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The Triple Focus of Health Care
Don MouldsChief Health Director
Dr. Julia LoganChief Medical Officer
Marta GreenChief, Health Plan Researchand Administration
Danny BrownChief, Legislative Affairs
AgendaHealth Program Strategic Priorities
Affordability
Quality and Access
Federal and State Legislative Update
2
Our Goal: High-Quality, Affordable Health CareImprove health care quality, access, and affordability
Ensure our members receive high-quality care
Ensure the care we provide is affordable
Ensure our members have access to care when and
where they need it
3
COVID-19 impacts to health care delivery system
4
Health Care Affordability
Increasing Competition
Insurer Competition
Provider Competition
6
Pharmaceutical Strategies
• Acquisition-based pharmacy benefit manager (PBM) contract• Biosimilars First• Next frontier for specialty drugs
7
Improved Rate Development Process More transparent and new timeline
Board approval of plan, service area, and benefit design changes
November
Develop baseline ratesReconcile with plan proposalsNegotiate with plans
January – May
Preliminary rates presented
June
Final rates approved
July
8
Expanding Plan Choice
2022 plan, service area, and benefit
changes
2022 PERS Platinum and Gold
PPO plans
2023 PPO benefit design
planning in 2021
9
Risk Mitigation via Portfolio Rating
Price Plans on Value, Not Risk
Reduce premium volatility & large
increases
Remove adverse selection member migration patterns
Price plans based on value of network, and benefit design
Stabilize Basic Plan portfolio & implement cost
saving programs
10
Health Care Quality & Access
COVID-19 Impacts – What We Know Now
Ensuring continued delivery of high
quality care
0.57% overall impact on
2021 premiums
Mainstream adoption of telehealth
Delayed and deferred
care
Health Disparities became forefront
12
COVID-19 Vaccine Update
Largest vaccination program in history
Science behind the vaccine
Distribution• Statewide rollout• County protocols• Timelines vary• How it’s working
on the ground
13
Behavioral Health
14
Ensuring High-Quality Care
Aligning health plan
requirementswith other purchasers
Clinical quality improvement
measures
Health data quality
Health equity
15
Health Equity
Everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential. (WHO)
Race
Ethnicity
LanguageSexual Orientation
Gender Identity
16
Federal and State Policy & Legislation
Federal Legislative Issues
State Legislative Issues
Transition Priorities
Governor’s Budget Issues
17
Questions & Discussion
Public Comment
The Triple Focus of Health CareAgendaOur Goal: High-Quality, Affordable Health CareCOVID-19 impacts to health care delivery systemHealth Care AffordabilityIncreasing CompetitionPharmaceutical StrategiesImproved Rate Development ProcessNovemberJanuary –MayJuneJuly
Expanding Plan ChoiceRisk Mitigation via Portfolio RatingPrice Plans on Value, Not Risk
Health Care Quality & AccessCOVID-19 Impacts –What We Know NowCOVID-19 Vaccine UpdateBehavioral HealthEnsuring High-Quality CareHealth EquityFederal and State Policy & LegislationQuestions & DiscussionPublic Comment