Microsoft word - 2013-02-18 retreat meeting minutes draft
COCHISE COMBINED TRUST
Minutes of Tuesday, February 19, 2013
Annual Retreat Work Session Meeting
J.D. Rottweiler, Vice Chairperson / Treasurer Wendy Davis, Trustee Julie Morales, Trustee
Rick Cajthaml, Meritain Wendy De La Cruz, Cochise County Rich Hanna, Ameritas Mike Hensley, Jones Skelton & Hochuli Andrea Mannino, Blue Cross Blue Shield of Arizona (BCBSAZ) Dion McKissick, Blue Cross Blue Shield of Arizona (BCBSAZ) Chris Mead, Navitus Bill Miller, Navitus Kristi Olivas, Buck Consultants Brandy Rossiano, ECA Karen Sandstrom, Meritain Jaime Schulenberg, ECA
1. Call to Order
The meeting was called to order at 8:01 a.m.
2. 2012 Medical Claims Review
Rick Cajthmal reviewed the July through December 2012 medical claims administered by Meritain as follows:
Statistical overview of demographics, claims paid, medical claims, network and
claims dollars paid by service. It was noted that the % change column was skewed because of the benefit code mapping from the AEI to the Meritain claims system.
Claims paid by status and tier. This report showed 784 claims as “Unknown” and
Mr. Cajthaml explained that these were old claims that were pended and closed as part of the system conversion. It also showed 4 unknown Retirees which was an error in College retirees placed in the wrong division, again as part of the conversion. Those errors have since been corrected.
Paid claim summary by claimant type which shows that although employees incur
more claims, spouses have a higher cost per claim.
Top medical providers. Claim distribution which shows number of claimants by dollar value of the claim.
Top diagnosis which includes musculoskeletal system and connective tissue,
factors influencing health status, digestive system, kidney and urinary tract, circulatory system, respiratory system, skin-subcutaneous tissue and breast, endocrine-nutritional and metabolic system, hepatobiliary system and pancreas, and ear-nose-mouth and throat. This report also noted the top 10 disease management related diagnosis which can be used to assist in developing wellness programs.
Preventive service utilization. Wellness utilization, which shows that only 13 employees used their entire $500
3. 2012 BCBSAZ Review
Dion McKissick, Strategic Relationship Executive and Senior Manager for Blue Cross
Shield of Arizona, went over the BCBSAZ network:
BCBSAZ is a not for profit corporation and the largest AZ-based health insurance
company offering the largest carrier based provider network;
97% of all Hospitals are in-network. Cancer Centers of America and Mayo are
the 2 facilities that are not in the network;
CCT’s claim savings are 56.8% for claims processed January 1, 2012 to
Top 25 inpatient claims is at a 71.9% discount; and
Overall, the Trust is saving money by utilizing the BCBSAZ network.
Andrea Mannino, CHS Account Manager for BCBSAZ, provided Trustees with information concerning value-added services available for plan members as follows:
Retail Health Clinics – 53 retail health clinics through select Walgreens, CVS and
Fry’s are located throughout Arizona and are in-network. These clinics see patients 18 months and older and offer services including vaccinations, physicals, illnesses, minor injuries skin conditions and screenings. Services are provided by nurse practitioners and/or physician assistants and patients pay the primary care physician copayment;
CHS Webpage – An updated website has been developed for CHS clients to make
it easier for patients to find providers, etc. Website address is azblue.com/CHSnetwork; and
ChooseHealthy – Provides discounts to plan members for services such as
acupuncture, fitness clubs, massage therapy and more.
4. 2012 Prescription Claims Review
Chris Mead and William Miller went over the prescription benefit management program for 2012 as follows:
Recommendations for the Trust including:
Implement a Generic Limit Program for an estimated annual savings between
$17,504 and $22,082. This program requires that patients pay the copay plus the cost difference if a brand medication is selected for use when a generic is available. The cost difference in estimated annual savings is based on whether the patient selects this option or whether the physician prescribes the brand.
Implement Specialty Medication cost sharing changes for an estimated annual
CCT’s program is running at $55.41 per member per month (PMPM) compared to
Navitus’ Arizona Book of Business (ABOB) average of $45.35 PMPM. CCT’s overall plan paid increased 7.5% in 2012 when compared to 2011, primarily as a result of increased use of specialty medications.
