2017 N NMPSI SIA Regiona onal Traini ning ng M Meeting ng - - PowerPoint PPT Presentation

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2017 N NMPSI SIA Regiona onal Traini ning ng M Meeting ng - - PowerPoint PPT Presentation

Jan 12, 2024 159 likes •307 views

2017 N NMPSI SIA Regiona onal Traini ning ng M Meeting ng ERNESTINE C ERN CHA HAVEZ DEPUTY DE TY DI DIRECTOR NMPSI SIA T A TODAY Covered Lives on Medical Staff 22,730 Employees 11 FTE 50,517 Total Lives

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SLIDE 1

ERN ERNESTINE C CHA HAVEZ DE DEPUTY TY DI DIRECTOR

2017 N NMPSI SIA Regiona

  • nal

Traini ning ng M Meeting ng

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SLIDE 2

NMPSI SIA T A TODAY

  • Covered Lives on Medical
  • 22,730 Employees
  • 50,517 Total Lives
  • 88 School Districts (Mandatory)

Excludes APS

  • 100 Charter Schools (Mandatory)
  • 26 Educational Entities
  • Staff
  • 11 FTE
  • Board of Directors
  • 11 Board Members
  • 2 NEA-NM
  • 1AFT-NM
  • 3 Governor Appointees
  • 1 Superintendents’ Association
  • 1 New Mexico Association of

School Business Officials

  • 1 Educational Entities at Large
  • 1 School Boards Association
  • 1 Public Education Commission
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SLIDE 3

Legis isla lativ ive Proces ess s – FY18 Appr 18 Approved ed Budget

Fund FY17 Operating Budget FY18 Appropriation Request FY18 Appropriation Benefits $320,859,700 $351,995,200 $325,783,600

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SLIDE 4

HISTORI RICAL L LOO OOK

Rat ate Increase ses a s and Fun und Bal alan ance

Plan Year Fund Balance at Start of Plan Year Rate Increase Fund Balance at End of Plan Year 2010-2011 $6.1 million Medical 6.4% Dental 6.4% $23.9 million 2011-2012 $23.9 million Medical 0.0% Dental 0.0% $28.5 million 2012-2013 $28.5 million Medical 6.1% Dental 0.0% $31.6 million 2013-2014 $31.6 million Medical 6.6% Dental 3.0% $42.3 million 2014-2015 $42.3 million Medical 1.5% Dental 0.0% $41.4 million 2015-2016 $41.4 million Medical 4.0% Dental 0.0% $20.4 million 2016-2017 $20.9 million Medical High 8.30% Medical Low 7.15% Dental 0.0% $15.6 million (projected) 2017-2018 $15.6 Million (Projected) Medical High 3.98% Medical Low 1.82% HMO 3.98% Dental 0.00% $23.2 million (projected)

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SLIDE 5

Fy17 Pl Plan Design gn Changes

Benefit P Plan Reduction

  • ns

Change Medical FY17 Estimated Savings

Increased calendar year plan deductibles effective 1/1/17 High Option Plan - from $300 to $750 for in-network services Low Option Plan – from $1500 to $2000 for in-network services $5.5 million Increased calendar year out-of-pocket maximum effective 1/1/17 High Option Plan – from $2800 to $3750 for in-network services Low Option Plan – from $3500 to $3750 for in-network services $5.0 million Value of Medical Plan Design Changes (6 months) $10.5 million

Change Prescription FY17 Estimated Savings

Increased copayments on diabetic oral medications, retail generic, mail generic, retail preferred brand, mail preferred brand, and specialty medications effective 7/1/16 $4.5 million Eliminate coverage for over-the-counter (OTC) medications (Proton Pump Inhibitors, Antihistamines and Intranasal Steroids) effective 7/1/16 $1.2 million Value of Prescription Plan Design Changes (12 months) $15.7 million

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SLIDE 6

Fy17/F /FY18 U Upcom

  • ming Pl

g Plan Design ch changes

Ben enefi fit p plan reducti tions

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SLIDE 7

SaveonSP Cop Copay Assistance O Offset Prog

  • gram

am ( (July 1, 1, 2017) 2017)

  • 52K lives
  • $70 copay for brand specialty
  • 379 Members with 2,438refills
  • $2.4M savings for the

plan

  • $3.84 PMPM client

savings*

  • $0

member copay

CLIENT EXAMPLE IMPACT FOR PATIENTS AND THE CLIENT

BY IMPLEMENTING SAVEON SP COPAY OFFSET PROGRAM

*Savings based on most expansive drug list and actual savings will vary based on state certification and are not guaranteed. Official savings will be provided by SaveonSP. ESI does not endorse the services provided by SaveonSP or provide any guidance or endorsement to SaveonSP on the legal structure of the services offered by SaveonSP, including without limitation, any representation of compliance with any applicable laws.

