Report to Benefits Administration Committee

Transcription

1 Report to Benefits Administration Committee Agenda of: MAY 7, 2013 From: Alex Rabrenovich, Chief Benefits Analyst ITEM: III SUBJECT: MEDICAL PLAN REQUEST FOR PROPOSAL (RFP) AND POSSIBLE COMMITTEE ACTION Recommendation: That the Committee discuss medical plan RFP proposals and recommend medical plan RFP finalists for continued evaluation, discussion, and negotiation. Discussion: On February 8, 2013, LACERS released a Medical, Mental Health, and Disease/Care Management RFP. The submission deadline was March 15, However, the deadline was extended until May 3, 2013, to allow for more complete submissions from interested parties. Below is a list of RFP respondents: Medical Plan Aetna Anthem Blue Cross Blue Shield of California Health Net Humana Kaiser Permanente SCAN Health Plan UnitedHealthcare (UHC) Mental Health Managed Health Network (MHN) Disease/Care Management Health Dialog Provant Keenan & Associates (Keenan), LACERS health and welfare consultant, reviewed the proposals. LACERS staff also conducted a review and met with Keenan to discuss the proposals, determine how well each proposal met the requirements of the RFP, and ascertain proposal scores. Committee Report 1 May 7, 2013

2 Based on these scores, staff and Keenan will be recommending finalists to the Committee. Upon approval of the finalists, Keenan will continue with more detailed evaluations of their proposals and begin discussions and negotiations related to their findings. Staff will return to the Committee with its final recommendations once the evaluations are completed. Keenan will be present to discuss the RFP process in greater detail and answer questions. Note: On March 22, 2013, LACERS released a Medicare Exchange RFP with a proposal submission deadline of April 29, The submitted proposals are still under review and staff will share its findings and recommendations at a future Committee meeting. Strategic Plan Impact Statement Conducting a medical plan RFP process allows staff to ensure that our medical plan premiums are competitive in the marketplace and supports Strategic Plan Goal 3, Maximize Value and Minimize Costs of our Health and Welfare Program. This report was prepared by Alex Rabrenovich, Chief Benefits Analyst of the Health Benefits Administration and Communications Division. AR:AR Attachments: 1) Keenan Presentation, 2014 Request for Proposal Medical, Mental Health, and Disease/Care Management Programs Summary of Results 2) Revised RFP Timeline Committee Report 2 May 7, 2013

3 ATTACHMENT Request for Proposal Medical, Mental Health and Disease/Care Management Programs Summary of Results Respectfully Submitted by: Steve Gedestad, Executive Vice President Jovita JJ Juanillo, Senior Vice President Isabella Janus, Consultant Erin Robinson, Senior Service Representative Michael Ahn, Asst Vice President May 7,

4 Contents Introduction Page 3 Request for Proposal Finalist Scoring Summary Page 4 Request for Proposal Financial Summary Page 7 Proposed Medical Plans Summary Page 8 Summary of Provider Network Analysis Page 11 Summary of Mental Health Program Proposals Page 13 Summary of Disease and Care Management Proposals Page 14 Recommendations Page 17 Acknowledgement Page 18 Appendix 2

5 Introduction This report presents our preliminary results from the 2014 Request for Proposal for medical, mental health and disease management programs. Our summary will provide finalist recommendations for the 2014 plan year. The results are preliminary and do not represent carrier s finalized premium rates and plan arrangements. Anthem, Blue Shield and United Healthcare are the three most competitive health plans. 3

6 Request for Proposal Finalist Scoring Summary Following is a summary of the carrier proposal scoring: Request for Proposal - Carrier Scoring Assigned Categories Scoring Anthem Aetna Blue Shield HealthNet Humana SCAN United Healthcare Financial Cost and Value Provider Disruption and Member Access Quality and Member Service Administrative Support and Account Management Service Total Scoring Carrier Scoring Rank The Request for Proposal category scoring is based on close consultation with LACERS staff and the City Attorney s office. 4

7 Request for Proposal Finalist Scoring Summary The scoring factors for the proposals are based on the following significant items: Financial Cost and Value: Overall rating competitiveness Plan design value Value added programs Provider Disruption and Member Access: Network accessibility for HMO, PPO and LPPO programs Network discount and overall competitiveness Quality and Member Service: Overall depth of Retiree only plan experience Service team experience Performance guarantee conditions Administrative and Account Management Support Account Executive and Senior Management support and experience Accuracy and promptness of responses to the Request for Proposal 5

