FCCMA CONFERENCE June 1, 2018 FGHS: Florida Government Healthcare - - PowerPoint PPT Presentation

▶
fccma
SMART_READER_LITE
LIVE PREVIEW

FCCMA CONFERENCE June 1, 2018 FGHS: Florida Government Healthcare - - PowerPoint PPT Presentation

Nov 13, 2022 91 likes •390 views

FCCMA CONFERENCE June 1, 2018 FGHS: Florida Government Healthcare Solutions FGHS is a program designed to provide Florida local governmental entities a way to reduce administrative expenses and provide TRANSPARENCY, SAVINGS and CONTROL

slide-1
SLIDE 1

FCCMA CONFERENCE June 1, 2018

slide-2
SLIDE 2

FGHS: Florida Government Healthcare Solutions

  • FGHS is a program designed to provide Florida local

governmental entities a way to reduce administrative expenses and provide TRANSPARENCY, SAVINGS and CONTROL over their health insurance

  • The goal is to use the collective purchasing power of

the group to secure the lowest possible cost for employee health benefits

slide-3
SLIDE 3

Consortium Model – A History of Success

3

Page 3

slide-4
SLIDE 4
  • Benecon is the general administrator of six local

government health insurance cooperatives/consortiums

  • First Cooperative was formed in 1991
  • Currently 382 local government entities are Members with

24,000+ covered employees

  • $53.8 million in surplus returned to Members last year
  • Model is built to benefit the MEMBERS!
  • 98% retention rate

Ben enec econ

  • n,

, th the e le lead ader er in in dev devel elop

  • pin

ing g an and ma d mana nagi ging ng lo loca cal l go gove vern rnme ment nt he heal alth th in insu sura ranc nce e pr prog

  • gra

rams ms.

Page 4

Consortium History – Overview

slide-5
SLIDE 5
  • IIC – Pa. Boroughs/Townships/Authorities: 55
  • PMHIC – Pa. Boroughs/Townships/Authorities: 268
  • LGIT Health – Md. Cities/Towns/Counties: 22
  • PCHIPC – Pa. Counties: 21
  • PSHIC – Pa. School Districts: 11
  • FGHS – Fl. Cities/Counties: 5

Total Municipal Members: 382 Total Employees: 24,123

Page 5

Benecon Public Sector Cooperatives

slide-6
SLIDE 6

Page 6

Benecon’s Role in FGHS

  • Manage the Consortium through Board oversight
  • Structure the Self-Funding model
  • Provide actuarial staff in-house
  • Provide assistance with compliance issues such as the ACA
  • Provide claims assistance and reporting
  • Explore ways to reduce costs for Members
  • Nurse navigation assistance and wellness programs through

ConnectCare3 and United HealthCare

  • Work collaboratively with our Members

to grow the Consortium

slide-7
SLIDE 7
  • Established: July 2014
  • Purpose: Provide a cost-effective approach to fund

employee health care

  • Partnership: Members, Benecon, CIGNA, United

HealthCare, and Brown & Brown

  • Governance: Policy and oversight through Board of

Directors elected by Members

  • Current Membership: 5 Cities/Counties

Page 7

FGHS Overview

slide-8
SLIDE 8

Group Year Joined Employee Size City of Haines City 2014 230 Madison County 2014 180 City of Madison 2014 58 Lafayette County 2015 76 City of Belleview 2016 50 Total 5 594

Page 8

FGHS Membership Report

slide-9
SLIDE 9
  • Transparency
  • Self-Funding – Safe and Secure Environment
  • Excellent Network of Providers – Nationwide
  • Performance Data
  • Benefit Design Flexibility
  • Surplus Returns
  • ConnectCare3/Wellness Services
  • A Helping Hand: Affordable Care Act – Compliance

Issues

Page 9

FGHS Key Characteristics

slide-10
SLIDE 10

Page 10

Mechanics of the Program

  • 10/1 common anniversary but can enter at any time
  • Full accounting of all costs that make up premiums
  • Deposits are maintained in interest-bearing accounts
  • Monthly reporting of claims
  • Detailed annual reports on medical and RX claims
  • No capital contribution to join program
  • Dollars remaining at year end returned to Members

as a surplus distribution

slide-11
SLIDE 11

Page 11

What are the key elements of the FGHS Model?

CONTROL

TRANSPARENCY

RESOURCES

PROTECTION

SAVINGS

FGHS

slide-12
SLIDE 12

12

Claim Fund with Corridor Aggregating Specific Stop-Loss Specific Stop-Loss Administrative Fund Aggregate Stop-Loss Member Surplus Great Year Expected Year Claim Fund Exhausted

12.7% 19.5% 67.8%

Cross Share Fund

Page 12

FGHS Model Overview

slide-13
SLIDE 13
  • West Chester, PA

143 Employees

  • Lower Merion Twp., PA

355 Employees

  • City of Haines, FL

242 Employees

Page 13

Presentation – Case Studies

slide-14
SLIDE 14

Ernie McNeely

Township Manager

Lower Merion Township Montgomery County Pennsylvania

Page 14

slide-15
SLIDE 15

Page 15

slide-16
SLIDE 16

Page 16

slide-17
SLIDE 17
  • In 2017 PMHIC returned 27 million dollars to 80% of the

members.