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SLIDE 8

Be Bene nefits f fund c und claims hi history

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SLIDE 9

Medical Cost Dr Drivers

  • Affordable Care Act costs
  • $2.7 million in Reinsurance fees in FY15; $1.7 million FY16; $700K FY17
  • Provider reimbursement fees
  • Increased Cost of Catastrophic Claims
  • FY14 - $23.4 million
  • FY15 - $44.7 million
  • FY16 - $51.4 million
  • Top Medical Conditions
  • Inflammatory Conditions
  • Diabetes
  • Cancer
  • Hodgkin’s Disease
  • Coronary artery disease
  • Cardiovascular disease
  • Stroke
  • Injury and poisoning
  • MS
  • Maternity
  • Vaccine Program
  • $1.4 million FY16 (FY15 cost - $740k; FY14 cost; FY14 $696k)
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SLIDE 10

Prescription d drug c cos

  • st d

driver ers

  • Increased prescription drug costs driven by increased utilization and

inflation

  • Rx Plan drug cost increased 7.4% from $77.69 per member per month

(PMPM) to $83.46 PMPM driven by Specialty Drugs

  • Non-specialty plan cost PMPM trend -0.6% - $51.80 PMPM
  • Specialty plan cost PMPM trend 23.8% - $31.66 PMPM
  • Largest trend driver – diabetes at 23.9% (prior was Hep C)
  • Top Drugs
  • Oral Diabetic Drugs/Insulin
  • Humira & Enbrel
  • Viekira Pak
  • Cancer Drugs
  • Top Conditions
  • Diabetes - $9.6 Million
  • Inflammatory Conditions $6.4 Million
  • Cancer - $3 Million
  • Hep C - $2.8 Million
  • MS - $2.5 Million
  • Asthma $2.3 Million
  • Hemophilia - $1.5 Million
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SLIDE 11

Clinical al Savi vings and and Rx Progr

  • gram

ams

  • Utilization Management (prior authorizations, drug quantity rules, step

therapy)

  • For FY16, NMPSIA saved $4 million
  • SafeGuardRx
  • Hepatitis Cure Value Program

Lowered the cost of a cure - 100k cap)

  • Cholesterol Care Value Program

(Avoiding up to 90% of the plan cost increases in this therapy class);

  • Oncology Care Value Program

(Aligning cost with efficacy for selected oncology drugs)

  • Inflation Protection Program for Brand Name Drugs (Inflation protection

guarantee)

  • Fraud Waste and Abuse Program Identifies outliers, flags suspicious

activity, gather evidence, investigate, intervention by restricting certain members to one pharmacy for substance abuse medications (opioids, ADHD, sleep, anxiety, muscle relaxers, anticonvulsants)

  • fraudulent claims - out-of-state pharmacy filling unauthorized diabetic

supplies

  • Flagged member with 9 prescribers and 2 pharmacies
  • SaveonSP Copay Assistance Offset Program
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SLIDE 12

Be Bene nefits U Upda pdate

  • Upcoming RFP for Pharmaceutical Benefits Management

Services - New contract effective July 1, 2018

Interagency Benefits Advisory Committee Albuquerque Public Schools (APS) New Mexico Public Schools Insurance Authority (NMPSIA) New Mexico Retiree Health Care Authority (NMRHCA) State of New Mexico, Risk Management Division (RMD)

  • 2017 Program Guides at print – will be shipped early

August

  • electronic copy available late-July at nmpsia.com
  • Individual benefit plan information under “Insurance Carriers”

tab at nmpsia.com

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SLIDE 13

NM NMPSIA W A Wellne ness

Visit: https://nmpsia.com

  • Click on “NMPSIA Wellness”
  • Select “Well onTarget” for Blue Cross Blue Shield Members
  • Select “Wellness at Work” for Presbyterian Members
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SLIDE 14

Questions???

410 Old Taos Highway Santa Fe, New Mexico 87501 Phone: 505-988-2736 Fax: 505-983-8670 Website: https://nmpsia.com ernestine.chavez@state.nm.us