Employee Health & Pharmacy Benefits Proposal. Presented to: Finance & Facilities Committee February 7, 2013

Transcription

1 Employee Health & Pharmacy Benefits Proposal Presented to: Finance & Facilities Committee February 7,

2 History Self-Insurance UNM s Group Medical Plan has been selfinsured since FY 2010 l Prescription Drug carve-out Third Party Administrators (TPAs) have administered the medical and pharmacy plans l Medical TPAs: Lovelace & Presbyterian l Pharmacy Benefit Manager: Express Scripts 2

3 Rising Cost of Health Care UNM Specific Challenges Average employee age ~ 50 Under age 65 retirees are on active plan UNM provides choice (3 provider networks): Lovelace, Presbyterian, & UNMMG Healthcare Reform has increased costs by approximately 2.2% 3

4 Current Enrollment Individuals Impacted Lovelace Presbyterian Active Employees 3,516 2,073 Active Dependents 3,505 2,302 Total Active Lives 7,021 4,375 Under 65 Retiree Under 65 Retiree Dependents Total Under 65 Retiree Lives Total UNM Medical Plan Lives 7,661 4,826 Total Membership Allocation 61% 39% Medical Plan Employees and Retirees 6,196 Medical Plan Dependents 6,291 Grand Total Medical Plan Lives 12,487

5 Rising Cost of Health Care Trends UNM s premium increases have averaged 2.7% since self-funding began UNM s claim increases have averaged 10% since FY 11 Excluding FY 10 due to first year self-insured transition Segal national trend survey for FY13 projects cost increase of: Medical without Rx 9.3% Rx carve out 6.4% 5

6 Fiscal Year 2014 Convened a committee with broad representation to develop RFP & evaluate proposals UNM advertised bids under the following financing options: l Medical Self Insured Administrative Services Only (ASO) l Pharmacy Traditional and Pass Through 6

7 Administrative Services Only (ASO) Six proposals were received Three finalists: l Blue Cross Blue Shield of New Mexico (BCBSNM) Uses the same facility provider network as Lovelace l Lovelace (incumbent) l Presbyterian (incumbent) 7

8 8 Pharmacy Benefits Manager (PBM) Bid two options at the recommendation of UNM College of Pharmacy Nine proposals were received Four finalists: l Catamaran Traditional proposal l Express Scripts (ESI) (incumbent) Traditional and Pass Through proposals l Navitus Pass Through proposal l Optum Rx Pass Through proposal

9 Fiscal Year 2014 Recommendations Medical: Lovelace & Presbyterian Pharmacy: Express Scripts Traditional 9

10 Changes in Average Premium 25% 20% 21% 22% 15% 10% 12% 12% 10% 11% 11% 9% 10% 8% 8% 9% 10% 9% 5% 3% 4% 2% 0% 0% FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 SELF FY11 SELF 0% FY12 SELF FY13 SELF FY14 SELF* 10 UNM *Projected National

11 $70,000,000 Changes in Medical and Rx Total Costs $60,000,000 $50,000, $40,000,000 $30,000,000 $20,000,000 $10,000,000 $0 $18,460,000 $28,873,000 $47,333,000 $21,443,000 $33,538,000 $54,981,000 $22,930,000 $35,865,000 FY10 FY11 FY12 FY13* FY14* Employee (39%) Employer (61%) Total *Projected $58,795,000 $24,173,000 $37,808,000 $61,981,000 $26,184,000 $40,954,000 $67,138,000

12 Medical and Rx Premiums Premium Changes Estimations Active Employees TPA Premium Percentage Increase Lovelace 4% 5% Presbyterian 13% 14% 12

13 Medical Proposal Rationale No disruption as TPAs will not change Although BCBSNM ASO fees were significantly lower than Lovelace, they could not offset Lovelace s lower provider discounts 13

14 Pharmacy FY14 Projected Costs Pharmacy Benefits Manager (PBM) PBM Projections Difference Express Scripts Traditional $11,775, Catamaran Traditional $11,777,586 $2,116 Optum Rx Pass Through $11,862,747 $87,276 Express Scripts Pass Through $12,269,039 $493,569 Navitus Pass Through $12,354,281 $578,810 14

15 Pharmacy Proposal Rationale ESI financial score was highest l Note: It was less than $2,000 apart from the next highest bidder for total drug spend l All finalists bids were lower than FY12 costs 15 No disruption l Third Party Administrator will not change l No formulary disruption l No network pharmacy disruption l Minimal reauthorization for existing Rx

16 Calendar of Events Date February 2013 Event Award Contracts (Purchasing) Begin Negotiating Contract Details Receive Draft Summary of Benefits from Vendors - Plan design changes must be made before Summary of Benefits (SBC) can be finalized - Significant retiree health care changes that impact under 65 retirees, who are covered on the active employee plan, are anticipated - Health Care Reform requires the SBC be provided by the first day of Open Enrollment 16

17 17 Calendar of Events Date February - June 2013 March 2013 Event Prepare New Plan Document - Changes related to under 65 retirees, who are covered on the active employee plan, must be made UNM Business Policy changes related to under 65 retirees must be made - A 30 day campus comment period is required Facilitate Vendor Implementation Finalize Projected Contribution Rates for UNM and Employees Banner updates/changes must be completed and tested Employee Self Service must be completed and tested

18 Calendar of Events Date April 2013 Event Receive Stoploss Rates from Gallagher Communicate with Benefits-Eligible Employees Begin Open Enrollment - Occurs before faculty leave campus for summer May 2013 Audit and Finalize Open Enrollment June 2013 Finalize Vendor Contracts July - September 2013 Complete Post Implementation Audit 18

19 19 Questions