8 Request for Proposal Finalist Scoring Summary In addition, the Request for Proposal finalist scoring included the following consideration: Overall quality and financial strength rating of carrier Attention to details in carrier proposals Clarity of facts and communication in carrier proposals Demonstrated ability to follow Request for Proposal directions Depth of experience and understanding of Retiree population Flexibility of financial and service arrangements and products Carrier s innovation in products and services for a Retiree population The category scoring methodology conforms fully to the industry standard and is highly recommended. 6

9 Request for Proposal Financial Summary Financially, Anthem, Blue Shield and UnitedHealthcare represent the three most competitive carriers. Blue Shield and UnitedHealthcare proposals do not completely duplicate the current Anthem plans and arrangement. We will need further review of conditions and requirements. 7

10 Request for Proposal Proposed Medical Plans Summary Following is a summary of carrier proposed medical plans: Current Plans Financical Arrangement Anthem Aetna Blue Shield HealthNet Humana SCAN United Healthcare Anthem PPO Participating, Refund Eligible Quoted Quoted Quoted Quoted Not Quoted Not Quoted Quoted - Non Par HMO Participating, Refund Eligible Quoted Quoted Quoted Quoted Not Quoted Not Quoted Quoted - Non Par MA-PD PPO Non-Paricipating, Non Refundable Quoted Quoted Not Quoted Not Quoted Quoted Not Quoted Quoted Optional Plans MA-PD PPO Participating, Refund Eligible Quoted Not Quoted Not Quoted Not Quoted Not Quoted Not Quoted Not Quoted Medicare Supplement Participating, Refund Eligible Quoted Not Quoted Quoted Not Quoted Not Quoted Not Quoted Not Quoted United Healthcare MA-PD HMO CA Non-Paricipating, Non Refundable Not Quoted Quoted Quoted Quoted Quoted Not Quoted Quoted MA-PD HMO AZ Non-Paricipating, Non Refundable Not Quoted Quoted Not Quoted Not Quoted Quoted Not Quoted Quoted MA-PD HMO NV Non-Paricipating, Non Refundable Not Quoted Quoted Not Quoted Not Quoted Quoted Not Quoted Quoted SCAN MA-PD HMO Non-Paricipating, Non Refundable Not Quoted Quoted Quoted Quoted Quoted Quoted Quoted PROPOSAL CONTINGENCY Aetna, Blue Shield, HealthNet and United Healthcare proposals assume full replacement of Anthem plans. Aetna, Blue Shield, HealthNet and UnitedHealthcare proposals are contingent to full replacement of current Anthem plans. For the Medicare Advantage Prescription Drug (MA-PD) plans, all carrier proposals are subject to approval by CMS. 8

11 Request for Proposal Proposed Medical Plans Summary Anthem s proposal includes the following significant items: Medicare Supplement plan is offered as replacement option to the LPPO Medicare Advantage plan. A participating, refunding LPPO Medicare Advantage plan is offered versus the current, non-participating arrangement. As an option, the HMO Select Network plan is offered at lower rate than the current HMO plan. Blue Shield s proposal includes the following significant items: Medicare Supplement plan is offered as replacement option to the Anthem LPPO Medicare Advantage plan. Medicare Advantage, PPO network based plan cannot be offered to replace Anthem s LPPO Medicare Advantage plan. Proposed HMO and PPO plans closely match the current Anthem plans. 9

12 Request for Proposal Proposed Medical Plans Summary UnitedHealthcare s proposal includes the following significant items: Medicare Advantage PPO network plan is offered as replacement to the Anthem Medicare Advantage LPPO plan. This is UnitedHealthcare s first year introducing this product in California. HMO, PPO and Medicare Advantage plans are quoted only on a nonparticipating, non-refunding basis. Further clarification is needed on the HMO and PPO plans offered as replacement to the current Anthem plans. The performance guarantee category measurements are not specified. The SCAN proposal is only for its own Medicare Advantage plan. It does not include a proposal to replace Anthem plans. A detailed plan benefits comparison of the carrier programs is shown in the Appendix Proposed HMO and PPO Plan Summary. 10

13 Summary of Provider Network Analysis Following is a summary of carrier network analysis: Categories Anthem Aetna Blue Shield HealthNet United Healthcare HMO Network Accessibility Highly Accessible Accessible Accessible Accessible Highly Accessible HMO Network Financial Competitiveness High Competitive High Competitive High Competitive Competitive Highly Accessible PPO Network Accessibility Highly Accessible Accessible Highly Accessible Accessible Accessible PPO Network Financial Competitiveness High Competitive High Competitive High Competitive Competitive Competitive LACERS Top 20 Hospital Facilities In-Network and In-Network and In-Network and Not Provided Not Provided Fully Available Partially Available Fully Available Notes: 1. Humana and SCAN are not listed above due to lack of HMO and PPO networks in California. Our analysis compared the carrier HMO and PPO network in accessibility and financial competitiveness. Further, we reviewed LACERS specific top 20 hospitals in HMO and PPO utilization during the past 12-months. 11

