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CalPERS Health Benefits Program 2007 Rates

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CalPERS Health Benefits Program
2007 Rates
Public Employees’ Medical and
Hospital Care Act (PEMHCA)
CalPERS Objective
• To provide you, our employers, with a
comprehensive, cost-effective health benefits
package
Why?
• To help agencies attract and retain qualified
employees
• To foster a healthier and happier workforce
2
What’s Happening in the
Public Employer Insurance Market?
• Local governments are under pressure to
reduce costs due to budget constraints
• Public agencies are looking for cost saving
alternatives
• Commercial rates may change significantly
after the first year
3
CalPERS Understands
Health Care Cost Drivers
• Aging population
• Escalating hospital costs
• Provider reimbursements
• Member health decisions
• Escalating pharmacy costs
• Medical technology
• Chronic diseases
• Uninsured population
• Provider disruptions
• Federal and state mandates
4
CalPERS Basic HMO Increase
Lower than the California and national averages for 10 years
5
CA Legislative Analyst’s Office
(LAO)
In 2006, LAO said CalPERS saved more than $168
million since 2002 by implementing the following initiatives:
• Did not renew contract with Health Net and Pacific Care $77M
• Narrowed Blue Shield’s hospital provider network - $45M
• Moved Medicare eligible members from basic to Medicare
plans - $19M
• Provided member incentives to use over the counter and
mail order prescriptions - $27M
Other Contracting Agency-specific initiatives:
• Adopted Regional Pricing - $40M
6
Approved Regions for Contracting
Agencies
2007 CalPERS Regions
• Bay Area/Sacramento
• Los Angeles Area
• Other Southern
• Other Northern
• Out-of-State
7
CalPERS 2007 Health Premiums
Medicare Rates
2006
2007
Medicare
Percent
Change (+/-)
Single
2-Party
Family
Single
2-Party
Family
Medicare Premium Rates - All Regions
Blue Shield CA
$286.49
$572.98
$859.47
$318.95
$637.90
$956.85
11.33%
Kaiser CA
218.59
437.18
655.77
289.68
579.36
869.04
32.52%
Kaiser/Out of State
209.99
419.98
629.97
271.78
543.56
815.34
29.43%
PERS Choice
322.03
644.06
966.09
341.75
683.50
1025.25
6.12%
PERSCare
347.20
694.40
1,041.60
371.68
743.36
1,115.04
7.05%
WHA
277.44
554.88
832.32
296.86
593.72
890.58
7.00%
12
CalPERS “More Than The Premium”
• Experienced
• Proven Leaders
• Committed
• Innovative
• Educators
13
CalPERS Quality Care and Coverage
Disease Management Programs
Programs to improve outcomes and cost-effectiveness
• Identify and educate high risk individuals
• Case management
• Five chronic disease care programs





Asthma
Diabetes
Cardiovascular risk reduction
Chronic Obtrusive Pulmonary
Heart Failure
CalPERS health plans provide these programs
at no additional premium cost.
14
CalPERS Quality Care and Coverage
Strategic Initiatives
Member Engagement
• CalPERS Web-based Health Plan Chooser Tool
• CalPERS Health Wallet
Member Incentives
• Pilot programs such as Blue Shield’s Healthy Lifestyle
Rewards program
Telemedicine
• Blue Cross telemedicine pilot program implemented for
select PERSCare and PERS Choice Basic plan members
in 2006
15
CalPERS Quality Care and Coverage
Strategic Initiatives (cont’d)
High-Intensity Case Management (HICM)
• Blue Shield pilot program indicates preliminary estimated
savings of over $7,000 per case
• Staff continues to review results of existing HICM
programs
Centers of Expertise (COE)
• CalPERS works with health plan partners to identify
certain procedures and facilities as Centers of Expertise
• Planning to implement bariatric COEs in 2006
• Reviewing joint replacement surgery COEs for 2007
16
Addressing Public Agency Needs
Ease of Program Administration
Administrative Support
• Established negotiating power with health plans and
providers
• Online enrollment system (ACES)
• Continuous educational and program support
• Timely grievance resolution of both provider and plan issues
• CalPERS Health Benefits Officer for retirees
17
CalPERS Administrative Costs
Lowest in the State
Our low administrative costs cover all of the following:
• Online enrollment costs
• Dedicated member services
• Open Enrollment support
• Annual Open Enrollment notification process
• Health Benefits Officer for retirees
Also, participating agencies pay no commissions
and there are no commission fees built into the
health plan partner rates.
18
CalPERS Board of Administration
Priya Mathur – Elected Member for Public Agency Membership
Tony Oliveira – Governor Appointee for Local Government Representative
Board Member
Constituency
Rob Feckner, President
Marjorie Berte
George Diehr
Charles P. Valdes
Steve Westly
Philip Angelides
David Gilb
Mike Quevedo Jr.
Maeley Tom
Kurato Shimada
Robert F. Carlson, Vice President
School Members - Elected
Insurance Industry Representative
State Employees - Elected
Total Membership - Elected
State Controller
State Treasurer
Department of Personnel Administration
Public Representative
State Personnel Board
Total Membership - Elected
Retired Members - Elected
19
Employer Engagement
Your Voice
Health Benefits Constituent Workgroup
• Stay informed and provide input
• Meets monthly (second Thursday) from 10:00 -11:30 a.m.
• Attend in person or via teleconference
Contact: Jennifer Rae at (916) 795-2807 or via email at:
Jennifer_Rae@calpers.ca.gov
Meetings held at:
CalPERS, Lincoln Plaza North at 400 Q Street, Room 1140
Sacramento, California
Dial-in number for teleconference is (877) 771-5833, Code 784356#
20
Employer Engagement
Your Voice (cont’d)
Health Benefits Committee and Board Meetings
• Generally held the third Tuesday and Wednesday
of each month
• Agendas available at www.calpers.ca.gov
21
Contact CalPERS
The highest level of customer service
• Contact us through CalPERS On-Line or our toll-free
Employer Contact Center:
 www.calpers.ca.gov
 888 CalPERS (or 888-225-7377)
22
CalPERS Health Plan Partners
Contacts
The following contacts are available to you when you need
additional assistance with a specific health plan question:
Ann DeRose, Account Manager for Blue Shield HMO N. CA
Call 916-329-4567 or email @ Ann.Derose@blueshieldca.com
Terri Raymond, Account Manager for Blue Shield S. CA
Call 310-568-2813 or email @ Terri.Raymond@blueshieldca.com
Mark Johnson, Account Manager for Blue Cross PPO PERS Choice or PERSCare
Call 916-636-2181 or email @ Mark.Johnson@wellpoint.com
Gladys Stone, Account Manager for Western Health Advantage
Call 916-563-2283 or email @ G.Stone@westernhealth.com
Josh Costa, Account Manager for Kaiser Permanente
Call 916-614-4557 or email @ Josh.S.Costa@kp.org
23
CalPERS Health Care for Today
and Tomorrow
CalPERS
• Fully committed to our partnership with you
• Delivering quality and affordable health
coverage
24
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