Cost trend graphs show increased utilization of specialty medications which has
driven increases in total cost and plan paid.
Utilization of generic drugs increased to 79.4% which is just slightly above the
Arizona Book of Business (ABOB) of 79.3%.
Top drugs by plan paid amount include Incivek (Hep C), Zytiga (prostate cancer),
Enbrel (Rheumatoid Arthritis), Abilify, Valcyte, Cymbalta, Xtandi (prostate cancer), Singulair, Advair and Crestor. Use of Enbrel and Singulair decreased compared to 2011 by 21.1% and 34.9% respectively due to fewer members taking these drugs and Singulair losing patent exclusivity in 2012.
Top 10 therapeutic categories include antidiabetics, antivirals, antineoplastics,
analgesics-anti-inflammatory, antiasthmatics, antihyperlipidemics, antipsychotics/antimanic agents, antidepressants, dermatological and analgesics-opioids.
Drug utilization review cost avoidance. The Trust avoided $233,194 in costs by
utilizing the Navitus’ prior authorization and step therapy programs.
CCT has saved $14,605 by members and their prescribers taking Navitus’
recommendations for changes in drug therapy.
CCT will receive an estimated $120,054 in rebates from 2012 utilization.
5. Dental Claims Review
Rich Hanna went over the January 1 through December 31, 2011 dental claims
administered by Ameritas as follows:
2011 dental claims were running at $579,967 vs. 2012 dental claims at $501,986
The Ameritas PPO network was implemented July 01, 2011 with no change in
Plan design and utilization of the Ameritas claims system.
In 2012, PPO network savings came in at $60,412 and claims savings were
43.6% of claims were for preventive services. 43% of claims are Non-PPO claims.
Recruitment is continuing; Jerrod Long, the top provider has joined the network.
6. Wellness Program Review
Brandy Rossiano explained that the wellness program goals are to manage health care cost utilization, improve the quality of life of members and improve productivity by reducing absenteeism. The program strives to meet these goals by analyzing the data, implementing programs and reviewing the programs. Ms. Rossiano reported that 73% of participants have utilized less than $199 of the $500 available for preventive services each calendar year. She also reported the top 9 disease management-related diagnoses which include diabetes, asthma and coronary artery disease. Programs will be targeted to address these conditions in an effort to reduce claims costs and enhance plan member’s quality of life. Ms. Rossiano reviewed the current wellness program activities that have been completed and are underway as well as the upcoming year’s programs including:
Hydration Challenge – 1,170 water bottles were distributed to participants who
were given the option to track water consumption. The County Health Department sent out weekly education on the importance of proper hydration.
Health Risk Assessment’s (HRA’s) include height, weight, body fat, complete
blood panel and self-reported questionnaire. In 2011 there were 200 participants and in 2012 there was a big jump to 303 participants. Ms. Rossiano explained that participation is vital because it is one way to determine the areas to target with wellness programs.
The HRA’s identified the top risk factors contributing to preventable death as
follows: Low exercise – 27% don’t get enough exercise; Smoking – 26% of participants are smokers; High Cholesterol – 16%; High Blood Pressure – 14%.
Prostate On-Site Project brought prostate and testicular exams on-site.
Participation increased from 56 to 80 between 2011 and 2012. 21.3% of participants had an abnormal result that required follow-up.
Spring Training was an email-based baseball themed activity challenge. 164
employees participated in the challenge.
Skin Cancer Screening participation increased slightly from 225 in 2011 to 232 in
2012 with 37 members referred for follow up because of abnormal results. 1 plan member was determined to have basal cell carcinoma.
Vital Organ Screenings offered bone density, kidneys, liver, gallbladder and
thyroid ultrasounds to 400 participants. 104 abnormal results were sent for follow-up, mostly related to thyroid.
Fit Cochise 5k Walk/Run had a slight increase in participation to 105 plan
members. The event was held at the College Sierra Vista Campus.
Flu and Pneumonia Vaccinations had a total of 453 participants. Vaccinations
were administered by Cochise County Health Department.
Assured Imaging Mobile Mammography participation decreased; there were 0
abnormal results in 2012. Assured Imaging was a new vendor and the Wellness Ambassadors will determine whether to continue to use them for 2013 or move back to MOM.