14 Summary of Provider Network Analysis Anthem s provider network is the most competitive overall among the carriers both financially and accessibility. Blue Shield and UnitedHealthcare provided the next most competitive networks. A further provider network analysis will be performed during the finalist review process, including for the Medicare Advantage program. A detailed HMO provider disruption analysis and LACERS top hospital listings are provided in the Appendix. - Appendix HMO Medical Group Disruption Report - Appendix LACERS Top Hospital Contract Summary 12

15 Summary of Mental Health Program Proposals As a part of the Request for Proposal, we requested carriers to propose a mental health services program. Our request was in response to the recent utilization increase in mental health services, particularly in the Kaiser plan: - Kaiser Mental Health In-Patient Claims on a Per Member Per Month (PMPM) Basis: $15.05 PMPM (2011) vs. $5.35 PMPM (2010) or a 181% increase. The medical carrier proposals did not produce any significant mental health program advantages. We recommend further review of Kaiser s mental health utilization during the finalist review. 13

16 Summary of Disease and Care Management Program Proposals As a part of the Request for Proposal, we requested carriers to propose a disease and care management program for Anthem subscribers. The carrier proposals did not produce any significant program advantages compared to the current Anthem program. Anthem s current disease and care management program is financially the most competitive and advantageous. Anthem has proposed to offer in 2014, 2015 and 2016 the following disease and care management programs for its subscribers: - Condition Care - 24/7 Nurseline and My Health Advantage Gold - Time Well Spent 14

17 Summary of Disease and Care Management Program Proposals In addition, Anthem has offered to its subscribers following programs at no cost in 2014, 2015 and 2016: - Diabetes, Asthma, Heart Failure, Coronary Artery Disease and Chronic Obstructive Pulmonary Disease - Oncology Program - Depression Screening - Physician Messaging 15

18 Summary of Disease and Care Management Program Proposals Further, we recommend a close integration of Keenan s wellness program team with Anthem and Kaiser s disease and care management team. A cooperation with Keenan s wellness program team with each carrier should result in overall improvement in the performance of disease and care management programs. 16

19 Recommendations Based on our initial review of the carrier responses to the Request for Proposal, our findings are as follows: Recommend Anthem, Blue Shield, Kaiser, SCAN and UnitedHealthcare as finalists for the interview and selection process. Review and negotiate with finalist carriers to include additional available data. Recommend to continue with current mental health services program with close attention to Kaiser utilization during finalist review. Recommend the continuation of Anthem s disease and care management program with greater involvement of Keenan s wellness program team. Review Kaiser s preliminary and final proposals and recommend appropriate findings. 17

20 Acknowledgement Keenan & Associates would like to thank Ms. Lita Payne, Mr. Alex Rabrenovich and the LACERS Health Benefits Administration staff for providing the necessary data for this preliminary renewal study. Their cooperation and guidance have been extremely valuable. 18

21 Appendix Proposed HMO Plan Summary Proposed PPO Plan Summary HMO Medical Group Disruption Report LACERS Top Hospital Contract Summary Performance Guarantee Comparison 19

22 Appendix Proposed HMO Plan Summary HMO Benefits Anthem Aetna Blue Shield Lifetime Maximum Unlimited Match Match Deductible None Match Match Annual Out of Pocket Maximum Individual $500 Match Match Family $1,500 Match Match Office/Urgent Care Visit $20 copay Match Physician Office Visit/ Urgent Care in area: $20 Out of area urgent care is offered through our BlueCard Program at $50/visit. Routine Physical Exam $20 copay No Charge Preventive Exam: No charge. Benefit offered in compliance with Health Care Reform. All other Office Visits: $20 per visit Hospital Services No Charge Match Match Emergency Services $100 copay, waived if admitted Match Match Prescription Drug Benefits Blue Shield of California standard edits, limitations, and formulary apply. Retail (30-day supply): Generic / Preferred Brand / Non-Preferred Brand $5/$25/$50 copay Match Match Note: BSC formulary applies. Specialty Mail Order (90-day supply): Generic / Preferred Brand / Non-Preferred Brand $10/$50/$100 copay Match Match Benefits Available - Inpatient Basis Inpatient Surgery No Charge Match Match Hospice Care No Charge Match Match Skilled Nursing Care No Charge; 100 days per calendar yr Match Match Benefits Available-Outpatient Basis Outpatient Surgery No Charge Match Match Physical Therapy $20 copay Match Match Allergy Testing / Treatment $20 copay Match Match Chiropractic Services $20 copay Match Match Limited to 30 visits per year Match Match Durable Medical Equipment No Charge Match Match Home Health Care No Charge; 100 days per calendar yr Match Match Lab and Radiology No Charge Match Match Mammography $20 copay No Charge No Charge, benefit offered in compliance with Health Care Reform. Mental Health / Substance Abuse Inpatient No Charge Match Match Unlimited Visits Outpatient $20 Match Match Unlimited Visits United Healthcare - Did not provide benefit deviation summary 20

