Opportunities and Challenges under the ACA for Covered California, - - PDF document

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Opportunities and Challenges under the ACA for Covered California, - - PDF document

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9/11/2014 Opportunities and Challenges under the ACA for Covered California, CalPERS, and Purchasing Pools Doug McKeever, Chief CalPERS Health Policy Research Division 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING

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9/11/2014 1

Opportunities and Challenges under the ACA for Covered California, CalPERS, and Purchasing Pools

Doug McKeever, Chief CalPERS Health Policy Research Division

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

CalPERS Overview

CalPERS:

  • Covers nearly 1.4 million active and retired state, local

government, and school employees and their families

  • Purchases health benefits for State of California and

more than 1,100 public agencies and schools

  • Largest employer health benefits purchaser in California

and second largest in the nation

  • Spent more than $7.5 billion in 2013 on health benefits

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

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CalPERS Membership

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR (571,800) (813,300)

CalPERS Health Plans

  • Six Health Maintenance Organization (HMO) plans

– Anthem Blue Cross, Blue Shield of California, Health Net, Kaiser Permanente, Sharp, and United Healthcare

  • Two Exclusive Provider Organization (EPO) plans

– Anthem Blue Cross and Blue Shield of California

  • Three self‐funded Preferred Provider Organization (PPO) plans

administered by Anthem Blue Cross

– PERS Select, PERS Choice, and PERS Care

  • Three Association member plans

– California Association of Highway Patrolmen Health Benefits Trust – California Correctional Peace Officers Association – Peace Officers Research Association of California 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

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Covered California: 2014

  • First Open Enrollment
  • Health Plan Enrollment

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

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Comparing Plans: Covered California v. CalPERS (2014)

Health Plan Actuarial Value

Covered California Platinum plan = 88% Gold plan = 78% CalPERS Kaiser 95% Blue Shield Access+ 94% Blue Shield Net Value 94% PERSCare 87% PERS Choice 84% PERS Select 79%

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

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CalPERS Path Forward

  • 21 Initiatives
  • Survey/Focus Groups
  • Other Efforts

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

Innovate/ Experiment Strong HIT Infrastructur e Manage Disease Promote Quality & Safety Prevent Illness Encourage Competition Optimized Eligibility Flex for Growth Influence Healthcare Delivery

Health Benefits Purchasing Strategies & Initiatives

Deliver Sustainable Programs

Evidence Based Medicine Value Based Purchasing Bundled Payments Integrated Healthcare Uniform Metrics Shared Decision-Making Transparency Incentives For Disease Mgmt. Intensive Case Mgmt. Reduce Unwarranted Care Wellness Platform

Improve Health Outcomes

11 8 9 10 7 6 5 1 2 3 4 HMO Procurement Kaiser Contract PPO Procurement 12 13 14 15 Risk Adjustment Medicare A & B Encourage Spousal Surcharge 16 17 18 19 Member & Children Tiering Dependent Eligibility Audits Expand PA Marketing 20 21 Regulatory Flexibility for PAs Complete In Process Not Started

Status Key

Not Pursuing

…2012 …

CalPERS Health Benefits

…2015 …

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Public Agency Health Benefits Needs Assessment

  • Purpose

– Help CalPERS gain better understanding about public agency/member organization experiences regarding Health Benefits Program to better serve employers and members

  • Survey Duration

– Released: January 31, 2014 – Closed: February 28, 2014

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

CalPERS Focus Groups

  • Feedback from focus group meetings consistent

with survey responses.

  • Large desire amongst employer/member
  • rganizations for:
  • 1. Implementation of State‐sponsored

wellness plan

  • 2. Health care cost savings for employers and

member organization groups

  • 3. Wider selection of benefit packages

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

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Transparency Efforts

  • Cal Index
  • Castlight

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR

Discussion

2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR