1 / 15

Medical Plan Analysis

Medical Plan Analysis. Review of Consortiums / TPA / Network / Stop Loss. March 2013. Agenda. Willis Public Sector Practice Group. Introductions. Ryan L. Barbieri – Sr. Vice President Member of the Willis Public Sector Practice Group

bowie
Download Presentation

Medical Plan Analysis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medical Plan Analysis Review of Consortiums / TPA / Network / Stop Loss March 2013

  2. Agenda

  3. Willis Public Sector Practice Group

  4. Introductions • Ryan L. Barbieri – Sr. Vice President • Member of the Willis Public Sector Practice Group • Consultant for Katonah Lewisboro S.D. on medical and pharmacy coverage and leads efforts with carrier negotiations • Leads a team of insurance professionals • Sharon Schulteis – Sr. Client Manager • Sara Malchow – Marketing Manager • Luke Allenson – Underwriting Consultant • Kathy Dobrzynski – Sr. Vice President & Actuary

  5. The Willis Public Sector Practice Group • Dedicated team of professionals with more than 150 years combined insurance experience • Services Include: • Communication strategies • Facilitating employee benefits competitive bid process • Technical Claims Analysis • GASB and OPEB resources • Pharmacy consulting • Assisting with union negotiations • Work with public sector employers across the United States

  6. Purpose Of This Market Study

  7. Business Case • Rising Expense and Declining Revenue • Rising Cost Environment • Medical trend continues to run 5% above normal inflation • 7-8% Eastern U.S. Medical Trend • KLSD utilization trends over 3 years have been relatively high • 2012 – 2013 slightly better than normal • Alternatives have been considered at a high level in the past • Consortium Plans • PNW BOCES • SWSCHP • State Run Health Insurance Programs • NYSHIP • These options have historically shown lower premiums

  8. Due Diligence • As One Of The District’s Largest Annual Expenditures • Periodic Review Is Required • Evaluation of multiple options to control district expenses • Having the right program from a cost AND a benefit standpoint is critical • District Administration has tried to be as proactive as possible

  9. Scope of Project & Progress to Date

  10. Scope of the Market Study • Review All Viable Options • Third Party Administrator and Network Review • Third Party Administrators • Approached 6 TPAs • Pomco (Inc.), UMR, Meritain, Empire Blue, Alicare and Aetna • Admin quotes received from all parties • Approached 10 Stop Loss carriers for reinsurance • 5 carriers presented options and 5 declined to quote • Network Analysis • Considered four networks • Pomco Allied (Inc.), UnitedHealthcare, Empire Blue and Aetna • Conduct discount and disruption analysis

  11. Scope of the Market Study • Review All Viable Options, cont. • Review State and Consortium Health Insurance Plans • State Plan • New York State Health Insurance Plan (NYSHIP) • Two plans • Excelsior and Empire • Conduct cost benefit analysis • Consortium Plans • Putnam Northern Westchester BOCES Plan and Statewide Schools Health Insurance Plan (SWSCHP) • Conduct cost benefit analysis

  12. Progress To Date • Good Progress Has Been Made • Highlights Of The Market Study • Good response from all parties • There are multiple opportunities for savings with minimal member disruption • Evaluation continues on State and Consortium plans • Barriers to entry and exit may pose a challenge to consortiums • State plan offers multiple options • TPA options present some network savings with the addition of an integrated managed care program (Quantum Health)

  13. Next Steps

  14. Next Steps • Move Project To Completion • Finalize Disruption and Savings Analysis • Target completion by end of May • Network analysis • Lock stop loss terms • Discuss preliminary transition plans with all options • Understand the process to help determine additional barriers if they exist

  15. Questions?

More Related