Budget Workshop May 15, 2018

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1 Budget Workshop May 15, 2018

2 GOALS OF COUNTY S BENEFIT PROGRAM Our goals remain unchanged: Provide affordable quality healthcare Improve health of our workforce Provide overall long-term stability to benefit plan and cost 2

3 PLAN PERFORMANCE

4 2018 UPDATE COUNTY IMPACT Overall Plan Performance - running well (i.e., increases to County and Employee have been below the national trend). The County net spend for 2017 was $52.6M (accounting for pharmacy rebates, stop loss reimbursements, employee payroll contributions and County HSA funding), which is a 3.8% increase over The 2018 projected net spend for the County is $54.7M, or 4.0% over National trend increases for 2018 are 8% for health and 12% for pharmacy, and are expected to remain the same for Projected County increase for 2019 is 4.7%. 4

5 2018 UPDATE EMPLOYEE IMPACT Employee out-of-pocket costs (deductibles, coinsurance, copayments, and payroll deductions less HSA/HRA contributions) have decreased.5% from 2015 and over 40% from On average, from 2013 through 2017, only 6% of all employees/families met their annual deductible. Since 2013, less than 1% of all employees/families exceeded their out-of-pocket maximum exposure. Numbers show that employees are utilizing services. In 2017, 92% of the employees/families utilized the benefit. 5

6 MEMBER UTILIZATION (COMPARED TO 2016) Preventive Visits Physician Visits Urgent Care ER Visits Outpatient Care Inpatient Care Preventive visits increased 17.3%, a significant increase over Without looking at the specific reasons and/or procedures, the increase or decrease in sites of service does not necessarily indicate a positive or negative result, i.e. a decrease in Urgent Care visits could indicate members are going to their physician for treatment. 6

7 INDIVIDUAL PLAN PERFORMANCE (CLAIMS TO PREMIUM RATIO) Claims costs are measured against the premium equivalent rates established for each plan to determine the individual plan performance known as Medical Claims Ratio (MCR) or Claims to Premium Ratio. In 2017, the HDHP Base and OON were below the target MCR which is good. PLAN HDHP BASE HDHP OON CDH LOW CDH HIGH COMBINED Jan-Dec % 78.9% 140.8%* 96.8% 80.1% Enrollment Jan-Dec % 131.2% 133.3% 142.2% 80.5% Enrollment

8 2017 GROSS CLAIM COSTS COUNTY PAID Gross Claim Costs are actual County-paid costs for medical and pharmacy claims only (does not include administrative or government fees) $60.0 $50.0 $49.0 $49.0 $46.5 $48.3 $42.0 $40.0 $30.0 $29.5 $33.0 $31.0 $32.0 $33.5 $20.0 $12.5 $16.0 $18.0 $14.5 $14.8 $10.0 $ Health Rx Total 8

9 WHAT WE DID IN Heath Savings Account (HSA) funding for HDHP Plans - a. HDHP Base - continued to fund 100% of deductible for third year; increased deductibles consistent with IRS Regulations: From $1,300 Single/$2,600 Family to $1,350/$2,700 b. HDHP OON - HSA funding the same as HDHP Base 2. Decreased Coinsurance for HDHP plans - from 30% to 20%. 3. Introduced new Narrow Network Plan through Community Care Plan with CDH High level benefits at a lower cost. No increase to employees 9 9

10 CONTINUATION OF PROGRAMS Annual waiver credit of $3,100 for employees who opt-out of the County s health insurance program with proof of other group coverage. $20 bi-weekly surcharge for working spouses/domestic partners who have health coverage available from their employers, but chose to enroll in the County health plan. Engagement Incentive to receive County-funding in the 2018 Health Savings Account or Health Reimbursement Account. Interactive, on-line enrollment decision support tool, ALEX. 10

11 2018 ENROLLMENT BY PLAN AND TIER OF COVERAGE CCP 1% HDHP OON 17% ENROLLMENT BY PLAN CDH High 10% ENROLLMENT BY TIER HDHP Base 72% EE ONLY EE/SP/DP EE/CHILD EE/FAMILY WAIVE Replaced CDH Low with new CCP Narrow Network Plan (CDH High benefit level at lower cost) 11

12 2017 WELLBEING SNAPSHOT Health Fairs 4,484 Participants with 3,143 Biometric Screenings Educational Classes Rally Tour, Rally Round-Up, 2,077 Participants Sport sponsorship 2 events Softball-95 Participants Corp Run-65 Participants Exercise/Wellness Equipment* 3 elliptical machines 5 recumbent bikes Ping Pong equipment 2 Medical Scales Financial Events 6 Mini Financial Fit Fairs* 12 Financially Fit Fairs 4 Realize Retirement* 22 FRS Seminars 19 Special Medicare Classes 12 Frozen HRA* Seminars 6 Financial Workshops* *New/added item or event in

