Report to Benefits Administration Committee

Transcription

1 Report to Benefits Administration Committee Agenda of: FEBRUARY 24, 2015 From: Thomas Moutes, General Manager ITEM: III SUBJECT: STRATEGIC PLAN HEALTH PLAN DATA INITIATIVE AND DASHBOARDS Recommendation: That the Committee receive and file this report. Discussion: Background As part of LACERS Strategic Plan, staff developed a health plan data initiative to meet Goal 3: Maximize Value and Minimize Costs of our Health and Welfare Program. The purpose of the program is to review various health plan data reports to better understand costs and trends, and to identify cost drivers that have the potential to be mitigated. Once such cost drivers have been identified, staff and its health and welfare consultant, Keenan and Associates (Keenan), will develop strategies to minimize their impact in an effort to reduce health plan premium increases. The results of these efforts will be monitored and reported back to the Board through health plan dashboards. Keenan developed a set of web-based dashboards to track utilization and cost trends associated with LACERS health plans, as they relate to diagnostic categories, inpatient and outpatient claims, and high cost claims and therapies. These health plan data dashboards are useful in monitoring the performance of each plan, explaining changes in premiums, and informing health plan decisions and negotiation points during contract renewals. Additionally, they may guide staff s communications and wellness efforts to encourage our Members to utilize their plans in a more cost-effective manner. Staff and Keenan, in meetings with Anthem Blue Cross and Kaiser Permanente, identified diagnostic categories that are having the greatest impact on premium costs. (More attention is placed on these two plans because they are able to provide the greatest amount of data and provide coverage to over 90% of our plans covered lives.) These categories are: Circulatory (e.g. cardiovascular disease), Musculoskeletal (e.g. osteoarthritis), Neoplasms (e.g. breast cancer), Obesity, and Diabetes. Strategies to reduce the claims costs and utilization trends associated with each of these diagnostic categories are being developed and will integrate with staff s wellness efforts. As a means of monitoring and reporting on the impact of the data initiative/wellness program strategies, Keenan has developed wellness-related dashboards to reflect any changes in participation in wellness programs and resources available to Members through their LACERS medical plan. These dashboards will compliment the health plan data dashboards. Committee Report 1 February 24, 2015

2 Staff and Keenan will be present to share highlights from the current set of data dashboards and discuss forthcoming contract renewal and program strategies. Strategic Plan Impact Statement The health plan dashboards support Strategic Plan Goal 3, Maximize Value and Minimize Costs of our Health and Welfare Program. These dashboards give the Board and LACERS staff insight into health plan utilization, which allows staff to develop strategies to minimize future increases in premium costs. This report was prepared by Alex Rabrenovich, Chief Benefits Analyst of the Health Benefits Administration and Communications Division. TM:AR Attachments: 1) Keenan Cover Memorandum 2) Keenan Reports 2015 Financial Dashboard and 2015 Health Management Dashboard Committee Report 2 February 24, 2015

3 Report to the Benefits Administration Committee Discussion Overview: Keenan has created financial and health management dashboards to monitor changes in utilization, anticipate contract renewal discussions, and assist in developing costsaving strategies. These dashboards provide a progress report with updated utilization and key condition management performance indicators. These dashboards will assist LACERS in making informed decisions to manage health care utilization and costs. By identifying key cost drivers, the dashboards will integrate with the renewals to monitor the plans more effectively. The Financial Dashboard Executive Overview The interactive dashboard provides financial and graphical presentation of the plan utilization from selected LACERS insurance carriers. These multi-carrier performance indicators will identify key cost drivers and plan performance metrics. This data analytical program will assist LACERS in quickly identifying emerging health plan utilization trends and measuring health plan cost and overall performance. The dashboard is web-based and available in a mobile device platform. The Financial Dashboard is a snapshot of premiums, claims and member utilization for the years of 2010 through 2013 for Kaiser, Anthem Medical, MetLife and VSP. The Health Management Dashboard Executive Overview The Health Management Dashboard is provided to LACERS to assist with overall development and coordination of the wellness program. It provides details of the Anthem and Kaiser groups prevalence rates and provides a history of total claims costs for chronic health conditions Details of health conditions, preventive care measures, condition management, health risks and wellness program participation are provided. The dashboard will provide the metrics to help guide the LACERS Well program and other health management initiatives, with the primary goals of avoiding unnecessary health care utilization, controlling future health care costs, and optimizing quality of life for LACERS members throughout their retirement years. 1

4 Analysis The information provided today has already allowed us to focus in on outreach opportunities to members with specific chronic conditions to help alleviate some of the inpatient claims as inpatient surgical is proven to be LACERS highest cost driver. Improving member engagement in utilization, case, and disease management programs are key to keep high cost drivers down. We share the dashboard findings with the carriers for the upcoming renewal and focus on the carrier programs to control inpatient utilization, increase outpatient services, reduce readmissions and assist in monitoring the high claimants. An area of concentration for the 2016 renewal is Kaiser. Today we examine recent claims experience to validate dashboard findings and explore plan alternatives for the future. By reviewing the recent experience we monitor the trend of the data which will assist us with renewal planning. However, the dashboard data will not impact the 2016 renewal as the carriers will use the most recent 2014 experience which is more current than the dashboard at this time. The true dashboard usefulness is to identify trends and tie them to the recent experience. This is our value proposition to the carriers as we provide them with additional focused data to implement cost effective measures. We know the LACERS population is growing older, sicker, and unfortunately heavier, with high rates of cardiovascular disease, hypertension, and diabetes. With the obesity-prone baby boomer generation heading into retirement, these conditions will continue to grow in prevalence among LACERS members and result in additional medical spending. To address these prominent health issues, the LACERS Well program promotes physical activity, healthy eating, and weight management along with member engagement in the program components. Through member outreach, education, and promotion of better health practices for both early and post-65 retiree, the goal of LACERS Well is to bend the medical care utilization curve and impact future renewals. Using the data provided in the data dashboards, LACERS can also pursue other strategies that will have an impact on the renewals, such as utilizing Accountable Care Organizations networks within Anthem and more closely reviewing high-cost facilities. Steerage into network facilities and use of urgent care vs. emergency rooms will help to keep health care costs down, which will ultimately impact the renewals. Performance guarantees can be used to hold the carriers accountable for utilization management. Tracking chronic disease rates and condition management metrics will help to drive the carriers involvement in engaging their members, resulting in better health outcomes and reduction in avoidable health care costs. 2

5 Prescription drugs are also continual high-cost drivers. LACERS brand name drug utilization has seen increases on the Kaiser plan, and has a stabilizing trend with the Anthem plan. Managing the carriers drug formularies and adjusting copays can assist in lowering the costs. We know that endocrine, antineoplastic, and cardiovascular therapy drugs are some of the most prevalent in the LACERS population. We will review condition management metrics and Rx utilization to assure appropriate medication management and adherence to drug therapy, such as use of beta blockers and non-rescue drugs, to avoid emergency room visits or inpatient hospitalization. We are continually seeking to implement innovative programs to assist the retirees in staying healthy and maintaining their quality of life. 3