[PPT] - L egislative F inanc e Committee Dec ember 7, 2017 Ric har d PowerPoint Presentation

SLIDE 1

L egislative F inanc e Committee Dec ember 7, 2017

E r ne stine Chave z De puty Dir e c tor Ric har d Vale r io Chie f F inanc ial Offic e r Sammy J. Quintana E xe c utive Dir e c tor

SLIDE 2

NMPSI A T

da y
Sc hool Distr

ic ts

88 Ma nda tor

y (E xc lude s APS)

Cha r

te r Sc hools

100 Ma nda tor

y

26 Othe r

E duc a tiona l E ntitie s

(Optiona l)
Sta ff
11 F

T E

Boa r

d of Dir e c tor s

11 Boa r

d Me mbe r s

2 NE

A-NM

1AF

T

NM
3 Gove r

nor Appointe e s

1 Supe r

inte nde nts’ Assoc ia tion

1 Ne w Me xic o Assoc ia tion of

Sc hool Busine ss Offic ia ls

1 E

duc a tiona l E ntitie s a t L a r g e

1 Sc hool Boa r

ds Assoc ia tion

1 Public E

duc a tion Commission

2

SLIDE 3

F Y19 Appro pria tio n Re q ue st

3

F und F Y17 Ac tual F Y18 Ope r ating Budge t F Y19 Appr

pr

iation Re que st Inc r e ase F Y18- F Y19 Pe r c e ntage Diffe r e nc e F Y18- F Y19 Be ne fits

$ 314,734,567 $ 325,783,600 $ 332,022,081 $ 6,238,481 1.91%

Risk

$ 84,246,273 $ 70,799,100 $ 82,965,060 $ 12,165,960 17.18%

Pr

gr

am Suppor t

$ 1,347,000 $ 1,299,900 $ 1,338,700 $ 38,800 2.98%

Age nc y T

tal

$ 400,327,841 $ 397,882,600 $ 416,325,841 $ 18,443,241 4.64%

 F

r

F Y19, NMPSIA ha s r e c omme nde d tha t the Public E duc a tion De pa r tme nt r e que st a n inc r e a se of $17,695,497 to fund the e mploye r sha r e of pr e mium inc r e a se s.  T he inc r e a se c onsists of:

 $13,329,192 for E mploye e Be ne fits Pr e miums  $4,366,305 for Risk Pr e miums

 APS will r e c e ive 1/ 3 of the tota l a ppr

pr

ia tion inc r e a se due the funding for mula . T his r e duc e s the a mount of a ny a dditiona l funding to NMPSIA pa r tic ipa ting sc hools.

SLIDE 4

Risk Pro g ra m F a c ts

Pr

pe r

ty:

Pro pe rty d e d uc tib le is $750,000; $750 Millio n in Insure d limits Pe r Oc c urre nc e

sub je c t to sub -limits suc h a s F lo o d a nd E a rthq ua ke : $100 Millio n Annua l Ag g re g a te ; $800 Millio n in T e rro rism L imits

Crime L

imit is $2 Millio n Pe r Oc c urre nc e

Asse ts insure d a re in e xc e ss o f $23 Billio n
$17 Billio n a re F

ra me / Stuc c o c o nstruc tio n, the mo st fla mma b le type o f c o nstruc tio n

60% o f pro pe rtie s a re lo c a te d in Pro te c tio n Cla ss 9 o r 10, 10 b e ing the wo rst

pro te c tio n c la ss

60% o f pro pe rtie s a re lo c a te d in 100 Ye a r F

lo o d zo ne s

T

he pro pe rty ra te ha s inc re a se d o nly .021 pe r $100 d o lla rs o f va lue s sinc e 1991

L ia bility a nd Wor ke r s' Compe nsa tion:

L

ia b ility d e d uc tib le is $1,000,000; $20 Millio n in L ia b ility L imits fo r Se xua l Ab use

T

he re a re no T

rt Cla ims Ac t L

imit pro te c tio ns fo r Sc ho o l Bus Co ntra c to rs

44,000 e mplo ye e s
$1.75 Billio n in pa yro ll
300,000 stud e nts
44,000 sc ho o l a thle tic pa rtic ipa nts
9,000 vo lunte e rs
9,300 ve hic le s inc lud ing b use s

4

SLIDE 5

Risk Cla ims

T

ta l $ Spe nt

5

Over the past several years, claim frequency has been steadily decreasing, while claim severity has been steadily increasing.

