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