Budget Work Session Employee Self-Funded Medical Plan. Human Resources May 5, 2015
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1 Budget Work Session Employee Self-Funded Medical Plan Human Resources May 5, 2015
2 Purpose To provide the BCC with an overview of the Employee Self-Funded Medical Plan and proposed FY 2016 Budget.
3 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
4 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
5 Organizational Chart Human Resources Director (1 FTE) Human Resources (4 FTE) Risk and Benefits (3 FTE) Human Resources - Lake EMS (1 FTE)
6 Organizational Chart Human Resources Director (1 FTE) Human Resources (4 FTE) Risk and Benefits (3 FTE) Human Resources - Lake EMS (1 FTE)
7 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
8 Mission To develop, implement and support programs and processes that add value to the County and its employees, leading to improved employee wellbeing, growth and retention, while committed to the County s goals and its management and prosperity for its employees, citizens, and customers/businesses. This is accomplished through compliance with applicable employment law, current employment policies and procedures, thorough guidance to departments and employees, equal opportunity recruitment, and employee development/training opportunities, as well as pro-actively administering the risk and benefits programs for the County and other participating entities.
9 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
10 Levels of Service Lake County manages a self-funded medical plan for its employees and their dependents. The Plan covers the following organizations in Lake County: Board of County Commissioners, Metropolitan Planning Organization, Supervisor of Elections, Property Appraiser, Water Authority, Tax Collector, Lake Emergency Medical Services, Clerk of Courts Plan Membership Average of 1158 EE participants (all entities), including approximately 595 Lake County BCC employees. Average of 2746 total plan members
11 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
12 Accomplishments In July 2014, provided benefits services and enrollments to approximately 1,154 employees. Employee Health screenings were held during July Flu shot clinics were held in October benefits-related information sessions provided. Conducted an ongoing Diabetes Self-Management Program.
13 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
14 Efficiencies Self-funded plan If claims are lower than anticipated, the County can invest any savings and earn interest. In the event that claims are higher than usual, stop-loss insurance coverage can pay for excess costs. Use of the Florida Blue network provides discounts, medical services, and pharmacy, and resulted in annual savings of: $15,573,927 savings on billed medical charges $2,450,498 as a result of pharmacy discounts
15 Efficiencies Reduction in ASO fees from $47.25 to $41.99 per employee per month, with estimated reductions of $497,964 over the 3- year contract (including wellness contributions). Lower Administrative Cost for Flexible Spending Program from $4.50 to $3.50 per participant per month. Employee Assistance Program RFP lowered fees from $1.30 to $1.22 per employee per month. Vision RFP reduced aggregate employee cost by $4,800 per year.
16 Efficiencies Purchased excess loss insurance to protect Lake County from large claims. Lake County has been reimbursed from excess loss insurance, pharmacy rebates, and wellness contributions from Florida Blue: $1,024, in FY 2013 $1,284, in FY 2014
17 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
18 Benchmarks 2014 Estimates of Population, Lake and Surrounding Counties ,227, , , , , , , ,851 0 Lake Seminole Orange Osceola Polk Sumter Marion Volusia Florida Estimates of Population 2014 Bureau of Economic and Business Research, University of Florida
