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AGENDA

AGENDA. Semi-Final Plan Designs Medical and Dental Renewals Preference-Sensitive/Evidence-Based Changes Under Consideration Retiree Options. The Scenarios. Scenario A

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AGENDA

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  1. AGENDA • Semi-Final Plan Designs • Medical and Dental Renewals • Preference-Sensitive/Evidence-Based Changes Under Consideration • Retiree Options

  2. The Scenarios • Scenario A • PY 2012 and PY 2013 funding PEPM is based on 5% increases over 2011 re-projected costs of $1,214.05 PEPM with the April 1, 2011 changes and March 2011 data. • Scenario B • PY 2012 and PY 2013 funding PEPM is based on 0% increases over 2011 re-projected costs of $1,214.05 PEPM with the April 1, 2011 changes and March 2011 data • Scenario C • 2012 to 2013 funding PEPM is based on 0% increase from proposed Governor’s Budget of $1,149.04 PEPM

  3. Plan Design Changes: These plan design changes (made to the Providence Statewide and Choice plans) will achieve a zero dollar deficit at the end of year 2013 to the midpoint of the recommended low and middle RBC, with all plan design changes occurring in 2012.

  4. Two-Year Plan Design Changes • The changes made in each of the scenarios are intended to be the only changes made during the biennium. • This will hold true unless utilization, cost of care or numerous high-expense claims drive costs above the predicted 9.7% trend.

  5. 2012 Medical and Dental Renewals • Kaiser Medical – 8.6% • Implement Sleep Study and Imaging co-insurance previously implemented for our Providence Plans • Providence Choice (4.4%) and Providence Statewide Plan (4%) • Plan design changes explained on previous slide • ODS (.2%) • No Plan Changes • Kaiser (3.1%) • No reductions, new PreventaMax Benefit added at no additional cost • Willamette Dental (0%) • Implement a $5 co-pay • Orthodontia co-pay increases from $1,200 to $1,500 • Increase applies to patients that have not been banded at time of implementation

  6. Preference-Sensitive Conditions • Trying to find $5M in savings through evidence-based medicine and preference-sensitive conditions • Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making.[1] It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests.[2] Evidence quality can range from meta-analyses and systematic reviews of double-blind, placebo-controlled clinical trials at the top end, down to conventional wisdom at the bottom. • Preference-Sensitive Conditions arethose for which two or more valid treatment choices are available for most patients. Chronic back pain, early-stage breast cancer, early stage prostate cancer, and benign prostatic hypertrophy are considered preference-sensitive conditions. Treatment choices for these conditions should be made by well-informed patients who base their decisions on the best available evidence as well as their personal values and preferences • PEBB is reviewing a list of 28 conditions where there is little evidence demonstrating that the treatment improves health or for which there are two or more valid treatments. A PEBB subcommittee will review this information and make a recommendation to the full Board. The list is a compilation of treatments under review by the Oregon Employees Benefits Board (OEBB), on tiers three or four of the Oregon Health Authority’s essential benefits model and either not covered or low on the list of effective treatments as determined by the Oregon Health Services Commission. • If we are unable to find $5M in savings, we will have to make other additional cuts to Scenario A to make up the difference.

  7. Retiree Options • PEBB has not made any decisions to change Retiree inclusion in PEBB Plans • 2,101 retirees comprise 4.1% of the PEBB plan. This number has declined each of the last four years. • Retirees do have other options for healthcare • PERS • COBRA • OMIP • Individual Market • Oregon’s Health Exchange in 2014 • PERS plans are valued between 93% and 97% of PEBB full time plans based on existing plan design features. When PEBB implements changes in 2012 this gap will narrow even more.

  8. Next Steps • May 17 Board Meeting Agenda: • Review Preference-Sensitive Subcommittee work • Review fees, consultant commissions and provider tax • Approve 2012 Plan Year composite rates • Approve HEM plan design and framework

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