state health benefit plan update presentation to hometown health, llc
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1Karen Benson, Healthcare Network Program Manager, SHBP
State Health Benefit Plan Update Presentation to
HomeTown Health, LLC
Department of Community Health December 17, 2008
www.dch.ga.gov/shbp_plans
2
ACCESS
Access to affordable, quality health
care in our communities
RESPONSIBLE
Responsible health planning
and use of health care resources
HEALTHY
Healthy behaviors and
improved health
outcomes
DCH Mission
3
FY 2008 FY 2009
DCH InitiativesFY 2008 and FY 2009
Medicaid Transformation
Health Care Consumerism
Financial & Program Integrity
Health Improvement
Solutions for the Uninsured
Workforce Development
PeachCare for KidsTM Program Stability
Customer Service
Medicaid Transformation
Health Care Consumerism
Financial Integrity
Health Improvement
Solutions for the Uninsured
Medicaid Program Integrity
Workforce Development
PeachCare for KidsTM Program Stability
SHBP Evolution
Customer Service and Communication
4
SHBP Mission
Execute a five year health care strategy with consumer driven
health care and consumerism as a key part of the strategy
Key Objectives• Promote consumerism• Streamline administration by consolidating options and
vendors• Maintain provider access and member choice• Meet financial target• Opportunity for long term success
5
High Level Strategy (2009 – 2013)• Streamline options to offer two statewide health plan vendors, each
offering four choices for active employees: – HRA (CDH Plan)– HDHP (CDH Plan)– PPO– HMO– Medicare Advantage Plan (for Medicare eligible retirees)
• Develop plan designs and incentives that promote consumerism and encourage members to engage in healthy behaviors
• CDH plan designs will be improved each year (one percent addition in actuarial benefit value each year starting in 2009)
• Consumerism features such as deductibles and coinsurance will be added to the HMO and PPO each year (two percent reduction in actuarial benefit value each year starting in 2009)
• Strategic pricing utilized to provide incentive for CDH plans• Expect gradual enrollment shift from HMO/PPO plans to HRA and
HDHP plans• Savings achieved on active population reduces OPEB liability
6
Procurement for 2009 Contracts • In accordance with the multi-year strategy to streamline
administration and focus on consumerism, SHBP conducted a procurement to identify two vendors who could offer the required five products on a statewide basis
• More than half of SHBP’s covered population lives outside metro Atlanta, and while members had very strong coverage and numerous choices in metro Atlanta, they were lacking choice in the rest of the state
• In the procurement evaluation, statewide access to a comprehensive network of providers was the category awarded the most points – over 1/3 of the total points available
• Legislation allowing SHBP the flexibility to not offer CCO (due to low utilization) was passed during 2008 Session
• In August 2008, DCH Board approved removal of CCO and Indemnity options from 2009 suite of products
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Impact to employees• Impacted employees/retirees:
– BCBSGa: 79,656– Kaiser: 21,241– Indemnity: 4,386– CCO: 6,419
• Based on claims analysis, over 97% of physicians utilized by the BCBS members are participating in the CIGNA and/or UHC networks
• Due to the unique nature of Kaiser’s staff model HMO, the decision was made to allow Kaiser members an additional year to research and select new physicians; therefore Kaiser will be offered to current Kaiser members for 2009
• Combining the 3% disrupted BCBS members and 100% of the Kaiser members, less than 7% of entire SHBP membership will be impacted by physician-patient disruption
8
Q1 2008 SHBP Product Performance
Q1 2008 SHBP Product Performance Per Member Per Month Claims
$268
$362
$449
$137
$184
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
$500
Consumer Driven HealthPlan - HDHP
Consumer Driven HealthPlans - HRA
HMOs PPO INDEMNITY
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Benefit Changes • Full Mental Health Parity on all options• HRA plan enhancements:
– $125 additional “cash” added to HRA accounts ($250 for employee + spouse) for members who get an annual preventive care screening and complete a Health Assessment
– No cost for certain drugs for members with diabetes, asthma and cardiac conditions who remain enrolled in and actively compliant with the Disease Management program guidelines
• Out-of-pocket maximums, some co-pays and some deductibles will be changed to provide more comparability between plans and further incent members into the consumer-directed plans
10
Medicare Advantage Plans
• Two Private Fee for Service (PFFS) plans covering entire state
• Optional for Medicare-eligible retirees• Automatically covers all parts of Medicare (A,B,C,D) • Benefits enhanced over standard Medicare to cover:
– $1,000 annual out-of-pocket maximum and lower co-pays – Unlimited inpatient hospital days– No hospital stay required prior to Skilled Nursing Facility– Worldwide emergency room coverage – Routine Chiropractic visits– Routine Podiatry visits– Routine vision exams and hardware ($125/2 years) – Hearing exams and hearing aid benefit ($1,000/4 years)
11
2008 Open Enrollment (OE) Activities
• 2009 OE: October 10 – November 10 • Letters to all members impacted by plan option
changes were mailed in July/August• Personalized benefits statements modeling which
plan option would result in lowest out-of-pocket costs (utilizing employee’s actual 2007 claims) will be mailed to all employees’ homes prior to OE – hand out
• Over 1,500 Webinars and face to face educational meetings will be conducted in preparation for OE
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SHBP Subscribers Enrollment 12 Plan Options:• PPO • HMO• HRA• High
Deductible Health Plan
• Medicare Advantage Private Fee for Service
– Cigna– United
Healthcare
• HMO• Senior
Advantage– Kaiser
94400
3789
107696
14599
2771
46823
5067513
10928
318 109 24260
20000
40000
60000
80000
100000
120000
UHCPPO
CignaPPO
UHCHMO
KaiserHMO
UHCHDHP
UHCHRA
CignaHRA
CignaHDHP
CignaHMO
CignaMA
KaiserMA
UHCMA
UHC PPO Cigna PPO UHC HMO Kaiser HMO
UHC HDHP UHC HRA Cigna HRA Cigna HDHP
Cigna HMO Cigna MA Kaiser MA UHC MA
January 2009
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Healthcare Vendor Sample ID Cards
See . . .
Exhibit A – CIGNA Healthcare, Inc.
Exhibit B – UnitedHealthcare, Inc.
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