$12,642,676 $17,176,097 $15,679,763 $17,975,573 $18,938,258 $20,858,870 $22,698,913 $12,616,778 $12,372,857 $11,805,391 $12,993,070 $12,128,141 $15,805,319 $16,172,195 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 F Y13 F Y14 F Y15 F Y16 F Y17 F Y18 Pro je c te d F Y19 Pro je c te d Pro pe rty a nd L ia b ility Wo rke rs' Co mpe nsa tio n

SLIDE 6

SE L F

I

NSURE D GOVE RNME NT WORK E RS’ COMPE NSAT I ON AVE RAGE COST PE R CL AI M

6

2000 4000 6000 8000 10000 12000 14000 2012 2013 2014 2015 2016 City of Alb ABCWUA City of SF APS NMPSIA NM Mun State of NM City of Farm City of LC City of Carls NMCIA

SLIDE 7

L

ss Pre ve ntio n Pro g ra ms
E

r g onomic s

Ob je c tive : re duc e the fre q ue nc y a nd se ve rity o f c o stly so ft tissue injurie s b y sc ho o l e mplo ye e s.
T

hr e a t Asse ssme nt a nd Ac tive Shoote r

Ob je c tive : Re duc e the pro b a b ility o f a n inc ide nt o f multiple vic tim sc ho o l vio le nc e .
E

mployme nt Pr a c tic e s Polic y a nd Consulting

Ob je c tive : Re duc e the numb e r o f e mplo yme nt pra c tic e s c la ims (wro ng ful te rmina tio n, vio la tio n o f c o ntra c t)
T

e c hnic a l Assista nc e Pr

g r

a m for Spe c ia l E duc a tion

Ob je c tive : re duc e the numb e r o f I

DE A (I ndividua l with Disa b ilitie s in E duc a tio n) Due Pro c e ss a nd L itig a tio n c la ims.

On- site Sc hool F

a c ility Audits

Ob je c tive : re duc e the fre q ue nc y o f Wo rke r's Co mpe nsa tio n, L

ia b ility a nd Pro pe rty Cla ims.

Ide ntifying a Pr

e da tor T r a ining

Ob je c tive : re duc e the numb e r o f se xua l mo le sta tio n c la ims in NM pub lic Sc ho o ls
Bullying Pr

e ve ntion T r a ining a nd susta ina ble polic y de ve lopme nt c onsulting

Ob je c tive : T
a ssist sc ho o ls with unde rsta nding o f the issue s a nd de ve lo pme nt o f po lic ie s a ddre ssing b ullying .
Ar

me d sc hool e mploye e s

Ob je c tive : T
a ssist sc ho o ls with a n unde rsta nding o f the re le va nt sta tute s, po lic ie s, pro c e dure s a nd lia b ilitie s ne c e ssa ry to

ma ke info rme d judg e me nts re g a rding a rming e mplo ye e s. 7

SLIDE 8

Risk F und

8

Plan Ye ar F und Balanc e at Star t of Plan Ye ar Rate Inc r e ase F und Balanc e at E nd

f Plan Ye ar

2010-2011 $23.3 millio n No Inc re a se $24.9 millio n 2011-2012 $24.9 millio n No Inc re a se $19.8 millio n 2012-2013 $19.8 millio n

10.00%

$12.3 millio n 2013-2014 $12.3 millio n 25.49% $5.4 millio n 2014-2015 $5.4 millio n 7.31% $4.0 millio n 2015-2016 $4.0 millio n 11.28% $-5.7 millio n 2016-2017 $-5.7 millio n 5.14% $-14.2 millio n 2017-2018 $-14.2 millio n 0.09% $-17.1 millio n (pro je c te d ) 2018-2019 $-17.1 millio n (pro je c te d ) 6.58% $-17.1 millio n (pro je c te d )

$16.0 million in fund swe e ps during F Y17!