19 Benchmarks County Lake Orange Osceola Polk Seminole Sumter Volusia Marion Self-Funded or Fully Insured Self-Funded Self-Funded Self-Funded Self-Funded Self-Funded Self-Funded Self-Funded Fully Insured
20 Benchmarks Number of Active Employees Participating in the County Medical Plan Lake Seminole Orange Osceola Polk Sumter Marion Volusia
21 Benchmarks Percent of Employee Share of Premium (Employee only Coverage) 27.0% 30.5% 9.0% 12.0% 0.0% 0.0% 4.1% 0.0% 4.6% 13.3% 11.8% 11.8% 9.4% 0.0% 7.0% 13.0% 7.7%
22 Benchmarks Percent of Employee Share of Premium (Family Coverage) 37.9% 41.0% 43.1% 17.0% 19.0% 29.8% 22.6% 24.0% 15.0% 18.9% 12.4% 10.5% 9.2% 21.6% 14.0% 17.0% 23.0%
23 Benchmarks In-Network Out of Pocket Maximums (Per Person) $6,000 $5,000 $4,000 $3,000 $2,000 $2,000 $2,000 $1,500 $1,500 $2,450 $3,000 $3,000 $4,000 $4,000 $3,150 $3,800 $3,875 $2,500 $5,000 $5,500 $3,000 $5,000 $1,000 $0
24 Benchmarks In-Network Out of Pocket Maximums (Family Aggregate) $12,000 $10,000 $8,000 $6,000 $4,000 $4,000 $6,000 $3,000 $3,100 $4,900 $6,000 $6,000 $8,000 $8,000 $6,300 $7,600 $7,750 $11,000 $10,000 $6,000 $5,000 $5,000 $2,000 $0
25 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
26 Proposed Medical Plan Budget Estimated Revenue FY 2016 Fund Balance 22.9% County Budgeted Contribution per Position $ 10,778,000 Other Revenue 0.4% Employee/Retiree/COBRA Contributions $ 2,796,785 Other Revenue 70,000 Total Operating Revenues $ 13,644,785 Estimated Fund Balance $ 4,051,620 Total Revenues $ 17,696,405 EE/Retiree/C OBRA Contribution s 15.8% County Budgeted Contribution per Position 60.9%
27 Proposed Medical Plan Budget FY 2016 Proposed Budget Operating Expenses $ 14,727,446 Reserves $ 2,968,959 Total Expenditures $ 17,696,405 Includes medical plan design changes Increase to employee and employer contributions 8% increase in claims 20% increase in excess loss insurance premium Includes mandated reinsurance fees
28 Proposed Medical Plan Budget Estimated Expenditures FY 2016 Budget % of Budget Claims Payments $ 12,547, % Reserves $ 2,968, % Administrative Fees $ 1,364, % Insurance Premiums $ 567, % Transfers (Salaries) $ 165, % Professional Services $ 72, % Other Charges $ 10, % Total Expenditures $ 17,696, %
29 Presentation Outline Overview Organizational Chart Mission Levels of Service Accomplishments Efficiencies Benchmarks Marion, Orange, Osceola, Polk, Seminole, Sumter, and Volusia Proposed Budget Self-Funded Medical Plan Updates and Proposed Changes
30 Overview of the Medical Plan The biggest portion of the County s Benefits Program is the self-funded medical plan, also known as an Administrative Services Only Plan (ASO). ASO is an arrangement where the employer pays a fixed administrative fee and reimburses the carrier for health plan claims from its own funds. The arrangement includes paying ASO fees to a health network provider (Florida Blue), as well as purchasing excess loss insurance (Symetra) for large claims.
31 Overview of the Medical Plan Plan Year is from October 1 through September 30 of each year. Employees are allowed to make election changes during the year if they have a qualifying event and also during Open Enrollment which takes place each year during the month of July. The County has two medical plan options: an HMO and a PPO plan. The plans are provided through Florida Blue. The HMO and PPO networks include Lake County hospitals and physicians as well as providers state-wide and national.
32 Overview of the Medical Plan Both the HMO plan and the PPO plan currently have two tiers of coverage. Employee and Employee plus Family. This allows the employees to choose from one of four options to provide health insurance coverage. Each of the four choices have different costs to the employee for premiums, prescription copays, and other employee paid costs.