23 Appendix Proposed PPO Plan Summary PPO Anthem Anthem Aetna Blue Shield of California Benefits In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Lifetime Maximum $2,000,000 An unlimited lifetime maximum will apply. PPACA prohibits applying plan dollar lifetime maximums. Unlimited Deductible Individual $750 Match Match Family $1,500 Match Match $2,000 per individual $5,000 per individual $10,000 per family Annual Out of Pocket Maximum $5,000 $5,000 Match Match $4,000 per family Office/Urgent Care Visit $20 copay 70% after deductible Match Match Match Match Routine Physical Exam 100% (no maximum) 100% (no maximum) Match Match Match Match Hospital Services 90% after deductible 80% after deductible Match Match Match Match Emergency Services 90% after deductible 90% after deductible Match Match Match Match Prescription Drug Benefits Retail (30-day supply): $5/$25/$50 copay 80% (deductible does not apply) Match Match Match Generic / Preferred Brand / Non-Preferred Brand Mail Order (90-day supply): $ 10 / $ 50 /$100 copay Not Covered Match Match Match Generic / Preferred Brand / Non-Preferred Brand Benefits Available - Inpatient Basis Inpatient Surgery 90% after deductible 80% after deductible Match Match 90% after deductible Member pays 20% of billed amount plus applicable retail copayment Match 80% after deductible The maximum allowed charges for non-emergency hospital services received from a non-preferred hospital is $600 per day. Members are responsible for 20% of this $600 per day, plus all charges in excess of $ % Hospice benefits are provided in accordance with Hospice Care 80% 80% Match Match Match AB 892. Non-preferred benefits are covered at the preferred level when prior authorized. Skilled Nursing Care 90% after deductible 70% after deductible Match Match Match 90% after deductible 100 days per year maximum Match 100 days per year maximum (3 day inpatient stay required) (3 day inpatient stay not required) (3 day inpatient stay required) Freestanding Skilled Nursing benefits are paid at the preferred level with prior authorization. Skilled Nursing in a facility: The maximum allowed charges for non-emergency hospital services Benefits Available-Outpatient Basis Outpatient Surgery 90% after deductible 70% after deductible Match Match Match Match The maximum allowed charges for non-emergency surgery and services performed in a nonparticipating Ambulatory Surgery Center or outpatient unit of a non-preferred hospital is $350 per day. Members are responsible for 30% of this $350 per day, plus all charges in excess of $350. Physical Therapy 90% after deductible 70% after deductible Match Match Match Match Allergy Testing / Treatment 90% after deductible 70% after deductible Match Match Match Match Chiropractic Services $20 copay 70% after deductible Match Match Match Match Limited to 30 visits per year Durable Medical Equipment 90% after deductible 70% after deductible Match Match Match Match Home Health Care 90% after deductible 70% after deductible Match Match Match 90% after deductible The number of home health visits must not be less than 100 in any calendar year or in any continuous Limited to 60 visits per year 12-month period for each person covered under the plan, per CA.mandate. Match Match Lab and Radiology 90% after deductible 70% after deductible Match Match Mammography 100% after deductible 70% after deductible No cost sharing/no deductible will apply for innetwork preventive care. PPACA requirements Match Match Match prohibit applying cost sharing to in-network preventive services. Mental Health / Substance Abuse Inpatient 90% after deductible 80% after deductible Match Match Match Match Unlimited Visits Outpatient $20 copay 70% after deductible Match Match Match Match Unlimited Visits United Healthcare - Did not provide benefit deviation summary 21