SLIDE 9

E mplo ye e Be ne fits Pro g ra m

NMPSIA offe r

s the following be ne fits a nd se r vic e s:

Se lf- Insur

e d High Option Me dic al Plan and L

w Option Me dic al Plan – BCBSNM and

Pr e sbyte r ian

Se lf- Insur

e d HMO Me dic al Plan - Ne w Me xic o He alth Conne c tions

Se lf- Insur

e d Pr e sc r iption Dr ug c ove r age - E xpr e ss Sc r ipts

Cove r

e d Me mbe r s on Me dic al/ RX

22,180 E

mploye e s

49,314 T
tal L

ive s

Se lf- insur

e d High and L

w Option De ntal Plans - Unite d Conc or

dia

F

ully insur e d Vision Plan - Davis Vision

F

ully insur e d L ife and Disability Plans - Standar d

Me a sur

e s ta ke n to impr

ve c ost c onta inme nt e ffor

ts:

Pur

c hase d Stop- L

ss Cove r

age in F Y16 to mitigate the r isk of c laims ove r $1 million

Pur

c hase d Data War e house , Re por ting and Data Mining Se r vic e s in F Y18 in or de r to be tte r de fine the he alth r isk of the plan par tic ipant population and to tr ac k c hange s ove r time . T his will allow NMPSIA to impr

ve the value of the plans and ide ntify oppor

tunitie s for futur e plan de signs and pr e miums.

F

inalize d 2016 me dic al plan c ontr ac ts with c ommitme nts to managing diabe tic s and me mbe r s with c hr

nic he alth c onditions, value - base d c ar

e ar r ange me nts, we llne ss and dise ase (c ar e manage me nt) manage me nt pr

gr

ams.

Imple me nte d signific ant me dic al and pr

e sc r iption dr ug plan de sign c hange s and imple me nte d pr

gr

ams to de c r e ase plan c ost and inc r e ase me mbe r c ost shar e .

9

SLIDE 10

10

SLIDE 11

E mplo ye e Be ne fits F und

11

Plan Ye ar F und Balanc e at Star t of Plan Ye ar Rate Inc r e ase F und Balanc e at E nd of Plan Ye ar

2013-2014 $31.6 millio n Me d ic a l 6.6% De nta l 3.0% $42.3 millio n 2014-2015 $42.3 millio n Me d ic a l 1.5% De nta l 0.0% $41.4 millio n 2015-2016 $41.4 millio n Me d ic a l 4.0% De nta l 0.0% $20.9 millio n 2016-2017 $20.9 millio n Me d ic a l Hig h 8.30% Me d ic a l L

w 7.15%

De nta l 0.0% $13.8 millio n 2017-2018 $13.8 millio n Me d ic a l Hig h 3.98% Me d ic a l L

w 1.82%

De nta l 0.0% $18.4 millio n (pro je c te d ) 2018-2019 $18.4 millio n (pro je c te d ) Me d ic a l Ble nd e d 10.39% De nta l 0.0% $20.5 millio n (pro je c te d )

T ar ge t fund balanc e is 1 month of c laims - $24.2 – 26.1 million.

SLIDE 12

F Y18 Mo nthly I nc re a se fo r E mplo ye e

E

ff. 10/ 1/ 2017

12

Rate Inc r e ase

Hig h Optio ns 3.98% L

w

Optio ns 1.82% HMO 3.98%

Plan Salar y Unde r $15,000 (75% / 25% ) Salar y $25,000 or Ove r (60% / 40% )

Sing le : Blue Cro ss Blue Shie ld Hig h Optio n $6.28 $10.04 Pre sb yte ria n Hig h Optio n $5.08 $8.12 Ne w Me xic o He a lth Co nne c tio ns $5.66 9.04 F a mily: Blue Cro ss Blue Shie ld Hig h Optio n $15.94 $25.52 Pre sb yte ria n Hig h Optio n $14.22 $22.74 Ne w Me xic o He a lth Co nne c tio ns $14.34 $22.96

SLIDE 13

F Y17 Pla n De sig n c ha ng e s

Me dic a l/ Rx

13

Change Me dic al E stimate d Savings (Annually)