33 Full Premium Equivalent The County s Actuarial Consultant determined the selffunded medical plan full-premium equivalent to be: HMO Per Month PPO Single $ $ Family $1, $1,406.19
34 MILLIONS Historical Overview $16.00 $14.00 Revenue vs. Expenditure $12.00 $10.00 $8.00 $6.00 $4.00 $2.00 $0.00 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 Proj Revenue Expenditure
35 Historical County Budgeted Contributions per Position $12,000 $10,925 $10,000 $8,000 $7,800 $9,500 $8,734 $8,200 $7,000 $6,900 $6,900 $6,900 $6,000 $5,500 $4,000 $2,000 $0 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015
36 Employee Contributions The current employee contributions are listed below and have not changed since FY 2008: Per Pay Period HMO PPO Single $26.25 $34.65 Family $ $136.96
37 $ MILLIONS Historical Overview Claims Payments % % FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 Bud FY 2016 Est FY 2017 Est Claims Payments Net Claims Payments
38 $ MILLIONS Historical Overview Fund Balance FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 Bud FY 2015 MYA 0.10 FY 2016 Est FY 2017 Est
39 $ MILLIONS Historical Overview Reserves (2.00) 0.10 Shortfall FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 Bud FY 2015 MYA FY 2016 Est FY 2017 Est (4.00) (6.00) (5.05)
40 FY 2016 Budget (Proposed) For FY 2016 Budget, staff recommends the following: 1. Change to plan design based on utilization 2. Increase employee contribution 3. Increase departmental budget contribution per position per year
41 FY 2016 Budget (Proposed) For FY 2016 Budget, staff recommends the following: 1. Change to plan design based on utilization 2. Increase departmental budget contribution per position per year 3. Increase employee contribution
42 Claims Utilization Analysis County staff identified several areas where the County has experienced high utilization and/or high costs including: Facility Copays (Inpatient, Outpatient, Emergency Room, Urgent Care) Imaging Copays (e.g., MRI, CT Scan, X-Ray) Pharmacy Copays Professional Services Out of Pocket Annual Maximums
43 Facility: Emergency Room ER Visits % visit increase 26% increase in cost, for FY 2014 total of $1,188,331 of claims FY 2014 FY 2013 ER Visits Ill Defined Conditions visits were 149 and cost was $437,685
44 Emergency & Urgent Care Facility FY 2014 Plan Cost Visits Emergency Room $2, Urgent Care $100 1,017 32% of Lake County ER visits occur during the weekend compared to Florida Blue average of 25% ER visits increased 31% while Urgent Care visits increased by 9.6%
45 Outpatient Surgery Facility FY 2014 Plan Paid Visits Outpatient Hospital $5, Ambulatory Surgical Center $ Of the $702,198 paid claims for outpatient surgeries, $685,127 was paid to hospitals for the surgeries.
46 Imaging Service FY 2014 Outpatient Hospital Free Standing Plan Cost Visits Plan Cost Visits CT/MRI $1, $ Imaging $ $ Imaging costs for FY 2014 were $692,159. The Outpatient Hospital cost increased by $223,546 and the Free Standing decreased by $3,470 from FY 2013.
47 Pharmacy Type Scripts % Total Cost % Cost Cost/Rx Generic 21, % $583, % $27.10 Brand 5, % $1,443, % $ Specialty % $367, % $3, Total 26, % $2,394, % $88.68 Total Pharmacy cost in FY 2014 was $2,394,309 and Plan Cost was $1,987,309, an increase of 17.2%. Fastest growing cost is Specialty Pharmacy
48 Average Costs per Other Services 10/1/13 9/30/14 Service Average Cost Visits/Services Hospital Admission $16, DME $ Laboratory $81 1,096 PCP Visits (Including Physicals) $110 4,603 Specialist Visits $177 10,448 Ancillary Professionals $196 2,381
49 Proposed Plan Changes In summary, the proposed plan design changes include the following: 1. Imaging Copays (e.g., MRI, CT Scan, X-Ray) 2. HMO and PPO Emergency Room copay 3. Rx and Durable Medical Equipment/Supplies Copays 4. HMO Inpatient Hospital copay 5. HMO Outpatient Hospital copay 6. Out of Pocket Maximum
