2016 Meeting # 29 Minutes May 20, 2016 State Health Benefits Program (SHBP) Plan Design Committee

Transcription

1 2016 Meeting # 29 Minutes May 20, 2016 State Health Benefits Program (SHBP) Plan Design Committee Adequate notice of this meeting has been provided and filed with and prominently posted in the offices of the Secretary of State. The meeting notice was mailed to the Secretary of State, Star- Ledger and Trenton Times on January 4, The meeting of the SHBP Plan Design Committee was called to order on Friday, May 20, 2016 at 1:05 P.M. The meeting was held at Thomas Edison State College, 101 West State Street, Trenton, and was attended by the following members of the Committee, Division Staff, and other representatives and was open to members of the public. The Secretary took Roll Call and established that a quorum was present. : Committee Members: Richard Badalato, Commissioner, Department of Banking and Insurance Jennifer Duffy, Special Assistant to the Commissioner, Department of Human Services David Jones, Retired President, STFA Kevin Lyons, NJ State PBA (via teleconference) Robert Little, AFSCME Patrick Nowlan, AAUP AFT Dave Ridolfino, Associate State Deputy Treasurer, Office of the State Treasurer Hetty Rosenstein, NJ Area Director, CWA Abdur Yasin (via teleconference) Also in Attendance: Eileen Schlindwein Den Bleyker, Senior Deputy Attorney General Florence Shepherd, Division of Pension and Benefits Dave Pointer, Division of Pension and Benefits Mark Cipriano, Division of Pensions and Benefits Douglas Martucci, Division of Pension and Benefits Connie Erney, Aetna Jennifer Moyer, Aetna William Hepfinger, Teledoc Cynthia Mark, Teledoc James Christ, Aon Hewitt Barry Shane, Aon Hewitt Dave Perry, Aon Hewitt Dave Perry, Horizon Dr. Paul Alexander, Horizon Sunshine Act Statement: The Sunshine Act Statement and the Executive Session Resolution were read by Mr. Martucci. The text of Resolutions A (Closed Session) and B (Executive

2 Session) were read in their entireties in the event that the Board desires, at any point in the meeting, to approve a motion to go into closed session. DPCMH Update Jen Moyer, Aetna, advised that there had been initial discussions with six (6) service providers, and from there, the field had been narrowed to two (2) remaining. The 2 remaining vendors had executed confidentiality agreements to facilitate data exchange. The providers were currently reviewing the data to ensure that they would be able to provide all the necessary services to Aenta membership. Finalized proposals from the providers were expected to be received shortly. Dave Perry, Horizon, advised that two (2) vendors had given presentations to the DPCMH subcommittee at their last meeting, and that Horizon had received signed letters of intent from both bidders. Vendor A was in the process of contract development. Mr. Perry stated that it was possible that Horizon would be able to credential some of the physicians that they had in place. Vendor B had the letter of intent for roughly 3 weeks, and were supposed to have returned a list of questions to Horizon within the week, but as of the meeting, they had not submitted anything. He noted that there had been a recent change in leadership at the vendor, and that the personnel situation was something that Horizon would keep an eye on and advise the Division of Pensions of any dramatic changes in the vendor s status. Rutgers Wellness Program Implementation Update Dave Pointer, Pensions, advised that the Division had facilitated talks between Rutgers and Treasury IT to coordinate enrollment of members at Rutgers. The goal was to create an online enrollment application, and also to finalize the format of reports to be exchanged. Another meeting was scheduled for the coming weeks, and the hope was for the project to be up and running by September 1. Prescription Benefit Manager RFP Update Mr. Pointer advised that the bidder submissions in response to the RFP were still under review by the Division of Purchase and Property. Acupuncture and Chiropractic Update Dave Perry, Horizon, advised that the Committee s resolution to limit out-of-network reimbursements for chiropractic and acupuncture visits was resulting in great savings for the SHBP, as intended per member per month costs for chiropractic visits was $3.91, and for the same period in 2016, the cost was cut to $1.95. Cost per visit in 2015 was $45, and in 2016 had been lowered to $25.92 per visit. Out-of-network utilization had dropped from 42% of all visits to 23%. If trend continues, the resolution will approach $20 million in annual savings for the SHBP. Committee Member Jones noted that focus should continue to be placed on growing the networks for Chiropractic and Acupuncture service providers. Jen Moyer, Aetna, noted that the resolution has provided Aetna with more leverage in discussions to bring highly utilized, outof-network service providers in-network. Both Mr. Perry and Ms. Moyer noted that their networks for both Chiropractors and Acupuncturists were adequate (as defined by the terms of the network required by their contract). Mr. Perry noted that Horizon would be more likely to make deals to bring additional acupuncturists in-network, due to the fact that they don t have many commercial accounts that choose to offer acupuncture benefits. He also noted that their