Inc r e ase d c ale ndar ye ar plan de duc tible s e ffe c tive 1/ 1/ 17 High Option Plan - fro m $300 to $750 fo r in-ne two rk se rvic e s L

w Option Plan – fro m $1500 to $2000 fo r in-ne two rk se rvic e s

$11.0 million Inc r e ase d c ale ndar ye ar

ut- of- poc ke t maximum e ffe c tive 1/ 1/ 17

High Option Plan – fro m $2800 to $3750 fo r in-ne two rk se rvic e s L

w Option Plan – fro m $3500 to $3750 fo r in-ne two rk se rvic e s

$10.0 million

Va lue of Me dic a l Pla n De sig n Cha ng e s $21.0 million

Change Pr e sc r iption E stimate d Savings (Annually)

Inc r e ase d c opayme nts on diabe tic or al me dic ations, r e tail ge ne r ic , mail ge ne r ic , r e tail pr e fe r r e d br and, mail pr e fe r r e d br and, and spe c ialty me dic ations e ffe c tive 7/ 1/ 16 $4.5 million E liminate d c ove r age for

ve r
the - c ounte r

(OT C) me dic ations (Pro to n

Pump Inhib ito rs, Antihista mine s a nd Intra na sa l Ste ro id s) e ffe c tive 7/ 1/ 16

$1.2 million

Va lue of Pre sc ription Pla n De sig n Cha ng e s $5.7 million

SLIDE 14

F Y17/ 18 Pla n De sig n c ha ng e s

Me dic a l/ Rx

14

Cha ng e Me dic a l E stima te d Sa ving s (Annua lly) Inc r e a se d offic e visit c opa ys for in- ne twor k PCP/ Spe c ialty se r vic e s e ffe c tive 5/ 1/ 17 Hig h Option Pla n – PCP fro m $20 to $30/ Spe c ia lty fro m $30 to $50 L

w Option Pla n – PCP fro m $25 to $35/ Spe c ia lty fro m $35 to $60

HMO Pla n – PCP fro m $15 to $25/ Spe c ia lty fro m $25 to $35 Inc r e a se d ur g e nt c a r e c opa y a nd c opa y for E R visits e ffe c tive 5/ 1/ 17 L

w Option Pla n ur

g e nt c a r e c opa y fro m $50 to $60 Hig h Option Pla n – E R fro m de duc tib le /20% c o insuranc e to de d./c o ins. +$150 c o pay L

w Option Pla n – E

R fro m de duc tib le /25% c o insuranc e to de d./c o ins. +$150 c o pay HMO Pla n – E R fro m de duc tib le /20% c o insuranc e to de d./c o ins. +$150 c o pay Va lue of Me dic a l Pla n De sig n Cha ng e s $4.0 million Cha ng e Pr e sc r iption E stima te d Sa ving s (Annua lly) R x c opa y c ha ng e s e ffe c tive 7/ 1/ 17 Ge ne r ic fro m $8 no n-Walg re e ns/$15 Walg re e ns to $10 fo r all partic ipating re tail

pharmac ie s

F

r

mula r y Br a nd 30% fro m 30% $25 min./$35 maximum no n-Walg re e ns and $35 min/$55

max Walg re e ns to $30 min./$60 max. all partic ipating re tail pharmac ie s and mail o rde r c o pay fro m $55 to $60

$282k Sa ve On Pr

g r

a m (spe c ia lty dr ug / dr ug ma nufa c tur e r c o- pa y a ssista nc e ) e ffe c tive 7/ 1/ 17 $2.4 million Va lue of Pr e sc r iption Pla n De sig n Cha ng e s $2.682 million

SLIDE 15

Me dic a l Co st Drive rs

ACA Costs

$5.1 million (F

Y15- 17)

Othe r

Ma nda te s

R

e move d pr e - e xisting c onditions

L

imits pr e mium inc r e a se s to r e ma in a ffor da ble

R

e move d pla n limita tions

Cove r

c hildr e n up to 26 – ma r r ie d/ unma r r ie d

Catastr

phic

Claims

372 Cla ima nts ha d

c la ims g r e a te r tha n $100K tota ling $83.8 million in F Y17

11 c la ima nts with

c la ims g r e a te r tha n $750K

3 c la ima nts with

c la ims g r e a te r tha n $1.0 million

Pr

vide r

Re imbur se me nt Rate s

Cha lle ng e s with

pro vide r re imb urse me nt ne g o tia tio ns, e spe c ia lly in rura l c o mmunitie s whe re a ppro x. 85% o f the me mb e rship re side s