24 Appendix HMO Medical Group Disruption Report Anthem Aetna Blue Shield United Healthcare HMO MEDICAL GROUP DISRUPTION REPORT County State In-Network In-Network In-Network In-Network Access Medical Group Inc Los Angeles CA x x x Adoc Orange CA x x x Alamitos IPA Los Angeles CA x x x x Alliance IPA Los Angeles CA x x Allied Physicians of Calif Los Angeles CA x x x x Antelope Valley Medical Group Los Angeles CA x Arcadia Health City Los Angeles CA x Axminster Medical Group Inc Los Angeles CA x x x x Bay Area Com Med Grp Los Angeles CA x Beaver Medical Group San Bernardino CA x x x x Bright Medical Associates Los Angeles CA x x x Bristol Park/El Toro Orange CA x x Bristol Park/San Juan Capistra Orange CA x x Caremore Medical Group Los Angeles CA x Cedars Los Angeles CA x x x Centinela IPA Los Angeles CA x x x x Chino Medical Group Inc San Bernardino CA x x Cmg Agoura Hills Los Angeles CA x Cmg Thousand Oaks Los Angeles CA x Community Medical Group IPA Los Angeles CA x Csmg/Cedars Los Angeles CA x x x Desert Medical Group Inc Riverside CA x Desert Valley Medical Group San Bernardino CA x x x Downey Select IPA Medical Grp Los Angeles CA x Eastland Medical Group Inc Los Angeles CA x x Facey Medical Found Los Angeles CA x x x x Facey Medical Foundation Los Angeles CA x x x x Facey/Alhambra Medical Clinic Los Angeles CA x x x Freeman Medical Group IPA Los Angeles CA x Gateway Medical Group Orange CA x x x x Gateway Phy Med Assoc@placenti Orange CA x x Genesis Healthcare Orange CA x x x x Glendale Memorial Medical Grp Los Angeles CA x Glendale Physicians Alliance Los Angeles CA x Golden Empire Managed Care Kern CA x x x Good Sam Med Prac Assoc Los Angeles CA x x x Greater Newport Phys@hoag Hosp Orange CA x x x x Greater Valley IPA Holy Cross Los Angeles CA x x Greater Valley IPA Northridge Los Angeles CA x x Greater Valley MG Holy Cross Los Angeles CA x x Greater Valley MG Northridge Los Angeles CA x x Guardian Medical Associates Ip San Bernardino CA x Harriman Jones La Palma Los Angeles CA x x x Harriman Jones Medical Group Los Angeles CA x x x Healthcare Partners Los Angeles CA x x x x Healthcare Partners Med Grp Los Angeles CA x x x x Healthcare Prtn Prov Ntw/Glend Los Angeles CA x x x x Healthcare Prtn Prov Ntw/Pasad Los Angeles CA x x x x Hemet Community Medical Group Riverside CA x x x x Heritage Physician Network Kern CA x x Heritage Victor Valley Med Grp San Bernardino CA x x x x High Desert Medical Group Los Angeles CA x x x x High Desert Primary Care MG San Bernardino CA x x x x Hill Physicians / East Bay Alameda CA x x x x Hollywood Presbyterian Medical Los Angeles CA x x x Inland Health Care Group San Bernardino CA x x x La Salle Medical Associates Los Angeles CA x La Vida Burbank Los Angeles CA x La Vida Image Los Angeles CA x La Vida Medical Group And IPA Los Angeles CA x La Vida Multispecialty Medical Los Angeles CA x Lakeside MG Burbank/N Hlywd Los Angeles CA x x x x Lakeside MG Central Valley Los Angeles CA x x x x Lakeside MG North Valley Los Angeles CA x x x x Lakeside MG Santa Clarita Los Angeles CA x x x x Lakewood Health Plan Inc Los Angeles CA x x x x Loma Linda University Health C San Bernardino CA x x x Magan Medical Clinic Los Angeles CA x x Memorial Healthcare Ipa/Lb Los Angeles CA x x x Memorial Healthcare/Orange Coa Orange CA x x x Memorial Medical Group Los Angeles CA x x x Midcoast IPA Santa Barbara CA x x Monarch/Orange County Orange CA x x x Monarch/Saddleback Mem Hosp Orange CA x x x x Monarch/South Coast Orange CA x x x 22

