Upload
bowie
View
28
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Medical Plan Analysis. Review of Consortiums / TPA / Network / Stop Loss. March 2013. Agenda. Willis Public Sector Practice Group. Introductions. Ryan L. Barbieri – Sr. Vice President Member of the Willis Public Sector Practice Group - PowerPoint PPT Presentation
Citation preview
Medical Plan AnalysisReview of Consortiums / TPA / Network / Stop Loss
March 2013
2
Agenda
I. Willis Public Sector Practice Group
II. Purpose Of The Review
III. Scope of Project & Progress To Date
IV. Next Steps
3
Willis Public Sector Practice Group
4
Introductions
Ryan L. Barbieri – Sr. Vice PresidentMember of the Willis Public Sector Practice Group
Consultant for Katonah Lewisboro S.D. on medical and pharmacy coverage and leads efforts with carrier negotiations
Leads a team of insurance professionals• Sharon Schulteis – Sr. Client Manager• Sara Malchow – Marketing Manager• Luke Allenson – Underwriting Consultant• Kathy Dobrzynski – Sr. Vice President & Actuary
5
The Willis Public Sector Practice Group Dedicated team of professionals with more than 150 years
combined insurance experience
Services Include:• Communication strategies• Facilitating employee benefits competitive bid process• Technical Claims Analysis• GASB and OPEB resources• Pharmacy consulting• Assisting with union negotiations
Work with public sector employers across the United States
6
Purpose Of This Market Study
7
Business Case
Rising Expense and Declining Revenue
Rising Cost Environment Medical trend continues to run 5% above normal inflation
7-8% Eastern U.S. Medical Trend KLSD utilization trends over 3 years have been relatively high
2012 – 2013 slightly better than normal Alternatives have been considered at a high level in the past
Consortium Plans‒ PNW BOCES‒ SWSCHP
State Run Health Insurance Programs‒ NYSHIP
These options have historically shown lower premiums
8
Due Diligence
As One Of The District’s Largest Annual Expenditures
Periodic Review Is Required Evaluation of multiple options to control district expenses Having the right program from a cost AND a benefit standpoint is
critical District Administration has tried to be as proactive as possible
9
Scope of Project &Progress to Date
10
Scope of the Market Study
Review All Viable Options
Third Party Administrator and Network Review Third Party Administrators
Approached 6 TPAs‒ Pomco (Inc.), UMR, Meritain, Empire Blue, Alicare and Aetna‒ Admin quotes received from all parties
Approached 10 Stop Loss carriers for reinsurance‒ 5 carriers presented options and 5 declined to quote
Network Analysis Considered four networks
‒ Pomco Allied (Inc.), UnitedHealthcare, Empire Blue and Aetna
‒ Conduct discount and disruption analysis
11
Scope of the Market Study
Review All Viable Options, cont.
Review State and Consortium Health Insurance Plans State Plan
New York State Health Insurance Plan (NYSHIP) Two plans
‒ Excelsior and Empire Conduct cost benefit analysis
Consortium Plans Putnam Northern Westchester BOCES Plan and Statewide
Schools Health Insurance Plan (SWSCHP) Conduct cost benefit analysis
12
Progress To Date
Good Progress Has Been Made
Highlights Of The Market Study Good response from all parties
There are multiple opportunities for savings with minimal member disruption
Evaluation continues on State and Consortium plans‒ Barriers to entry and exit may pose a challenge to consortiums‒ State plan offers multiple options
TPA options present some network savings with the addition of an integrated managed care program (Quantum Health)
13
Next Steps
14
Next Steps
Move Project To Completion
Finalize Disruption and Savings Analysis Target completion by end of May
Network analysis Lock stop loss terms
Discuss preliminary transition plans with all options Understand the process to help determine additional barriers if
they exist
15
Questions?