Pro vide rs a tte mpt

to ma ke up fo r lo we r Me dic a re a nd Me dic a id re imb urse me nt ra te s

T

p Me dic al

Conditions

Infla mma to ry

Co nditio ns

Dia b e te s
Ca nc e r
L

e uke mia

Ho dg kin’ s Dise a se
Co ro na ry Dise a se
Ca rdio va sc ula r

Dise a se

Stro ke
Injury a nd Po iso ning
Multiple Sc le ro sis
Ma te rnity

Vac c ine Pr

gr

am

$1.6 millio n – F

Y17

$1.4 millio n – F

Y16

$740K – F

Y15

Sta tue re q uire s

va c c ine s fo r priva te ly insure d c hildre n to b e purc ha se d a t re ta il c o sts.

15

SLIDE 16

Pre sc riptio n Drug Pla n Pe rfo rma nc e

16

SLIDE 17

T

p 25 Drug s

17

T

p 25 Drug s Re pre se nt

38.2%

f T
ta l Pla n Co st a nd

Co mprise 9 I ndic a tio ns 14 o f 25 T

p Drug s

a re Spe c ia lty Drug s, Ma king up 59.5% o f T

p 25 Spe nd

1 Me mb e r With Drug Spe nd Of Ove r $2.0 Millio n Annua lly

SLIDE 18

Clinic a l Sa ving s a nd Rx Pro g ra ms

18

SLIDE 19

Rx Pro g ra ms

19

Rx Pr

gr

ams De sc r iption of Pr

gr

am

I nfla mma to ry Co nditio ns Ca re Va lue Pro g ra m I ndic a tio n-le ve l ma na g e me nt, e xte nsive c linic a l do c ume nta tio n, a nd e a rly disc o ntinua tio n re imb urse me nt g ua ra nte e Ma rke t E ve nts Pro te c tio n Pro g ra m Quic ke r fo rmula ry c ha ng e s whe n pric e s inc re a se le a ding to fa ste r sa ving s He pa titis Cure Va lue Pro g ra m L

we re d the c o st o f c ura tive he pa titis C tre a tme nts b y ne a rly 50% a nd e xpa nds

a c c e ss to a n a ffo rda b le he pa titis C c ure . Cho le ste ro l Ca re Va lue Pro g ra m Avo iding up to 90% o f the pla n c o st inc re a se s in this the ra py c la ss Onc o lo g y Ca re Va lue Pro g ra m Alig ning c o st with e ffic a c y fo r se le c te d o nc o lo g y drug s I nfla tio n Pro te c tio n Pro g ra m F

r Bra nd

Na me Drug s I nfla tio n pro te c tio n g ua ra nte e F ra ud Wa ste a nd Ab use Pro g ra m I de ntifie s o utlie rs, fla g s suspic io us a c tivity, g a the r e vide nc e , inve stig a te , inte rve ntio n b y re stric ting c e rta in me mb e rs to o ne pha rma c y fo r sub sta nc e a b use me dic a tio ns (o pio ids, ADHD, sle e p, a nxie ty, musc le re la xe rs, a ntic o nvulsa nts) Multiple Sc le ro sis Ca re Va lue Pro g ra m Drive s me mb e r a dhe re nc e a nd inc lude s a disc o ntinua tio n g ua ra nte e if me mb e r disc o ntinue s tre a tme nt in the first thre e mo nths Ra tio na lMe d Sa fe ty Pro te c tio n Pro g ra m I de ntifie s pa tie nts a t risk – a le rts physic ia ns o f he a lth a nd sa fe ty issue s Mo b ile Adhe re nc e App – Pilo t Pro g ra m I mpro ve a dhe re nc e fo r me mb e rs with dia b e te s, hype rte nsio n, a nd b lo o d c ho le ste ro l T he ra pe utic Re so urc e Ce nte rs Me mb e r e duc a tio n a nd he lps with me mb e r a dhe re nc e

SLIDE 20

410 Old T aos Highway Santa F e , Ne w Me xic o 87501 Phone : 505.988.736/ 1.800.548.3724 F ax: 505.983.8670 We bsite : nmpsia.c om

Que stio ns? ? ?

Sa mmy.Quinta na @ sta te .nm.us E rne stine .Cha ve z@ sta te .nm.us

20