alaskacare health plan ashnha september 11, 2014

ALASKACARE HEALTH PLAN

ASHNHASEPTEMBER 11, 2014

AlaskaCare - ASHNHA - September 11, 20142

State Health Care Spending20

01

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

Union Premium Contributions

Workers comp

Corrections

Medicaid

Active (AlaskaCare)

JRS

TRS

PERS

2013 = $2.28 billion


PERS/TRS Unfunded Liability

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 est 2014

est 2015

$0

$2,000,000,000

$4,000,000,000

$6,000,000,000

$8,000,000,000

$10,000,000,000

$12,000,000,000

$14,000,000,000

TRSPERS


Benefits: PERS/TRS

PERS AssistanceTRS Assistance

PERS/TRS GF State Assistance (SB125 & HB 385)

Projected GF State Assistance (Level Dollar)

FY08

FY09

FY10

FY11

FY12

FY13

FY14

FY15

FY16

FY17

FY18

FY19

FY20

FY21

FY22

FY23

FY24

FY25

FY26

FY27

FY28

FY29

FY30

FY31

FY32

FY33

FY34

FY35

FY36

FY37

FY38

FY39

$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

$3,000,000,000


Retiree Plan Demographics• Average number of members (plus dependents) is around 67,000• Higher distribution of women, especially between the ages of 45

and 64• Average age is 64• Top 5 diagnostic categories, 57.2 of total medical spend:

1. Musculoskeletal: Back Pain/Degenerative, Mechanical Joints, Thoracolumbar, Fractures2. Oncology: Chemotherapy, Breast Cancer, Neoplasms, Prostate Cancer3. Digestive: Intestinal Disorders, Abdominal Pain, Hernias, GI cancer4. Cardiac: Atrial Fibrillation, Angina/chest pain, Acute M.I. (Heart Attack), Valvular Disease5. Neurologic: Cerebrovascular (brain), Peripheral Nerve (brain and spinal cord)

• High cost claimants significantly impact spending: – 62 individuals, $10,533,721 in spending

• Challenges specific to this plan:– Specialty medication (Sovaldi: 13 members, $842,271 in costs)– Unmanaged diabetes– Specialty surgery


Retiree Plan Challenges• Lack of agility/flexibility

(diminishment clause)• Outdated plan structure and

benefits • Plan is not mainstream• Dispersed population• Plan demographics• Network development/access• Cost of services

Plan Provisions

Deductible $150 individual$450 family

Coinsurance 80%

Annual Out-of-PocketMaximum

$800 per person after deductible

Lifetime Maximum

$2,000,000$5,000 annual restoration

Preventive Care Not covered

Dependents Covered up to age 19, or age 23 if a student

7

Next Steps



AlaskaCare Health Plan GoalsProvide AlaskaCare members with the care they need at a price they can afford by:

• Building out the provider networks• Increasing member engagement• Supporting evidence-based medicine and promoting data-

driven decision making• Collaborating with providers to transform the Alaska

health care market


2014 Accomplishments• First quarter savings estimated at more than $15 million in

the retiree plan when compared to same period in 2013• Introduction of a dental network and reduced DVA

premiums• Held 10 town halls to understand member concerns• Modified plan administration based on input from

members• Maintained medical expertise in health leadership team• Developed better internal processes and procedures to

manage the health plan


Improving service with Aetna

• Plan administration—working on this daily• CareEngine and Care Considerations program by

ActiveHealth• Increased plan savings and more robust network• Use of data warehouse to inform plan decisions• Single point of contact concierge team

11

Monthly Health Insurance Benefit Credit

• Average annual growth of 7%• Almost doubled in 10 years• Recent effort to proactively management of costs• FY 2015 -- beginning to bend the curve down


FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$742$835 $851 $867 $910

$1,088$1,250

$1,330 $1,389 $1,371

Fiscal Year

Bene

fit C

redi

t (pe

r mon

th)

More information online atwww.AlaskaCare.gov

THANK YOU.

12 AlaskaCare - ASHNHA - September 11, 2014

alaskacare health plan ashnha september 11, 2014

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