3 Chiropractic network growth exceeded fifteen (15) percent since Committee Member Jones noted that he had received correspondence from various chiropractors and chiropractic groups who feel that they haven t had a chance to make their case to Aetna and Horizon. Both Mr. Perry and Ms. Moyer stated that they would be happy to take names of any providers who had expressed interest in having discussions to come in network in order to have the Horizon/Aetna network teams reach out to them. Telemedicine Presentation by Teladoc Bill Hepfinger and CJ Mark, Teladoc provided an overview of the services they provide. Teladoc is the first and largest telemedicine provider in the United States. Teladoc offers coverage nationwide. Members get 24/7 access to state licensed physicians who can diagnose, treat, and when medically appropriate and in accordance with state laws, prescribe medications. Their service model is to never undermine the patient s Primary Care Physician. Members can use services via the telephone, a mobile app, and via laptop computer video. National coverage allows members to access services in cases when they may fall ill while traveling. The copay for telemedicine services would be equal to the member s copay for a primary care visit. The Teladoc call center is located in Dallas, Texas, but patients are connected to doctors living and working in the state that they are calling from. There are currently 129 physicians participating with Teladoc in New Jersey. Committee Member Jones asked what preventative procedures are in place to prevent the fraudulent use of someone else s health insurance. Ms. Mark advised that, in addition to their insurance information, patients have to verify their medical history with the Teladoc physician. Committee Member Jones stated that it wouldn t be possible for a telemedicine provider to give as thorough of an examination as is provided in a physician s office. Committee Member Ridolfino pointed out that the telemedicine services are not intended to replace regular visits with a doctor. Committee Member Duffy asked if it would be possible to receive follow up information on what the subscription fee would be for the SHBP. Medicare Advantage Presentation Jim Christ and Barry Shane, Aon Hewitt, provided an overview of the proposal to move Medicare eligible retirees into Medicare Advantage plans. Dave Perry and Dr. Paul Alexander, Horizon as well as Jen Moyer, Connie Erney, and Amanda Lewis-Art filled in details and answered questions from the Committee. Traditional Medicare supplement plans pay the cost of care after Medicare pays for the first 80% of the bill. Member s care is not managed in any specific way, by either Medicare or the member s Health plan. Traditional Medicare plans are therefor considered to be somewhat insufficient, with services such as emergency room usage higher than among single-payer health plans. Medicare Advantage plans work differently in that the member s health insurer takes over the responsibility for the full cost of the member s care, and receives payment from the federal Center for Medicare and Medicaid services CMS) in exchange for the health carrier being the sole manager of the member s care. This arrangement provides incentive to the health plan administrator to provide additional coordination of the member s services and keep member s healthy, which in turn lowers the total cost of the member s care. The level of payments provided by CMS vary based on the quality of care management provided by the plan administrator. Plans that provide better service and care

4 coordination to their members receive higher payments than plans with lower ratings. In addition to the increased attention to care coordination, Medicare advantage plans also offer members the simplicity of being able to carry just one insurance card (traditional Medicare Supplement plans require members to present their Medicare card as well as their secondary insurance card in order for service providers to bill the separate insurers) and an expanded network because any Medicare service provider is considered in network. Traditional Medicare Supplement plans require members to utilize service providers who not only accept Medicare, but also participate in their supplementary health insurer s network to receive in-network level benefits. Committee Member Rosenstein asked if moving to a Medicare Advantage replacement with lower premiums would result in lower premiums for retirees who pay the full cost of their health plan premiums. Dave Pointer, Pensions, advised that, if premiums decreased, those members would also pay less for their coverage. Committee Member Rosenstein asked what is done with regard to plan members who may be happy with the care they are receiving, and don t wish to be subject to additional care-coordination from the health plan. Dr. Alexander, Horizon, advised that the health plan administrator would not interfere in such a member s care. Committee Member Ridolfino pointed out that many plan members may not have anyone to advocate for them or to assist in coordinating their care, and that those are the cases where the added level of care management in Medicare Advantage plans can be very useful. Committee Member Rosenstein asked if there are any other elements to the premium savings within Medicare Advantage plans, such as a decrease in covered services as compared to traditional Medicare Supplement plans. Barry Shane, Aon Hewitt advised that all covered services under the traditional Medicare Supplement plans would be covered by a Medicare Advantage plan, along with additional benefits not provided by the traditional Supplement plans. Savings are realized through the streamlined claims process and the improvement in management of members care. Committee Member Rosenstein asked if it would be possible to see the actual premium differences that would be realized from switching to a Medicare Advantage plan. Mr. Pointer stated that Aon Hewitt was still in the process of analyzing the proposals and would be able to provide those details once finished. Committee Member Rosenstein asked if moving to a Medicare Advantage plan would mean that members would no longer be subject to balance billing by out-of-network providers. Dave Perry, Horizon, stated that members receiving covered services from Medicare providers would not receive balance bills. He stated that a member receiving a service that is not covered, such as a cosmetic procedure, or from a non-medicare service provider could still end up receiving balance bills. It was noted that non-medicare service providers are required to disclose the fact that they do not accept medicare to patients up front, which includes a waiver the members must sign acknowledging that they are aware that they ll be responsible for the cost of their services. There being no further business, Committee Member Jones made a motion to adjourn. Committee Member Duffy seconded the motion. All voted in favor (9-0-0). The meeting was adjourned at 3:34 p.m. Respectfully submitted,

5 Douglas Martucci Acting Secretary, SHBP Plan Design Committee