Health Care Todays Discussion Together Health Care Clinical - - PowerPoint PPT Presentation

▶
health care today s discussion together
SMART_READER_LITE
LIVE PREVIEW

Health Care Todays Discussion Together Health Care Clinical - - PowerPoint PPT Presentation

Apr 04, 2023 487 likes •684 views

Health Care Todays Discussion Together Health Care Clinical Priorities & PPO Plans Costs Drivers Measurement Assessment 2 Health Care Cost Drivers Health Care Spending Price not Price utilization Variation driving cost based

slide-1
SLIDE 1

Health Care

slide-2
SLIDE 2

Today’s Discussion Together

2

Clinical Priorities & Measurement Health Care Costs Drivers PPO Plans Assessment

slide-3
SLIDE 3

Health Care Spending

Health Care Cost Drivers

3

Price Variation

based on geography

  • Competition
  • Consolidation

Price not utilization

driving cost

slide-4
SLIDE 4

Price Variation - CalPERS Non-Kaiser HMO and PPO plans

4

More than 20% lower than statewide average, 9% of TCL 10% to 19.9% lower than statewide average, 24% of TCL 0% to 9.9% lower than statewide average, 11% of TCL 0% to 9.9% higher than statewide average, 15% of TCL 10% to 19.9% higher than statewide average, 15% of TCL More than 20% higher than statewide average, 26% of TCL Counties with fewer than 80 members, 0.1% of TCL

Blue - lower healthcare costs than the statewide average. Red - higher healthcare costs than the statewide average. Lighter shades indicate less expensive counties. Darker shades indicate more expensive counties.

Source: September 2018 PHBC agenda item 7b attachment 1, County cost relativities

slide-5
SLIDE 5

Health Care Cost Drivers - Pharmacy

5

Managing Rx Costs – Part I

  • Reference pricing for pharmaceuticals
  • Biosimilars

Managing Rx Costs – Part II

  • Strategy for specialty drugs
  • Innovative drug purchasing
slide-6
SLIDE 6

Clinical Priorities 2020-21

  • Dr. Julia Logan, Chief Medical Officer,

Health Policy and Benefits Branch

slide-7
SLIDE 7

Institute for Healthcare Improvement Triple Aim

Clinical Priorities

7

slide-8
SLIDE 8

Managing Rx costs Access and treatment of mental health conditions High cost, high- need members

CalPERS Clinical Priorities

Prevention and treatment of chronic disease

12

slide-9
SLIDE 9

Meaningful Measurement

slide-10
SLIDE 10

Marta Green, Chief, Health Policy and Research Administration Emily Zhong, Supervising Health Actuary

PPO Health Plan Assessment Project

slide-11
SLIDE 11
  • Increased copays for urgent care and specialist visits for

PERS Choice and PERSCare (2019)

  • Implemented VBID for PERS Select (2019)
  • Eliminated Risk Adjustment (2019)
  • Spend downs for PERSCare to reduce premium increase to

20% (2019) and 6.5% (2020)

CalPERS PPO Health Plans – A Recent History

PPO Health Plan Assessment

11

slide-12
SLIDE 12

Risk adjustment implementation and elimination produced premium changes for PERSCare and PERS Select.

2019 VBID implementation further impacted PERS Select premium change.

PERS PPO Basic 2012-2019 Historical Premiums

PPO Health Plan Assessment

12

**

** 2019 Published Single-Party Premium Including Spend-Down

slide-13
SLIDE 13

Scope

PPO Health Plan Assessment

13

Perform actuarial analysis and stakeholder outreach to identify challenges to PPO Health Plan affordability. Based on the results, consider potential plan redesign.

  • Achieve sustainability for the PPO Health Plans
  • Reduce year-over-year premium volatility
  • Minimize member disruptions
  • Stabilize plan populations
slide-14
SLIDE 14

Plan Differential – Actuarial Value

PPO Health Plan Assessment

14

Broad Network Richest Benefit Design PPO Tier Plan Value in Ideal Environment PSPM Value

Care ✓ ✓ High + 7% 781 $ Choice ✓  Middle + 2% 752 $ Select   Low

  • 8%

677 $ Average PPO Basic Total 100% Member migration patterns appear to be strongly influenced by each plan’s network, benefit design, and overall value.

Network and Benefit Comparison

slide-15
SLIDE 15
  • What is the most important factor when choosing a Health Plan?
  • Premium?
  • Provider?
  • Conduct data analysis using 8 years of enrollment and claims data
  • Conduct a survey to ask members about what matters most

Understanding Member Behavior

PPO Health Plan Assessment

15

slide-16
SLIDE 16
  • Random selection of members from the PERS PPOs
  • Analysis of survey answers based on targeted groups
  • Responses are important to produce valid results
  • Online survey to be sent via mail and email in February

Please encourage members to complete if they are contacted

PPO Member Survey

PPO Health Plan Assessment

16

slide-17
SLIDE 17

Timeline

PPO Health Plan Assessment

17

  • Implement

redesigned plans

  • Pricing of

approved scenario during Rate Development Process for Plan Year 2022 June 2021

Phase IV Implementation

  • Analysis and

benefit design modeling of potential 2022 premiums

  • Pros and

Cons of each scenario

  • Recommend

a scenario

  • to Board for

Approval September & November 2020

Phase III Benefit Design

  • Outreach

Strategy

  • Survey
  • Results
  • Final

Outreach Report April/May 2020

Phase II Stakeholder Outreach

  • Progress

Reports

  • Literature

Review

  • Data Analysis

Report March 2020

Phase I Analysis

slide-18
SLIDE 18

Questions?