1. Finance Committee Review
Partnership for Health and Welfare Benefits Management Big Spring School District
Finance Committee Review
April 10, 2019
Robbi Ritter

2. Agenda 2018/2019 Financial Summary
Calendar Years and 2018 Utilization Review
Renewal Projection
South Central Trust Marketing Results
Medical and Prescription Drug Cost Trends

3. 2018/2019Financial Summary

4. Financial Summary Overview
Through February 2019, total costs have decreased $141,785 (-7.76%) to $1,807,258 in 2018/2019 vs. $1,949,043 during the same eight (8) month period in 2017/2018
YTD Paid Claims are $1,628,330; which represents a % increase vs. the prior period, driven primarily through a significant increase in prescription drug spend
Medical Paid Claims decreased %, from $1,444,448 ($678 PEPM) in 2017/2018 to $1,189,445 in 2018/2019 ($ PEPM)
Prescription Drug Paid Claims increased % from $321,000 in 2017/2018 ($ PEPM) to $438,885 in 2018/2019 ($ PEPM)
Enrollment remained fairly steady, with a slight increase of +1.13%; 268 average YTD vs. 266 average YTD for the prior period
There is currently two (2) claimants at 50% of the Specific Deductible of $150K for the reporting period

5. 2018/2019 YTD Financial Summary

6. Financial Statement through June - 2018 and 2017

7. Calendar Years - 2018 and 2019 Utilization Review

8. Utilization Overview – CY 2017 and 2018

9. Claims Paid by Location
Top Hospitals by Number of Admissions and Total Paid for 2018
UPMC Pinnacle 16 Admissions; Total $322,445
UPMC Pinnacle Carlisle 12 Admissions; Total $77,013
Chambersburg 2 Admissions; Total $12,083

10. Rx Paid Per Member Per Month for CY 2017 and 2018

11. Gaps in Preventive Care Coverage

12. Renewal Projection

13. 2019/2020 Renewal Projection

14. 2019/2020 Renewal Projection – Experience Period

15. South Central Trust Marketing Results

16. 2018 Health Plan Marketing Results
Capitalized on aggressively negotiated incumbent vendor relationships to produce savings while limiting disruption
Savings generated through—
Medical Administrative Fee: $183K
Partnership Credits: $28K
Rx Improvements: $700K
Secured Performance Guarantees placing 10% (HBS) - 20% (CBC) of ongoing administrative fees at risk based on service metrics
Additional Rx improvements available in the carve-out market; however, LEAs agreed that fully leveraging incumbent vendors now to allow for a paced carve-out project plan was most desirable
Should LEAs consolidate to a single medical plan/TPA later, point-in-scale pricing (i.e. headcount credits) and implementation credits will provide further savings opportunities
Prior Plan Year
( )
$798,552
$139,634
$278,214
$1,216,400
($46,872)
($438,000)
Renewal 1,2
$671,760
$120,840
$240,768
$1,033,368
($74,424)
($700,000)
$136,860
Medical Admin Fee
RSP Rollup
Big Spring
Mechanicsburg
Sub-Total
Additional Partnership Credits
Stop Loss Reporting Fees3 $0 $0
Rx Improvements4
$1,169,528
Total Cost
($1,032,668)
Delta Over Current:

17. Medical and Prescription Drug Trends

18. Change in Access to Care/Care Delivery Models
New, high-touch points of care, from retail clinics to video visits and urgent care, continue to be introduced and many consumers are seeking out care in setting other than the traditional physician office
In a recent PwC Health Research Institute Consumer Survey
60% of those surveyed said that they have received care in an urgent care center
25% of those surveyed have received care in a retail health clinic
11% of those surveyed have received care via Telemedicine/Virtual Visits
While the short-term result of increased access may be increased utilization, it is expected that enhanced access points will reduce costs in the long term through detecting and treating health concerns early, and shifting care form higher-cost environments to those that are more efficient and cost-effective

19. Pharmacy – Controlling growth in Pharmacy Costs
There is increased focus on proactively managing pharmacy benefit costs through evaluation of pharmacy benefit contracts, emphasis on specialty pharmacy costs addressed through plan design adjustments, coverage changes to continue to promote the use of generic drugs and options for lower-cost sites of care for specialty infusions
Over the past five (5) years, the most commonly used brand drugs experienced list price inflation of 62.1%; of that, 55.3% of spend was filled through traditional prescription drug channels and 44.7% was filled through Specialty drug channels
Utilization of new drug therapies for lung cancer and breast cancer will drive oncology cost trends, as these therapies have higher costs then prior treatment and approvals for multiple high-cost therapies are ongoing

20. Trend for the Top 15 Drug Therapy Classes, by Spend

21. Integrated Employee Wellbeing and Engagement
Today’s multigenerational employees have varied and complex needs and employers are recognizing that driving a commitment to wellbeing should be a top priority. Over the next three (3) years, the industry predicts that 82% of all employers will move from reward programs to an investment in holistic wellbeing initiatives and target these four keys to wellness
Physician Wellbeing
Emotional and Mental Wellbeing
Financial Wellbeing
Social and Community Wellbeing
The average participation rate for employer-sponsored wellbeing programs is only 39%, so employers are working to build health and wellbeing into the employee value proposition in order to boost interest and focus on the overall employee experience

22. Questions. Robbi Ritter, VP, Manager, Benefits Consulting robbi
Questions? Robbi Ritter, VP, Manager, Benefits Consulting