13 RX PLAN OPIOID UPDATES Increased Opioid Risk Management effective 1/1/18: New CDC dispensing guidelines o Short-acting max 49 morphine equivalent mgs per day, max 7 day supply, two 7 day supply fills within 60 day timeframe o Long-acting refill window narrowed to 90% (10 days prior to expiration vs 24 days) to limit early refills and stockpiling. Prior Authorization on 1 st fill for brand and generic required o Pediatric opioid-based cough preparations - require Prior Authorization Provider must have controlled-rx DEA prescribing authority Enhanced Point of Sale edits Increased member and provider education Additional Services Available for a Fee 1. Auto-generated patient letter following first fill of an opioid $4,740 annual 2. Intensive Case Management for highest-risk utilizer intervention $9,480 annual (pharmacist case review, prescriber outreach, drug level-lock-in) 13

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15 CONTRACT RENEWALS FOR 2019 Plan Renewal Status Renewal Approval Authority Allstate (Personal Final year renewal No increase in Dir. of Purchasing Income Protection) premiums for Voluntary, EE Paid 2019 Community Care First renewal ASO Admin Fee Dir. of Purchasing Plan (CCP Narrow increase as (unless new plans Network Plan) negotiated in added) Agreement CCP proposed adding two new plans as part of renewal. Still reviewing with CCP. 15

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17 HSA FUNDING County has funded 100% of HDHP deductible for 3 years ($1,350 Single/$2,700 Family). Not typically funded at 100%. Cost of current HSA funding is approx. $8M per year. Consider: Reducing HSA funding (to pre-shift levels of $1,000/$2,000). Est. cost of $6M per year. and/or Requiring annual physical to receive full or partial funding in Currently, only require a biometric screening and online Health Assessment ( Know Your Numbers ) or annual preventive exam (Step 1 on Wellness Spectrum) Trend to Physician engagement - Annual physical with blood work ( Know Your Doctor ) (Step 2 on Wellness Spectrum) 17

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19 REDUCE BENEFIT WAITING PERIOD TO 30 DAYS In a candidate-driven marketplace, waiting periods in recruiting professional level positions. are a factor AGENCY WAITING PERIOD DAYS* BENEFITS START DATE Broward County 60 1 st of month Seminole County 30 1 st of month Palm Beach Schools 30 1 st of month State of Florida Up to 60 1 st of month after 1 months premium is deducted from paycheck Miami-Dade County 60 1 st of month Palm Beach County 60 1 st of month Orange County 60 1 st of Pay Period Broward School Board 90 1st of month Miami-Dade Schools st day *Maximum waiting period allowed is 90 days under Affordable Care Act and Dept. of Labor 19

20 OTHER PLAN CONSIDERATIONS Bundled Payment Arrangements explore arrangements with facility/provider where all technical and professional services for a procedure are covered under a single price. Diabetic Health Plan incentivize members with diabetes or pre-diabetes who routinely follow independent, medically proven steps to help manage their condition (such as regular blood sugar tests, routine exams, and preventative screenings, and use wellness coaching) with premium reductions or other incentives. (79% of members who have done a biometric screening are pre-diabetic or diabetic) Real Appeal consider implementing this behavior based program from UHC that focuses on nutrition and physical fitness. 20

21 REAL APPEAL BY UHC 52 week, interactive, personalized, online, intensive lifestyle intervention program centered on helping members learn how to lose weight and keep it off. Goal of Program is to reduce employer s medical expense related to diabetes and obesity related diseases. 79% of EEs & Sp/Dp completing biometric screening are pre-diabetic or diabetic No cost to member, paid by County through claims Behavioral Assessment $103 per member Behavioral Counseling $49 per weekly session, max 12 per year* Average cost per enrollee $300, max cost $690 Estimated plan cost $326,000 per year * Plan only billed if participant attends weekly group session and is on track for weight loss 21

22 ELIMINATE HRA VESTING Original Health Reimbursement Account (HRA) has vesting rules based on six years of continuous enrollment in one of the CDH plans. Separation Reason 2 yrs 3 yrs 4 yrs 5 yrs 6 yr Retirement 20% 40% 60% 80% 100% Termination % Currently only 18% enrolled in CDH plans, 72% in HDHP. HRA automatically vests for HDHP members not enrolled in a Health Savings Account (HSA). Elimination of vesting requirements would provide consistency across all plans. 22

23 RECAP Overall Plan Performance running well projected net spend for $54.7M (4% increase) County is Consider reducing HSA receive HSA funding. funding or implementing more stringent requirements to Consider reducing waiting period for as positions budgeted for full year). benefit eligibility to 30 days (no increase in cost Explore Bundled Payment Arrangements. Consider introducing a Diabetic Health Plan with incentives. Consider implementing Real Appeal program (est. cost of $326,000). Consider eliminating old vesting rules for Health Reimbursement Account for plan members with balances to treat similarly as those in HDHP. CDH 23

24 DISCUSSION

25 ACRONYM ASO CCP CDC CDH DEA FRS HDHP HRA HSA IRS MCR MGS OON Rx UHC DEFINITION Administrative Services Only Community Care Plan Center For Disease Control Consumer Driven High Plan Drug Enforcement Agency Florida Retirement System High Deductible Health Plan Health Reimbursement Account Health Savings Account Internal Revenue Services Medical Claims Ratio Milligrams Out of Network Plan Prescription UnitedHealthcare 25