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Center for Collaborative Solutions/The CECHCR ProjectFebruary 12, 2019Presenters:John GlynnPresident of J. Glynn & CompanyAja SimpsonHealth Benefits Consultant,J Glynn & Company
Today’s Agenda Timeline Review Network CoverageHMO vs PPO : How You Are Covered Current Coverage: A Brief Look Network Coverage Comparison Provider Search Walkthrough Quality of Healthcare Networks Recap Questions 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com2
Time Line Review Committee meeting: Network coverage – 2/12Committee meeting: Plan Comparison Values – 3/12Secure/Renegotiate RFP bids – 4/1Committee meeting: Overall matrix – 4/9CalPERS preliminary rates – 5/15Go/No-Go decision – May 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com3
Network Coverage What is Network Coverage? Why does this matter? How does it impact you? 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com4
HMO vs PPO:How You Are Covered (HMO) Health Maintenance Organization A type of health insurance plan that usually limits coverage to carefrom doctors who work for or contract with the HMO. It generallywon't cover out-of-network care except in an emergency and when theplan specifically authorizes an out-of-network provider. (PPO) Preferred Provider Organization A type of health plan where you pay less if you use providers in the plan’snetwork. You can use doctors, hospitals, and providers outside of thenetwork without a referral for an additional cost.****There are some services for which your PPO may require in network utilization for them to cover(i.e. diagnostic services, physical medicine services and durable medical equipment and/or supplies. 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com5
Knowledge Checkpoint 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com6
Current Coverage:A Brief LookActiveKaiser PermanenteBSC Access PERS Choice (Anthem Blue Cross)Health Net Salud y MásPERSCare (Anthem Blue Cross)PERS Select (Anthem Blue Cross)UnitedHealthcareAnthem HMO SelectHealth Net SmartCareAnthem HMO TraditionalSharpUnitedHealthcare/Grp Med Adv/PPOHealth Only860405164121353332272017411Retirees – Up to 65Anthem HMO SelectBSC Access Kaiser PermanentePERS Choice (Anthem Blue Cross)PERS Select (Anthem Blue Cross)PERSCare (Anthem Blue Cross)Contracts123349129Total97Retirees – 65 Anthem Traditional/Med AdvKaiser Senior AdvPERS Choice/Med Supp PPO (Anthem Blue Cross)PERSCare Med Supp PPO (Anthem Blue Cross)UnitedHealthcare Grp Med Adv/PPOContracts19472402Total515*See supplemental document provided for break out by bargaining unit attached as a separate document.7
Network Coverage ComparisonCalPERS 9 carrier options HMO and PPO options PBM*: BS Access utilizesCVS/Caremark, all otherplans except Kaiser utilizeOptum Rx*PBM is a Pharmacy Benefit Managers, which isthe entity that manages pharmacy benefits.SISC Anthem, Blue Shield and Kaisercarrier options HMO and PPO options. **HealthNet, United Healthcare andSharp are unavailable through SISCso provider availability search will benecessary PBM*: All plans exceptKaiser utilize Navitus RxPBM 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com8
Conducting a Provider Search A provider search will help you determine ifyour current provider falls within thenetwork of your potential new plan A provider search can be conducted for aprovider, specialist, hospital or facility 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com9
Knowledge Checkpoint 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com10
Quality of Care &Network Disruption11
The High Cost of Low Quality Care 30% of all direct health care outlays today arethe result of poor-quality care Midwestern Business Group on Health, Reducing the costs of poor quality healthcare, April 2003, JuranInstitute Hospitals/Doctors provide less than 50% of carerequired to meet evidenced based medicalquality standards The Rand Corporation, Elizabeth McGlynn.12
Los Angeles Gets a C Link to Leapfrog Group Hospital Safety Score13
Los Angeles Gets a C Link to Office of Patient Advocate Report Card14
Los Angeles Gets a C Link to Office of Patient Advocate Report Card15
Quality Ratings Sites Hospital Ratings Overall Letter Grades - US https://www.hospitalsafetygrade.orgSpecific Clinical Service Ratings - California http://calhospitalcompare.org Medical Group Ratings - California http://www.opa.ca.gov/Pages/ReportCard.aspx Health Plan Ratings - California http://www.opa.ca.gov/Pages/ReportCard.aspx 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com16
Network Disruption orIs my doctor on on the plan?*See supplemental document provided detail quality rankings and network participation attached as a separate document. 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com17
Network Disruption orIs my doctor on on the plan? Anthem Blue Cross rreimagine-directory/searchcriteria?brand ABC# Blue Shield of Califonria -area.sp#la HealthNet tion?calpers true UnitedHealthcare http://calpers.welcometouhc.com/find-a-doc.html Kaiser fornia/doctors-locations#/search-result 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com18
Final Recap HMO vs PPO Network utilization CalPERS vs SISC carrier/networkdifferences Provider Search Resources Quality of Care & Network Disruption 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com19
Questions? 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com20
Thank You &Stay Healthy! 2019 J. Glynn & Company. All Rights Reserved. 1300 Clay Street, Suite 600, Oakland, CA 94612-1427 www.jglynn.com21
Health Net Salud y Más PERSCare (Anthem Blue Cross) PERS Select (Anthem Blue Cross) UnitedHealthcare Anthem HMO Select Health Net SmartCare Anthem HMO Traditional Sharp UnitedHealthcare/Grp Med Adv/PPO Health Only 860 405 Anthem HMO Select Contracts 1 164 BSC Access 23 121