Handling the Holidays was an email-based program to assist participants in
dealing with the stress associated with holidays. On-site seminars were provided by Cochise County Health Department staff.
Maintain Don’t Gain was an email-based program to help participants maintain
their weight over the holiday season from Thanksgiving through New Year’s. 88 people began the program and 31 finished it.
WellRewards participation increased with 84 participants achieving prizes in
April – Skin Cancer Screening / Fit Cochise 5k Run/Walk May – Wellness Education
July – Wellness Education August – Wellness Education
September – Cardiac/Organ Screening
October – Onsite Mammograms / Flu-Pneumonia Vaccinations November – Great American Smokeout / Lung Function Screening
7. Healthcare Reform
Kristi Olivas from Buck Consultants gave a presentation on upcoming healthcare reform laws that will impact the Trust. Highlights included:
Implementation of women’s preventive services (effective 07/01/13);
Comparative Effectiveness Fee (payable by 07/31/13 based on 2012 data); New taxes that will impact premiums;
Summary of Benefits and Coverage (due for open enrollment 2013/14);
Limitations for Health Flexible Spending Accounts (effective 01/01/13); Exchange Notices (delayed);
Temporary Reinsurance Program (fees payable to stabilize premiums in the
individual health market – payment expected to be due in January 2015);
Employer Mandate (Pay or Play – effective 07/01/14).
More information on these laws and how they will impact CCT specifically will be provided as guidance is released.
8. Domestic Partners
Michael Hensley, the Trust’s legal counsel, reviewed the legal, tax and payroll implications of implementing domestic partner benefits.
9. Trust Financial Status through December 31, 2012
Jaime Schulenberg reviewed the Trust financial performance through December 2012 noting the following:
The YTD financial position is at $659,130;
The cash position for all years is at $7,029,634 and the estimated surplus for all
The Trust has no large claims over $90,000 (50% of the specific reinsurance
deductible) as compared to 11 large claims for the same period in 2011;
Medical, Prescription Drug, Dental and Short Term Disability claims are running
very well at 88.58%, 81.44%, 92.46% and 22.99%, respectively, of the year to date budget;
Overall the Trust is doing very well for the 2012-13 plan year.
10. Actuary Report
Kristi Olivas, the Trust’s actuary, reviewed the renewal rate development presentation and renewal actuary report for the 2013-14 plan year highlighting the following:
The report reflects a minimum, recommended and conservative increase to the
Plan experience charts were reviewed including medical claims experience,
prescription drug experience, combined experience, dental claims experience, and short term disability experience.
The various benefit changes that ECA had requested to be priced out for
11. 2013-14 Renewal Discussion and Budget Building
Jaime Schulenberg reviewed the proposed 2013-2014 budget in detail including the
various line items that make up the premium rates. The draft budget utilized minimum
recommended funding factors and assumed only those benefit changes required by
healthcare reform with the following insurance and administrative fees:
Life/AD&D coverage includes the reduction to $.04/$1,000 for the County
An estimated 15% increase to the stop loss premiums.
Third Party Administrator includes an overall estimated annual reduction of
$10,631 based on the anticipated award of a contract to a new TPA effective July 01, 2013.
Blue Cross Blue Shield of AZ (BCBSAZ) includes an increase of $.25/PEPM.
Rate increases for all of BCBSAZ’s CHS clients are being requested; the amount of the increased is based on the size of the group.
Erin P. Collins & Associates – Benefits Consulting/Pool Administration
Erin P. Collins & Associates – Wellness Consulting requested an increase of
Doug Kienitz, CPA proposed a slight rate increase with auditing services
Jones, Skelton and Hochuli (legal counsel) increased their current hourly rates
by $5/hr. in accordance with the contract.
The following vendors will retain their rates for the 12-13 plan year either due
to contract requirements or through negotiation: American Health Group; Buck Consultants; EAP Preferred; and Navitus Health Solutions.
Ms. Schulenberg also went over the proposed benefit changes that could either increase or decrease the funding factors. Trustees requested additional pricing on the in- and out-of-network dental schedule; those updated numbers will be presented at the Trust meeting scheduled for February 20, 2013.
The meeting was adjourned at 4:18 p.m. Respectfully Submitted, Jaime Schulenberg Account Manager
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