1 Public Employees Benefits Public Employees Benefits Board Board 2006 Medical Procurement 2006 Medical Procurement July 12, 2005 July 12, 2005 Richard Onizuka, Health Care Policy Richard Onizuka, Health Care Policy Washington State Health Care Authority Washington State Health Care Authority
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1 Public Employees Benefits Board 2006 Medical Procurement July 12, 2005 Richard Onizuka, Health Care Policy Washington State Health Care Authority.
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Public Employees Benefits BoardPublic Employees Benefits Board
2006 Medical Procurement2006 Medical Procurement
July 12, 2005July 12, 2005
Richard Onizuka, Health Care PolicyRichard Onizuka, Health Care PolicyWashington State Health Care AuthorityWashington State Health Care Authority
Stay within fiscal limits set by the Stay within fiscal limits set by the Legislature in the budgetLegislature in the budget
Provide health plans that compare well Provide health plans that compare well with other quality employerswith other quality employers
Ensure adequate access to providers and Ensure adequate access to providers and hospitals for employees and retirees in all hospitals for employees and retirees in all countiescounties
Encourage the use of quality providers and Encourage the use of quality providers and evidence-based medicineevidence-based medicine
HCA Recommends Adoption of the HCA Recommends Adoption of the Proposed Eligibility Rules under WAC Proposed Eligibility Rules under WAC 182-08 and WAC 182-12. 182-08 and WAC 182-12.
$30 premium rebate (one-time) for healthy lifestyle and use of preventive care services (NEW)
√ √
Cover routine eye exams once per year (now once every 2 years) √ √Same network benefits in other states as currently provided for services in Washington/Oregon (now 80% for network services in other states)
√ no
Increase the annual out-of-pocket maximum to $1,500 per individual / $3,000 per family (now $1,125 per individual / $2,250 per family)
√ √
Separate 16-visit massage therapy benefit (now included with Physical, Occupational and Speech Therapy in 60-visit benefit)
√ √
Pay 90% for Tier 1 (generic) prescriptions filled at retail pharmacies(now paid at 80%)
√ √
Enrollee coinsurance cap @ $75 per 30-day supply for Tier 1 and 2 (generic and preferred brand name) prescriptions filled at network retail pharmacies (now capped at $50 per 30-day supply)
√ √
$100 enrollee co-payment for up to 90-day supply of a Tier 3 (non-preferred brand name) prescription filled through mail order(now $80 enrollee co-payment)
√ √
Eliminate annual medical / surgical deductible (now $200 per individual or up to $600 per family)
no √
UMP Benefit Recommendation (Requires Board Action on Overall Benefit Package)
Overall package is cost neutral.
1010
Bariatric SurgeryBariatric Surgery
HCA does not recommend inclusion of HCA does not recommend inclusion of Bariatric Surgery for 2006Bariatric Surgery for 2006
Legislative Directive: Legislative Directive: No Benefit Enhancements if at, or above, budgetNo Benefit Enhancements if at, or above, budget
Final Procurement Results: Final Procurement Results: 8.0% 8.0%UMP PPO with Alternatives = .8% UMP PPO with Alternatives = .8% UMP NBR with Alternatives = 2.6%UMP NBR with Alternatives = 2.6%MCOs= 14.2%MCOs= 14.2%
1212
Non-Medicare Average Bid Rate Non-Medicare Average Bid Rate IncreasesIncreases
Plan Name
1-Year Bid Rate Avg. I ncrease
(2005-2006)
3-Year Bid Rate Avg. I ncrease
(2004-2006)
5-Year Bid Rate Avg. I ncrease
(2002-2006)
CHPWA 9.8% 19.0% 15.3%Group Health Coop. 15.2% 11.3% 13.9%Kaiser Foundation 10.9% 14.0% 12.9%Options Health Care 18.9% 13.6% 15.3%PacifiCare 10.3% 16.8% 16.4%Regence 13.1% 15.5% 16.3%UMP PPO 0.8% 7.0% 10.1%UMP Neighborhood 2.6% n/a n/a
Notes: 1) Increases shown are average increases in normalized bid rates after implemented benefit changes. 2) Average increases are simple unweighted averages and do not reflect enrollment shifts. 3) UMP Neighborhood first offered January 1, 2004. 2005 increase was 14.0%
1313
Increase in Average Non-Medicare Increase in Average Non-Medicare ContributionsContributions
$13 $14 $14
$27$37
$72$79
$68
$81
$-$10$20$30$40$50$60$70$80$90
CY1998
CY1999
CY2000
CY2001
CY2002
CY2003
CY2004
CY2005
CY2006
Year
Avg E
mplo
yee
Contr
ibuti
on
2006 Contribution does not include “switching assumptions”
1414
Change in Non-Medicare Bid RateChange in Non-Medicare Bid RateSubscriber Only (First Tier)Subscriber Only (First Tier)
Medicare Average Bid Rate Medicare Average Bid Rate IncreasesIncreases
Plan Name
1-Year Bid Rate Avg. I ncrease
(2005-2006)
3-Year Bid Rate Avg. I ncrease
(2004-2006)
5-Year Bid Rate Avg. I ncrease
(2002-2006)
CHPWA 9.3% 19.4% 15.7%Group Health Coop. 17.1% 15.7% 19.1%Kaiser Foundation 21.3% 16.0% 16.0%Options Health Care 25.1% 24.9% 20.8%PacifiCare 1.4% 24.4% 22.5%Regence 3.3% 17.5% 14.0%UMP PPO 7.8% 13.8% 7.5%
Notes: 1) Increases shown are average increases in normalized bid rates after implemented benefit changes. 2) Average increases are simple unweighted averages and do not reflect enrollment shifts. 3) UMP Neighborhood is not offered to the Medicare risk pool.