50 Proposed Plan Design Changes COST SHARING BlueChoice PPO PPO Changes BlueCare HMO HMO Changes Out of Pocket Maximum $2,000 / $6,000 $3,000/$6,000 $2,000 / $4,000 $3,000/$6,000 Physician Office PCP/Specialist $20/$35 $20/$45 $20/$35 $20/$45 Wellness Examination $20/$35 $0/$0 $20/$35 $0 /$0 Convenient Care $15 $20 $20 $20 Emergency Room $50 $250 $100 $250 Urgent Care $20 $50 $30 $50 Independent Clinical Lab 20% (No DED) $0 $20 Advanced Imaging/ Other Imaging 20%/$35 20%/$35 20%/$75 20%/$50 $200/$0 $15 $300/$75 $50/$50 Inpatient Hospital DED + 20% $200 per day up to $300 per day up to $1,000 $1,200 Outpatient Hospital DED + 20% $200 $300 DME DED + 20% $0 $50 Pharmacy Generic/Brand 2/Brand 3 $15/$25/$40 $15/$40/$55 $15/$25/$40 $15/$40/$55 Pharmacy Specialty $40 $100 $40 $100
51 Proposed Plan Design Changes Assuming utilization would have remained the same, the proposed plan design changes are expected to result in an estimated cost shift of $589,312 from the health insurance fund to the employees in FY 2016.
52 FY 2016 Budget (Proposed) For FY 2016 Budget, staff recommends the following: 1. Change to plan design based on utilization 2. Increase employee contribution 3. Increase County budget contribution per position per year
53 Employee Contributions Staff recommends a 10% increase to employee contributions. Per Payperiod Current per Pay Period Proposed 10% Increase/PP HMO Single $26.25 $28.88 $2.63 Dollar Increase/PP HMO Family $ $ $11.32 PPO Single $34.65 $38.12 $3.47 PPO Family $ $ $13.70 This change will result in an estimated cost share increase for employees of approximately $226,880.
54 FY 2016 Budget (Proposed) For FY 2016 Budget, staff recommends the following: 1. Change to plan design based on utilization 2. Increase employee contribution 3. Increase County budget contribution per position per year
55 County Budget Contribution per Position per Year Staff recommends that the County increase the budget contribution for benefits from $6,900 to $8,500 per position per year. This will be across all County Funds and will also impact Lake EMS and the other participants in the health insurance plan. This change will result in an increase of approximately $2,020,800 to the health insurance fund.
56 Employer Contribution Impacts $6,900 $8,500 Difference General Fund County Depts $1,255,109 $1,554,649 $299,540 Constitutionals (TC, PA, Clerk, SoE) $2, $2,822,000 $531,200 Total GF impact $3,545,909 $4,376,649 $830,740 Fire Fund $1,412,776 $1,740,376 $327,600 Lake EMS $1,328,250 $1,636,250 $308,000 Other Funds and Agencies $2,427,765 $2,982,225 $554,460 Total Impact All Funds $8,714,700 $10,735,500 $2,020,800
57 Summary of Proposed Changes FY 2016 Proposed Health Benefit Fund changes are in 3 areas: Plan Design Changes Estimated cost shift for claims for employees of $589,312 Increase in Employee Contribution $226,800 Increase in budgeted Employer Contribution $2,020,800 Total Fiscal Impact - $2,836,912
58 $ MILLIONS Updated Reserves with Proposed Changes Reserves FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 Bud FY 2015 MYA FY 2016
59 Next Steps Ongoing communication with employees on plan design changes and ways to reduce the financial impact of those changes on the employee. Implement plan design changes with Florida Blue. Conduct open enrollment sessions with information on the new self-funded medical plan design.
60 Next Steps The County will need to continue to explore options in the future to manage the claims experience including: Analyzing the effects of the proposed plan design changes on claims trends Looking at plan changes that could include high deductible plans and HSA s (Health Savings Accounts) Looking at other options including an employee health clinic and increasing wellness programs
61 Requested Action Approve Tab 19, proposed changes to the Lake County Selffunded Employee Medical Plan, for Fiscal Year
62
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