Public Employees Benefits Board

1
Public Employees Benefits Board

• April 20, 2004
• AG Office Training Center
• Rowe 6, Bldg. 1 4224 6th Ave SE
• Lacey, Washington

2
2005 PEBB Procurement

• April 8, 2004 Release of RFP
• April 19, 2004 Final Bidders List
• May 13, 2004 Proposals Due
• June 22, 2004 Board Vote Award Contracts

3
Final 2004 supplemental budget PEBB

• February 2004 PEBB fund projection
• 36 M projected surplus (up from 25 M projected
  in Governors budget)
• Major drivers of surplus
• Better UMP 2003 experience
• Expected to continue for 2004 and 05
• An increase in employees waiving medical coverage
  currently 4,184

4
Final 2004 supplemental budget PEBB

• Use of projected 36 M surplus
• 3 M Ending fund balance
• 4 M Reduce FY 05 K-12 remittance to projected
  level (45.50)
• 1 M Fund administrative budget supplemental
  requests
• 23 M Reduce FY 05 state agency funding rate by
  18.12 pspm
• 5 M Reduce CY 05 employee contribution by
  3.59 pspm

5
Final 2004 supplemental budget PEBB

• Other changes in the conference budget
• Different CY 05 trends
• Maintain est. average employee contribution _at_ 79
  in CY 05
• Net additional CY 05 cost of 26.8 M
• Half funded in FY 05 by increasing FY 05 funding
  rate
• Half will need to be funded in 05-07 biennium

6
Final 2004 supplemental budget PEBB
Summary of supplemental budget changes
7
Prescription Drug ProgramPEBB Board Meeting
April 20, 2004

• Duane Thurman, Program Manager

8
Evidence-based Prescription Drug Program

• Components of the Program
• Washington Preferred Drug List
• Pharmacy Therapeutics Committee
• Endorsing Practitioner Therapeutic Interchange
  Program

9
Therapeutic Interchange Program Status

• UMP and LI will implement TIP for the entire PDL
  the week of May 1, 2004.
• MAA will phase in the implementation of drug
  classes on the PDL subject to TIP beginning May
  5, 2004.
• We have completed 10 training sessions for
  pharmacists across the state.
• We are meeting with various medical groups to
  explain the program and encourage participation.
• We currently have approx. 3,500 endorsing
  practitioners. There are approx. 27,000
  prescribers in the state, of which we estimate
  15,000 will write the bulk of Rxs affected.

10
Next Steps

• The agencies are working with stakeholders to
  develop dose conversion guidelines for
  pharmacists to use when making a therapeutic
  interchange.
• The agencies are preparing for a rush of new
  endorsing practitioners and questions about the
  program beginning May 1, 2004.
• Questions?

11
Uniform Medical Plan Update PEBB Board Meeting
April 20, 2004

• Janet Peterson, Director

12
Current UMP Activities

• Enrollment growth
• Express Scripts transition
• Quality Improvement program
• Tobacco cessation and flu shot promotions
• UMP Neighborhood pilot

13
Enrollment Growth
UMP PPO only. Does not include UMP Neighborhood.
14
Express Scripts Transition

• Mail order issues
• State Preferred Drug List
• (January 1, 2004)
• Therapeutic Interchange Program
• (May 1, 2004)

15
Quality Improvement Program

• Effective January 1, 2002 Changes to appeals and
  other procedures to meet Patients Bill of Rights
  requirements
• 18 appeals sent to IRO from 1/2002 through 3/2004
• All upheld
• Nearly all are contractual (not clinical) issues
• New Utilization Management and Credentialing
  Committees

16
Tobacco Cessation Promotion

• 2003 First place award for Achievements in
  Tobacco Control from American Association of
  Health Plans (with Center for Health Promotion)
• UMP participation increased from 163 in CY 2000
  to 756 in CY 2001
• Good response continued in 2002 and 2003 (400-500
  per year)

17
Flu Shot Promotion

• Flu shot promotion 2002/2003
• Enrollees can receive flu shots at pharmacies,
  etc., without appointment
• Claims more than doubled (approximately 12,000
  active employees received flu shots in 2003)

18
UMP Neighborhood Pilot

• Enrollment
• Approximately 800 subscribers
• 1,640 members
• About 13 came from UMP 87 from managed care
  organizations
• Survey to PEBB members in King, Pierce, and
  Snohomish counties
• Results due end of April

19
UMP Neighborhood Pilot (cont.)

• Two-year pilot
• No major changes expected for 2005 (depending on
  survey results)
• Quality projects developed by participating care
  systems
• Quality measures also being developed

20
Looking Towards 2005 UMP Benefit Changes

• Growing gap between actuarial value of current
  MCO and UMP benefits (estimated at 14)
• Themes
• Simplify or standardize benefit design
• Promote appropriate use of preventive services

21
Simplify or Standardize Benefit Design
(preliminary recommendations)

• Eliminate prescription drug deductible
• Implement 3-month carry-over of payments towards
  the annual medical/surgical deductible
• Make enrollee cost-sharing for out-of-state
  network providers (Beech Street) equivalent to
  cost-sharing for in-state network
• Combined premium impact of above recommendations
  is approximately 2-2.5 percent.

22
Promote Appropriate Use of Preventive Services
(preliminary recommendations)

• Routine eye exam every year (instead of every two
  years)
• 100 payment for enrollees first colonoscopy
• Incentives based on healthy lifestyle and use of
  preventive services