  • PMHIC grows approximately 10% each year from new

Membership

  • The program offers flexibility in benefits which benefits our

employees and offers management many options

  • Through PMHIC’s unique cross-share program reinsurance rates

remain stable with no lasers

  • Board of Directors set policy and understand all facets of the

program

Page 17

Page 21

Success of the PMHIC Program

slide-18
SLIDE 18

Page 17

Tavia Conner

Office of Management and Budget Director

City of Haines City Polk County Florida

slide-19
SLIDE 19

City of Haines City

FGHS CLAIM FUND PERFORMANCE REPORT 2014-2015 2015-2016 2016-2017 2017-2018 Claim Fund Deposits $896,503 $1,099,086 $753,547 $676,148 Reinsurance Reimbursements $104,402 $273,008 $560,394 $549 Claims Paid $874,756 $1,550,892 $991,749 $531,378 Cross Share $12,615 $0 $0 $4,090 Surplus $88,105 ($178,799) $322,193 $141,229 Performance Ratio 94.5% 127.89% 63.0% 86.4% * TOTAL SURPLUS

$410,298

*Through March 31, 2018

Page 18

slide-20
SLIDE 20

Page 20

Savings for Haines City

2014-15 Plan Year FGHS Actual Fully Insured Savings/ (Cost) Total Cost $1,198,251 $1,700,137 $501,886 Assumed Increase 5.0% 2015-16 Plan Year FGHS Actual Fully Insured Savings/ (Cost) Annualized Estimate $1,536,774 $1,785,144 $248,370 Assumed Increase 5.0% 2016-17 Plan Year FGHS Actual Fully Insured Savings/ (Cost) Annualized Estimate $1,557,647 $1,874,401 $316,754

Savings since joining FGHS $1,067,010

In 2017, Haines City paid $250k of stop loss premium and had over $1m of claims paid.

Page 19

slide-21
SLIDE 21

*Through 5/31/17

Subscriber Spouse Dependent/Other Total Benefit Type Payments Payments Payments Payments Prescription Solutions/OptumRX $135,852.78 $89,527.21 $2,869.49 $228,249.48 Inpatient Hospital Room & Board $330,186.35 $0.00 $0.00 $330,186.35 Inpatient Hospital Miscellaneous $349,225.48 $0.00 $0.00 $349,225.48 Outpatient Hospital Miscellaneous $30,694.59 $1,452.13 $3,919.52 $36,066.24 Emergency Room $73,139.51 $18,998.79 $13,884.00 $106,022.30 Surgery $40,883.38 $1,133.34 $404.64 $42,421.36 Anesthesia $18,667.13 $342.14 $0.00 $19,009.27 Assistant Surgical $1,010.51 $0.00 $0.00 $1,010.51 Inpatient Medical $51,288.57 $0.00 $0.00 $51,288.57 Outpatient/Professional Medical $57,594.75 $7,392.26 $5,974.72 $70,961.73 Other Medical $2,851.69 $0.00 $0.00 $2,851.69 Outpatient X-Ray and Lab $64,099.96 $6,398.10 $1,222.61 $71,720.67 Outpatient Psychiatric $1,317.00 $40.00 $55.00 $1,412.00 Comprehensive Medical Expenses $0.00 $0.00 $12.00 $12.00 Pharmacy - Health $4,058.14 $259.90 $0.00 $4,318.04 Total $1,160,869.84 $125,543.87 $28,341.98 $1,314,755.69

Page 20

Example of Detailed Claim Data City of Haines: 2016-2017*

slide-22
SLIDE 22
  • The 5 Members have saved over $1.5m in the first three ($2,500

per employee)

  • 2017 plan year---A great year to be part of FGHS

– Funded $3.9m to pay claims – Model paid $4.2m in claims on behalf of FGHS – Returned $380k in surplus

  • As a member we receive much more data with our program

compared to our previous fully insured program

  • We have ownership in this program and by working together we

reduce costs and save on administrative expenses

  • Statement of actuarial soundness reviewed annually and

approved by the Florida OIR

Page 22

Page 21

Success of the FGHS

slide-23
SLIDE 23

ConnectCare3 services

  • ffered through FGHS

Available to all employees and family members enrolled in FGHS

Nurse Navigator

  • When primary care physician refers to a specialist for a

non-work related condition

Certified Health Coach

  • Can help patients achieve wellness goals

– weight loss, conditioning, improving diet, etc.

13

Page 22

slide-24
SLIDE 24

Healthy Goals helps you set and achieve goals so you can live a healthier and happier life

Work one on one with a certified health coach to achieve reasonable goals with a step-by-step program customized to your needs

http://connectcare3.com/healthy-goals-success- stories/

Healthy Goals is a service of

slide-25
SLIDE 25
  • http://connectcare3.com/healthy-goals-

success-stories/

  • http://connectcare3.com/

Page 24

Success Stories

slide-26
SLIDE 26
  • Funding model designed to benefit group, not

insurance carrier

  • Return of unused claim fund dollars – surplus
  • Eliminates insurance company profit margin and

risk charges

  • More flexibility & control over benefit designs
  • Totally transparent…know where every dollar goes

Page 26

Page 25

Benefits of the FGHS Model

slide-27
SLIDE 27
  • UHC Network – Nationwide
  • Direct savings from Wellness Programs and

wellness dollars

  • You become a decision maker in FGHS
  • ConnectCare3 helps to lower costs and provide
  • utstanding care for your employees

Page 26

Additional Benefits of the FGHS Model

slide-28
SLIDE 28

The Benecon Group

The leader in municipal health care Consortiums Experience & Expertise

‒ Over 25 years experience and 15 established consortiums in public and private sectors ‒ Professional expertise in-house: Former Municipal Manager, Actuaries, Compliance Attorneys, Financial Experts, Nurses and Account Managers We look forward to working with you in managing your health care costs Please contact: Claudia Burchstead: cburchstead@Benecon.com

Page 28