis of claims data and customized recommendations for corrective action when appropriate

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Educational Services
The most important component of our services is education. The primary goal of the education program will be to make employees informed consumers of health care services and to motivate them to improve their health status.

As partners, we can create a group of informed consumers by helping employees to achieve the following educational/behavioral objectives:

Learning the drivers of health care cost.
Learning the value of the health benefit provided by the employer.
Learning how individual choices affect future plan cost for the individual and the group.
Inform each individual of their health status and how to improve it.

The education program will be customized for employees based on the information developed from a free annual health screening provided to all eligible employees. The health screening will enable FCCIC to provide a summary Health Status Profile of the group. During the plan year we will supplement the Screening data with a monthly claims analysis. We will develop both group and individual programs that will zero in on targets revealed by the health screening and claims analysis. Past experience in this region has shown that there will be opportunities in the areas of: hypertension, diabetes prevention and management, obesity management, and tobacco cessation.

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Local, Onsite Services
FirstCarolinaCare Insurance Company is based in Pinehurst, NC and our business activity is centered in the six county region surrounding Moore County. Our service model is based on program efficacy that results only when services are strengthened through face-to-face contact. We use today’s technology to gain efficiency, but when it comes to affecting behavioral changes we recognize the benefit of personalized, human contact. Our staff of Account Managers and Nurses will make onsite visits to work with the management team and employees to develop and deliver a program that will help to improve the health status of your employees and slow the rate of medical inflation.

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Plan Design
One irrefutable principle we have learned is that to affect behavior change, employees have to have skin in the game. When a plan design is so rich and an employer so generous that employees experience little or no financial impact as they access health care, they both underestimate the value of the plan and make consumption decisions without regard to medical necessity.

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