25 Appendix HMO Medical Group Disruption Report Anthem Aetna Blue Shield United Healthcare HMO MEDICAL GROUP DISRUPTION REPORT County State In-Network In-Network In-Network In-Network Northridge Medical Group IPA Los Angeles CA x x x Oasis IPA Riverside CA x Ojai Valley Medical Group Ventura CA x Omnicare Medical Group Los Angeles CA x x x Pacific Independent Phy Assoc Los Angeles CA x x x x Phys Med Grp of Santa Cruz Cou Santa Cruz CA x x x x Physician Assoc/Methodist Los Angeles CA x x Physician Assoc/San Gabriel Los Angeles CA x x x Physician Assoc/Verdugo Los Angeles CA x x Physician Associates/Foothill Los Angeles CA x x Physician Associates/Pasadena Los Angeles CA x x x Physician Associates/San Dimas Los Angeles CA x x Pioneer Provider Network A Med Los Angeles CA x x x x Prairie Medical Group Los Angeles CA x Presbyterian Health Physicians Los Angeles CA x x Primary Care Associated Medica San Diego CA x x x Primary Care Associated MG San Diego CA x x x Primecare MG of Chino Valley San Bernardino CA x x x x Primecare MG of Inland Valley San Bernardino CA x x x x Primecare MG of Temecula Inc Riverside CA x x x x Primecare of Corona Inc Riverside CA x x x x Primecare of Riverside Inc Riverside CA x x x x Professional Care IPA Los Angeles CA x x x Promed Hlth Ntwk/Pomona Vly San Bernardino CA x x Prospect Health Source Medical Los Angeles CA x x x x Prospect Medical Group/North Orange CA x x x x Rancho Family Medical Group/Gr Riverside CA x Regal Medical Group Long Beach Los Angeles CA x x x x Regal Medical Group Whittier Los Angeles CA x x x x Regal MG Burbank/Glendale Los Angeles CA x x x x Regal MG Central Valley Region Los Angeles CA x x x x Regal MG Downtown La Region Los Angeles CA x x x x Regal MG Greater Covina Los Angeles CA x x x x Riverside Medical Clinic Inc Riverside CA x x x x Robert Kennedy IPA Med Grp Los Angeles CA x San Bernardino Medical Group San Bernardino CA x x x x San Diego Phys Mg/No Coastal San Diego CA x x x x Sansum Santa Barbara CA x x x x Sansum Santa Barbara CA x x x x Santa Barbara Select IPA Santa Barbara CA x x x x Sante Community Phys Fresno CA x x x SCMG/Graybill San Diego CA x x x x Scripps Clinic/Penn Elm San Diego CA x x x x Scripps Clinic/San Diego San Diego CA x x x x Sea View Medical Group Ventura CA x x Sharp Community Med Grp San Diego CA x x x x Sharp Mission Park Med Grp San Diego CA x Sierra Medical Group Los Angeles CA x x x x Sierra Nevada Medical Assoc Nevada CA x x x Simi Valley DCN PCPs Ventura CA x Slo Select IPA No Cnty San Luis Obispo CA x Slo Select IPA So Cnty San Luis Obispo CA x St Francis IPA Medical Group Los Angeles CA x x St Mary/Choice Medical Group San Bernardino CA x x x x St Vincent Medical Group IPA Los Angeles CA x x x x Sutter Independent Physicians Sacramento CA x x x x Sutter Medical Group Sacramento CA x x x x Sutter Medical Group of The Re Sonoma CA x x x x Talbert MG Orange CA x x x Talbert MG Los Angeles CA x x x Talbert MG Orange CA x x x Thousand Oaks DCN PCPs Ventura CA x x Uc Davis Medical Group Sacramento CA x x x Ucla Medical Group/ IPA Los Angeles CA x x x Ucsd Medical Group San Diego CA x x x Unified Physicians South Bay Los Angeles CA x x United Family Care of Fontana San Bernardino CA x x x x Upland Medical Group San Bernardino CA x x x x Valley of The Moon Medical Grp Sonoma CA x Verdugo Hills Medical Group Los Angeles CA x x Visalia DCN PCPs Tulare CA x x West Covina Medical Clinic Los Angeles CA x x Mesa Lutheran Phoenix AZ x Phoenix Metro Phoenix AZ x Phycor Las Vegas NV x Rual - Lake Rural NV x Rural - CRC Rural NV x Tucson Metro Tucson AZ x Total Medical Groups In Network Note: Provider disuption reports were based on medical group names only. Providing tax ID numbers will yield more accurate results for carriers. 23

26 Appendix LACERS Top Hospital Contract Summary LACERS TOP HOSPITALS: HMO AND PPO UTILIZATION UTILIZATION BY HOSPITALS: BASED ON PAST 12-MONTHS OF CLAIMS Provider Tax ID Hospital Anthem HMO Anthem PPO Aetna HMO Aetna PPO Blue Shield HMO Blue Shield PPO United Healthcare HMO United Healthcare PPO Cedar Sinai Med Cnt Y Y Y Y Y Y Not Provided Not Provided Northridge Hospital Cnt Y Y Y Y Y Y Not Provided Not Provided City Of Hope Natl Med Cnt Y Y Y Y Y Y Not Provided Not Provided Ronald Reagn UCLA Med Cnt Y Y Y Y Y Y Not Provided Not Provided Presbyterian Intercommunity Hospital Y Y Y Y Y Y Not Provided Not Provided St. Jude Med Cnt Y Y Y Y Y Y Not Provided Not Provided Huntington Memorial Hosp Cnt Y Y Y Y Y Y Not Provided Not Provided Santa Monica UCLA Med Cnt Y Y Y Y Y Y Not Provided Not Provided Torrance Memorial Med Cnt Y Y Y Y Y Y Not Provided Not Provided Providence Little Co of Mary Y Y Y Y Y Y Not Provided Not Provided HOAG Memorial Hospital Presby Y Y Y Y Y Y Not Provided Not Provided Saint Johns Health Cnt Y Y N N Y Y Not Provided Not Provided USC University Hosp Cnt Y Y N N Y Y Not Provided Not Provided Glendale Adventist Med Cnt Y Y Y Y Y Y Not Provided Not Provided Loma Linda Univ Med Ctr Y Y Y Y Y Y Not Provided Not Provided Note: United Healthcare did not provide information regarding hospital contracts 24

