MEASURES TO REDUCE PLAN COSTS Cost Containment Strategy Transparent - - PDF document

▶

Jun 12, 2023 293 likes •384 views

9/27/2016 MEASURES TO REDUCE PLAN COSTS Cost Containment Strategy Transparent Pricing Pharmacy Transparency Tools Whats next? W W W . B E N E F I T S . M T . G O V 1 9/27/2016 COST CONTAINMENT STRATEGIES Manage the

SLIDE 1

9/27/2016 1

MEASURES TO REDUCE PLAN COSTS

Cost Containment Strategy
Transparent Pricing
Pharmacy
Transparency Tools
What’s next?

W W W . B E N E F I T S . M T . G O V

SLIDE 2

9/27/2016 2

COST CONTAINMENT STRATEGIES

W W W . B E N E F I T S . M T . G O V

Manage the Benefit Design
Data Analysis
Manage Risk
Manage the Contracts
High Dollar Claim Management
Address the highest spend

areas

Engage Members in Cost

Containment

CHARGE LESS DISCOUNT

W W W . B E N E F I T S . M T . G O V

SLIDE 3

9/27/2016 3

CHARGE LESS DISCOUNT

WWW.BENEFITS.MT.GOV Hos Hospital A

Hospital Charge $115,000 Discount 10% Cost to State Plan $103,500

Hos Hospital B

Hospital Charge $25,000 Discount 7% Cost to State Plan $23,250

2016 SEGHP Claim Data - Knee Replacement Surgery
Comparison between two Montana Hospitals
Higher Discounts don’t always result in Lower Costs
Not Predictable
Not Transparent
Not Comparable
Not Consistent

TRANSPARENT PRICING

W W W . B E N E F I T S . M T . G O V

SLIDE 4

9/27/2016 4

Libby bby Kalis Kalispell White itefis ish Plains Plains Sup Superior Po Pols lson Ron Ronan Cu Cut Ba t Bank She Shelby Con Conrad Ch Chester Ha Havr vre Bi Big S Sandy For Fort Be Benton Gre Great t Falls lls Ch Choteau Misso Missoula Ha Hamilton Deer eer Lod Lodge Philip Philipsbu rg rg Bu Butt tte An Anacond a Dillo Dillon She Sherid idan an Ennis nnis To Townsen d Boz Bozeman Li Livingst sto n Wh White Sulp Sulphur Sp Springs Hel Helena na Ha Harl rlowto n Bi Big Ti Timber Red Red Lod Lodge Le Lewistow n Col Columbu s Rou Roundup Billin llings Ha Hard rdin in Cro Crow Ag Agency Fors Forsyth Jor Jordan Malt Malta Glas Glasgow Mile Miles C City Ci Circ rcle Te Terry Ekal alak aka Gle Glendi dive Sidn Sidney Wol Wolf Po Point int Sco Scobey Ple Plenty tywo wo

Cu Culbertso n Ba Baker

MAP OF PARTICIPATING PROVIDERS

7

TRANSPARENT PRICING

W W W . B E N E F I T S . M T . G O V

SLIDE 5

9/27/2016 5

FINANCIAL PROJECTION

W W W . B E N E F I T S . M T . G O V

RX CHANGES – EMPLOYEE PLAN

W W W . B E N E F I T S . M T . G O V

URx URx Navit itus Projected Annual Drug Costs $83,329,000 $83,329,000 Retail Discount

$25,687,000
$27,095,667

Mail Discounts

$9,467,333
$9,567,333

Specialty Discounts

$4,085,667
$4,497,000

Total After Discounts $44,089,000 $42,169,000 Rebates

$2,617,500
$3,982,000

Gross Rx Spend $42,568,167 $39,278,333 Em Empl ployee ee Sa Savi vings ngs $914,3 4,334 Plan Sa Plan Savin vings $2,3 $2,375,50 500 Tota tal Sa l Savi vings ngs $3,289 $3,289,8 ,834 34

SLIDE 6

9/27/2016 6

RX CHANGES – MEDICARE RETIREES

W W W . B E N E F I T S . M T . G O V

URx URx Navit itus Projected Annual Drug Costs $23,812,336 $23,812,336 Administration Costs $90,027 $498,750 Dispensing Fee $178,605 $117,699 Total Costs $24,080,968 $24,428,785 Retail Discount

$11,213,336
$11,762,001

Coverage Gap Discount

$991,800

Direct Subsidy

$427,500

Reinsurance Program

$1,573,200

RDS Subsidy

$1,450,000
Rebate Guarantee
$828,380
$845,966

Gross Rx Spend $10,589,252 $8,828,318 Total Sa l Savings ngs $1, 1,760,9 60,934

TRANSPARENCY TOOLS

W W W . B E N E F I T S . M T . G O V

Health Care Blue Book

SLIDE 7

9/27/2016 7

TRANSPARENCY TOOLS

Navi-Gate Rx

W W W . B E N E F I T S . M T . G O V

WHAT’S NEXT?

W W W . B E N E F I T S . M T . G O V

Performance Monitoring
Data Analytics
Out of State Facility Costs
Primary Care

SLIDE 8

9/27/2016 8 QUESTIONS?

W W W . B E N E F I T S . M T . G O V