August 4, 2009 ORANGE COUNTY 2010 MEDICAL PLAN CHANGES
PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED
PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED
BACKGROUND 2007 –County moved to self- funded medical 2009 –Approved new contract with UHC as ASO provider –Contracted with Express Scripts as PBM
BACKGROUND Move to Self-funded working well Provides the County: -More detailed claims experience information -Increased flexibility in plan design
BACKGROUND Plan Trend (Experience) Remains a Challenge Plan Costs Increase 8–10% Each Year Continued Increases Are Not Sustainable
BACKGROUND County Able to Absorb Costs in 2010 with No Premium Increase Plan Changes Needed To: –Help Offset Cost Increases in Specific Areas –Influence Member Lifestyle Choices and Plan Utilization
PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED
TOBACCO USE SURCHARGE Tobacco Use Is a Leading Cause of Death and Key Driver of Medical Costs 2008 WFL Screenings Tied to Medical Claims Results Show Medical Claims Higher for Smokers -$5,412 – Current or Previous Smokers -$3,567 – Never Smoked
TOBACCO USE SURCHARGE Medical Plan Oversight Committee (MPOC) Recommends Implementing $25 Per Pay Period Tobacco Use Surcharge in 2010.
PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED
MEDICAL PLAN C0-PAY CHANGES MPOC Met with UHC, HR Benefits & RobinsonBush Reviewed 2008 & 1 st Quarter 2009 Plan Experience Identified Key Cost Drivers and Solution Opportunities
MEDICAL PLAN C0-PAY CHANGES Outpatient Surgery –Hospital Outpatient Surgery Costs Increased 17.7% –Average Cost $3,700 - Versus $723 for Surgery Performed in Ambulatory Surgery Center –Average Cost of Colonoscopy $1,853 – Versus $513
MEDICAL PLAN C0-PAY CHANGES Inpatient Hospital –Inpatient Admissions Decreased by 5% –Average Cost per Admission increased 11% - From $10,708 in 2007 to $11,867 in 2008 Need to Better Align Inpatient & Outpatient Co-Pays
MEDICAL PLAN C0-PAY CHANGES MPOC Recommends: Increasing Co-Pay for Non- Preventive Outpatient Surgery and Preventive Colonoscopy Performed in a Hospital to $200 Moving Inpatient Hospital Co-Pay to $300 for 1 st Day and $100 for Next Three Days to Maximum $600 Per Admission
PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED
PHARMACY PLAN CHANGES Outsourced Pharmacy to Express Scripts in 2009 Few Changes Made in First Year New Programs Recommended to Control Rx Costs
PHARMACY PLAN CHANGES Select Home Delivery & Call 4 Generics –Voluntary Programs –Projected Savings - $402,000 to County & $251,000 to members Step Therapy Program –Grandfather Provision –Projected County Savings - $539,000
PHARMACY PLAN CHANGES MPOC Recommends: Adding Select Home Delivery, Call 4 Generics and Step Therapy Programs to Pharmacy Plan
PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED
SPOUSAL WELLNESS FOR LIFE SCREENINGS 2008 Spousal Claims Averaged 27.5% Higher Than Employee Claims Spouses Not Included in Health & Wellness Programs WFL Screenings Offered to Employees Only Need to Engage & Encourage All Plan Members to Make Wise Healthcare Decisions
SPOUSAL WELLNESS FOR LIFE SCREENINGS MPOC Recommends: Extending Voluntary Annual Wellness for Life Screenings & HRAs to Spouses Covered Under the County’s Medical Plan
PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED
Approve the Following MPOC Recommended Changes to the County’s 2010 Medical & Pharmacy Plans: $25 Per Pay Period Tobacco Use Surcharge $200 Co-Pay for Non-Preventive Outpatient Surgery and Preventive Colonoscopy Performed in Hospital Surgery Center
ACTION REQUESTED Inpatient Hospital Co-Pay of $300 for 1 st Day and $100 for Next Three Days to Maximum $600 Per Admission Adding Select Home Delivery, Call 4 Generics and A Step Therapy Program to Pharmacy Plan Extending Voluntary Annual Wellness for Life Screenings & HRAs to Spouses Covered Under the County’s Medical Plan
August 4, 2009 ORANGE COUNTY 2010 MEDICAL PLAN CHANGES