27 Appendix Performance Guarantee Comparison ANTHEM BLUE SHIELD UNITED HEALTHCARE PERFORMANCE GUARANTEE CATEGORIES Penalty: % or Penalty: % or Penalty: % or Measure Measure Measure Retention or $ Retention or $ Retention or $ Commercial Medical Claims Turnaround Claims Processed Within 14 days 85% 1.0% 90% $7,142 maximum With 18 days Not Available Claims Processed Within 30 days 99% 1.0% 95% $7,142 maximum With 18 days Not Available Claims Accuracy PPO/FFS/BC/HMO - Financial Accuracy 99% 2.0% 98% $7,142 maximum With 18 days Not Available PPO/FFS/BC/HMO - Claims Accuracy 97% 1.0% 97% $7,142 maximum With 18 days Not Available Customer Service Average Speed of Answer in Secs 30 Sec 1.0% 30 Sec $7,142 maximum 30 Sec Not Available Lost Calls 3% 1.0% 3% $7,142 maximum 30 Sec Not Available Commercial Pharmacy & Part D Guarantees Retail Claims Processing Accuracy Annual Pharmacy Retention % of retail claims processed without payment errors for entire PBM 99% 1.5% 99% $7,142 maximum Not Available Not Available book of business for Anthem Blue Cross and its affiliates Dispensing Accuracy % Retention of mail claims dispensed without medication or strength errors for entire PBM s book of business for Anthem Blue Cross and its affiliates 99.98% 1.5% 99.00% $7,142 maximum Not Available Not Available Mail Turnaround Time for Clean Electronic Claims % of mail claims not requiring intervention shall be processed within an average of three (3) 99% 1.5% 99% $7,142 maximum Not Available Not Available business days for entire PBM s book of business for Anthem Blue Cross and its affiliates Mail Turnaround Time for Electronic Claims Requiring Intervention % of mail claims requiring intervention shall be processed within an average of five (5) business 98% 1.5% 99% $7,142 maximum Not Available Not Available days for entire PBM s book of business for Anthem Blue Cross and its affiliates Commercial ID Cards Distribution of ID Cards New ID cards mailed by Dec 15th of previous year and <1% require re-issuance 3.0% 3.0% $7,142 maximum Not Available Not Available Commercial Disease Management Identification Vendor will provide reports of its quality assurance process to ensure that all eligible (covered under the benefit plan) at risk members identified for outreach are referred to case management or 75.00% $7,142 maximum Not Available Not Available disease management, as appropriate Reporting Only Predictive Model Vendor will provide reports of its quality assurance process to ensure that all eligible (covered under the benefit plan) at risk members identified for outreach are referred to case management or N/A N/A N/A N/A Not Available Not Available disease management, as appropriate Reporting Only Commercial Clinical Outcomes Diabetes Management Increase in percent of diabetics who had lipid test (LDL-C screen); improvement is 5% relative N/A N/A N/A N/A Not Available Not Available improvement (reduction) in those not compliant in the previous period Reporting Only Commercial Reporting Annual Report Vendor will provide an annual Plan Program Report including analysis and recommendations within Agreed 2.0% 2.0% $7,142 maximum Not Available Not Available 180 days of the close of the reporting period Performance Guarantees Report submitted by April 1st of following year and check issued to LACERS within 30 calendar Agreed 1.0% N/A N/A Not Available Not Available days, subject to executed agreement Maximum at risk for all for all categories of service and levels of performance 10.0% N/A Not Available Medicare Advantage LPPO Guarantees Payment Accuracy 97% of Claims free of payment error as related to total claims paid for entire Medicare Advantage 97% 1.5% N/A N/A N/A N/A population for Anthem Blue Cross and its affiliates Financial Accuracy 98% dollars paid correctly as related to total dollars paid for entire Medicare Advantage population 98% 1.5% N/A N/A N/A N/A for Anthem Blue Cross and its affiliates Claims Turnaround Within 30 calendar days from date claims received to date processed for entire Medicare 95% 1.5% N/A N/A N/A N/A Advantage population for Anthem Blue Cross and its affiliates Abandonment Rate 5 % of calls accepted into system that are abandoned before reaching final destination for Group 5% 1.5% N/A N/A N/A N/A Medicare Advantage population for Anthem Blue Cross and its affiliates Service Level Average Speed of Answer 80% of member calls answered in 30 seconds for calls received during normal business hours for 80% 1.5% N/A N/A N/A N/A Group Medicare Advantage population for Anthem Blue Cross and its affiliates First Call Resolution 85 % of all call activity resolved upon first contact with member services. Anthem will measure using the results of the One Touch Resolution data captured in the Customer Viewpoint Survey. One Touch Resolution is defined as an issue not fully resolved with one call, but expect Anthem to 85% 1.5% N/A N/A N/A N/A resolve the issue and do not anticipate member to call again. For Group Medicare Advantage population for Anthem Blue Cross and its affiliates Maximum at risk for all for all categories of service and levels of performance 10.0% Not Available $100,000 Note: 1) Anthem is the only carrier offering Performance Guarantee on the Medicare Advantage MA-PD programs. 2) United Healthcare Performance Guarantee did not specify the amount at risk of most of the category items. 3) Aetna Performance Guarantee did not include majority of categories for PPO and HMO plans and is not shown. 25

