MONTHLY MEETING RECAP August 2015
Board of Managers
The August meeting was cancelled.
Quality Committee
Quality Coordinator Update Ms. Rutherford provided an update as follows: Aetna Metrics & Targets (handout): I have requested a list an adverse events numerator from Aetna, however, I haven’t received anything just yet.
Generic Dispensing Rate (handout): Based on Aetna data and our best claims data, this shows the prescribing habits of our primary care providers. What reasons to you see providers prescribing generic only? By default – drug first came out name brand only, however, once a generic became available, the system wasn’t changed so it is still defaulting to name brand. Lack of information – provider learned how to use the brand name and doesn’t know how to changes to generic – hasn’t studied enough to feel comfortable switching to generic. Not available – still many drugs not available in generic.
How do we change habits? Can we expose the data and hope for changes? • Give them the practice manager and let them distribute to their providers • Provide a blind data comparison chart • Create a list of the Top 25 drugs with generic suggestions (Dr. Buehrens has volunteered to do this)
HCA Quality Plan & Metrics Will bring the HCA workplan quality data to the Quality Committee on a quarterly basis to review.
Quality improvement plans There are multiple service lines, all based on Bree Collaborative. Julie Sylvester, from VM, is the PSHVN Account Manager coordinating our deliverables for the HCA contract. Wellcentive Last week, our implementation team was on-‐site for 2 days working through the roll out plan. Some interfaces are ready to go live. Payer feeds are almost complete, validating and ready to test. Plan to move care managers onto the system in mid-‐September with the first PCP on-‐line in late October.
Payer Committee
EH 2014 performance plan payout • Gregg reported that the First Choice reported numbers have been verified by AON/Hewitt and the EH finance department. • As approximated, plan savings of $780,696 were generated, resulting in a distribution to EHP providers of $390,348 • Sara is computing the individual payouts which is expected to occur on time by the end of July.
EH 2015 performance plan budget • Gregg reviewed the First Choice analysis of 2014 claims with 5 complete months of claims run out. • With the change in stop-‐loss definition from $150K to $275K as approved previously in the EHP payout memorandum, the
number of effective stop-‐loss cases changed from 20 to 8. • Adjusting for those outlier cases, the 2014 PMPM cost was $439.09; after applying an AON/Hewitt recommended
budgeted increase of 5.7%, the target PMPM becomes $464.11. • This amount was approved by the EHP payer committee.
2015 funds flow model • Tom reviewed a projected income statement for EHP showing the revenue and expenses through 2016.
• He also covered the proposed principles for payout along with corresponding chart. • The group asked for a couple of items to be brought back to the next meeting (September):
o Creation of a diagram to show the flow of funds o Development of some scenarios
Cigna CAC reports from May quarterly meeting • Gregg reviewed some summary reports from Cigna’s last quarterly joint operating committee meeting. • The next set of reports will be presented in August and will be distributed to the payer committee by email. • Gregg shared how the utilization and financial stats are looking good for the forthcoming settlement. • Work prior to June 30 focused upon the quality indicators and closing the care gaps; Cigna stated previously that this
would help increase the PMPM care management fee from the current $1.50 to $4.11 of we meet enough quality improvement targets.
• Upon review of the pharmacy reports, the group agreed that efforts should be made to improve the generic rates for cost savings.
HCA/PEBB funds flow – withhold model • Gregg shared a working document that the PSHVN is using to determine an appropriate withhold model and distribution
of upside/downside risk. • Gregg also shared that latest analysis regarding provider network adequacy and the potential shortages of providers in
certain specialties.
Premera ACO implementation • Gregg shared the email from Premera regarding starting work to implement the new ACO product for 1/1/16. • Work meetings will be scheduled and members of the payer committee will be invited and kept posted on developments
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