Managed Care Round Table Beth Spoto, Spoto & Associate Mike Scribner, SHP Savannah shpllc.com & Associates, LLC Spoto.

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Presentation transcript:

Managed Care Round Table Beth Spoto, Spoto & Associate Mike Scribner, SHP Savannah shpllc.com & Associates, LLC Spoto

Georgia’s Payer Mix Medicare13% Medicaid16% State Health Benefit 7% Commercial46% (52% 4 years ago) Uninsured18% Georgia’s Current Population is 9.6 million shpllc.com & Associates, LLC Spoto

State Retirees Retirees moving to be under either Cigna (2) or UHC (2) Medicare Advantage PFFS Plans effective 1/1/10 Plans must move from PFFS to MA PPO/HMO for 2011 Active State Employees All new employees must be enrolled in HRA or HSA high deductible plan United PPO no longer offered to state employees State Health Benefit Plan shpllc.com & Associates, LLC Spoto

WellCare ◦Small impact of HB 1234 ◦Aggressive stance to avoid cost increases Peach State ◦Outsourcing therapy network to TRS with caps on daily rates ◦Requesting take-backs based on adjusted CCR or pricing increases (assumed or actual).  Need to check your letter/computed amounts. ◦Increasing triage rate CMO Update shpllc.com & Associates, LLC Spoto

PFFS plans must be contracted by 2011 to continue Coventry and Wellcare discontinuing PFFS plans effective 12/31/2009 (they will still have MA PPO/HMO plans Clients received solicitations from many plans recently: HumanaAetnaUnited (Secure Horizons) CignaSterlingAmerigroup Wellcare Many solicitations will attempt to add PPO/HMO as well. SHBP moving retirees to Cigna/UHC MA Plans Cigna – No action required, providers will be “deemed” into PFFS UHC – Opt In for PFFS and Opt Out for PPO/HMO shpllc.com & Associates, LLC Spoto Medicare Advantage

Blue Cross Blue Shield of GA Losing market share in rural areas Overtaken by UHC in several markets Still retained Board of Regents / University System Big push to complete Open Access products statewide and MA in targeted areas Moving business to POS product shpllc.com & Associates, LLC Spoto

3 Major Initiatives Ongoing Move to OOPS Moving to Medicare rates/methodology for PPS hospital CAH move to Medicare rates/methodology 12/01/09 Selected as program administrator United awarded contract from Humana – effective 4/1/09 Humana appealed award –final decision 12/31/2009 Humana will now administer at least through 9/30/2009 shpllc.com & Associates, LLC SpotoTRICARE

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