28 ATTACHMENT 2 LACERS 2013 Medical RFP for Plan Year RFP Timeline with Board Dates Group Medical Health Plans ACTION TARGET DATE RESPONSIBILITY Develop RFP Specifications & Requirements 12/1/2012 Keenan & Associates/LACERS Develop RFP Scoring Methodology 12/1/2012 Keenan & Associates/LACERS Obtain LACERS Sample Health Plan Agreements & other required documents for RFP 12/1/2012 LACERS Meet with LACERS to review RFP Draft 12/10/12-12/14/12 Keenan and Associates/LACERS Consideration of Medical RFP to the Benefits Administration Committee 12/17/ /19/2012 Keenan & Associates/LACERS Obtain RFP Marketing Data (Census Data, Plan Summaries, and Experience Data) 12/15/2012 Keenan & Associates Create RFP and Cover Letter 1/2/2013 Keenan & Associates Submit RFP and Cover Letter to City Attorney/Lita/Tom for Review 1/4/2013 LACERS RFP Goes to the Benefits Administration Committee (pending BAC guidance) 1/14/2013-1/18/13 Keenan & Associates/LACERS RFP Goes to the Board of Administration 1/22/2013 LACERS Distribution of RFP & Data to Medical Plans 2/5/2013 Keenan & Associates Proposal Q&A Period (Bidders Conference?) 2/5/2013-2/15/2013 Keenan & Associates RFP Due Date 5/3/2013 extension Keenan & Associates Review Submitted RFPs 3/5/2013-3/25/2013 Keenan & Associates Present Initial RFP Marketing Results (Summaries & Comparisons) to LACERS 4/1/2013 Keenan & Associates Select RFP Finalists 4/15/2013 Keenan & Associates/LACERS Present Recommendation of Finalists to Benefits Administration Committee 5/7/2013 Keenan & Associates/LACERS Notify RFP Finalists 5/15/2013 Keenan & Associates/LACERS Finalist Interviews (Including LACERS) 5/15/2013-5/30/2013 Keenan & Associates/LACERS Check References 6/1/2013-6/15/2013 Keenan & Associates Final Rating of Health Plans 7/1/2013 Keenan & Associates Presentation of Recommended Health Plans to Benefits Administration Committee 7/16/2013 Keenan & Associates/LACERS Presentation of Recommended Health Plans To LACERS Board 7/23/2013 Keenan & Associates/LACERS Announcement of Selected Health Plans 7/26/2013 Keenan & Associates Obtain Final Health Plan Agreements 8/1/2013 Keenan & Associates/LACERS Dental/Vision Renewals, Final Rates & Subsidies to Benefits Administration Committee 7/22/2013-7/26/2013 Keenan & Associates/LACERS Final Health Plan Agreements Signed 8/10/2013 Keenan & Associates/Health Plans Dental/Vision Renewals, Final Rates & Subsidies to Board of Administration 8/13/2013 Keenan & Associates/LACERS Develop Implementation & Transition Plan 8/15/2013 Keenan & Associates / LACERS/ Health Plans Open Enrollment 10/15/2013 to 11/15/2013 Keenan & Associates / LACERS/ Health Plans Plan Effective Date 1/1/2014 Health Plans