AGENDA - transform.ar.gov · Naturally Slim Update by: Sandy Schenck, Naturally Slim Schenck...

AGENDA

State and Public School Life and Health Insurance Board Benefits Sub-Committee

March 15th, 2019 10:00 a.m.

EBD Board Room – 501 Building, Suite 500

I. Call to Order .............................................................................. Claudia Moran, Chair

II. Approval of February Minutes .................................................. Claudia Moran, Chair

III. Financials ............................................................... Bonnie Casey, Asst. Comptroller

IV. Naturally Slim Update ............................................... Sandy Schenck, Naturally Slim

V. Catapult Overview ....................................................................... Lee Dukes, Catapult

VI. Trend Analysis ............................................ John Colberg & Gaelle Gravot, Cheiron

VII. Director’s Report .......................................... Chris Howlett, EBD Executive Director

VIII. Adjournment .............................................................................. Claudia Moran, Chair

2019 upcoming meetings:

April 12th, 2019, May 17th, 2019, June 14th, 2019

NOTE: All material for this meeting will be available by electronic means only ASE-PSE

[email protected]

Notice: Silence your cell phones. Keep your personal conversations to a minimum.

BENEFITS MEETING MINUTES The Benefits Sub-Committee of the State and Public School Life and Health Insurance Board (hereinafter called the Committee) met on March 15, 2019, at 10:00 a.m. in the EBD Board Room, 501 Woodlane, Suite 500, Little Rock, Arkansas.

Date | time 3/15/2019 10:00 AM | Meeting called to order by Claudia Moran, Chair

In Attendance

Members Present Members Absent Claudia Moran Susan Gardner Carla Haugen - Teleconference Stephanie Lilly-Palmer Ronnie Kissire Cindy Allen Herb Scott - Proxy - Cayce Rainey Chris Howlett, Executive Director, Employee Benefits Division (EBD)

Others Present Rhoda Classen, Shalada Toles, Eric Gallo, EBD; Takisha Sanders, Health Advantage; Ronda Walthall, ARDOT; Mike Motley, ACHI; Bill Clary, ARSEBA; Treg Long, ACS; Sylvia Landers, Securian; Stephen Carroll, AllCare Specialty; Lee Dukes, Catapult; Sandy Schenck, Naturally Slim; Donna Morey, ARTA; Treg Long, American Cancer Society; Suzanne Woodall, MedImpact

Approval of Minutes by: Claudia Moran, Chair

MOTION by Kissire:

Move to approve the February 15, 2019 minutes.

Lilly-Palmer seconded; all were in favor.

Minutes Approved.

Naturally Slim Update by: Sandy Schenck, Naturally Slim

Schenck provided a brief update on the progress of the Naturally Slim pilot program. A few key points included: 381 individuals lost more than 10 pounds and 32% of individuals lowered their diabetes risk. A few potential initiatives are: pre/post program biometrics analysis with Catapult, one-year follow up survey with May 2018 participants, partnering with EBD to offer Naturally Slim as behavioral alternative to bariatric surgery program, and a celebration video produced in conjunction with onsite event at Arkansas State Capitol for local participants.

Catapult Overview by: Lee Dukes, Catapult

Lee Dukes provided an overview of Catapult results from the last year. There were 86,286 eligible participants, 35,315 checkups delivered, 198 ASE locations and 276 PSE locations served. Discussion: Blood Sugar Kissire: Some of the issues we had were related to scheduling. I don’t know if there is a way

to limit who can schedule those early appointments, but we had some with Diabetes

that had to wait and almost passed out. In the future, maybe we can look at those

that we know have an issue and schedule them first.

Dukes: We would like to do something but communicating with people who have a condition

puts you at risk for violating HIPPA. In the future, they can eat something small and

just report it and can still be meaningful.

ASE/PSE Observations

Howlett: Will we be able to correlate with the metabolic syndrome that is associated here as

we move in to next year and then take the data to cross examine with Naturally Slim?

Dukes: Yes, we have done that with other groups that Naturally Slim has been involved with.

Kissire: I think it would be good to show some of the schools that are still not involved in

Catapult the results from these and how well they are benefiting the members and

saving lives.

Howlett: I agree, we are still working on getting more accessibility and exposure. We have set

another goal of around 50,000. We are seeing a lot more participation this year, early

on, than last year.

Trend Analysis by: John Colberg, Gaelle Gravot, Cheiron

Colberg and Gravot provided a trend analysis for ASE and PSE. They also provided 2020 ASE/PSE considerations as listed below:

Medical Trend (5% used for 2019 rate)

• Was higher than 2016-2017 trends

• Will PSE demographic improvement continue?

• Possible market pressures for increasing trends

• Considering 5.5% trend assumption

Pharmacy Trend (8% used for 2019 rates)

• National forecasts have come down and the last couple of years of data supports lower trends

• Generic utilization steady at 91.5%

• Specialty drugs will drive the pharmacy trends

• Considering 5.5% trend assumption

Director’s Report: Chris Howlett, EBD Executive Director

EBD Director Chris Howlett provided a short report on legislation and bills that pertain to EBD. SB480, from a plan perspective, is the biggest item of cost to focus on right now.

Comments:

Allen: I was at a retired teacher meeting recently and one of the issues happening right now is teachers that have moved from QualChoice to HealthAdvantage for their supplement are having trouble with their claims going through. Is this a problem that EBD is having?

Howlett: In the fall, notice was given to Medicare that we would be switching from QualChoice to HealthAdvantage. Medicare did have a little latency issue when they posted that on February 8th. All the claims that were caught up in this were reprocessed and adjudicated appropriately. If they are still having issues, we would need to know that.

Allen: If they are still having issues what would you have them do?

Howlett: Have them call into EBD.

Moran: Will we have another round of Naturally Slim?

Howlett: Once we see the combined data between Catapult and Naturally Slim and see how that has joined forces, we can then integrate that within our medical management. Instead of having another pilot program, we will explore looking at that for the whole population and have predetermined kickoff points. Another key item would be integrating Naturally Slim with our bariatric program.

MOTION by Kissire:

Move to adjourn the meeting. Lilly-Palmer seconded. All in favor. Meeting adjourned.

1

Measurable results. Guaranteed.

1

Powerful

Testimonials

Emotional

Connections

V I R A L M O V E M E N T

Leading program proven to reverse

metabolic syndrome, prevent diabetes

& reduce obesity prevalence Years

implementation fees,

kit fees, or PEPM

ZERO

Leading

P U B L I C

S E C T O R

P R O V I D E R

with the most

experience in S T A T E & L O C A L

G O V E R N M E N T

Evidence-based, unique

M I N D F U L E A T I N G

and skill-building program

Simple, scalable

technology platform

reaches the masses

PREVENTIVE CAREIn-network benefit billed through

claims with BlueAdvantage

Naturally Slim® is the leader in the public sector.

Arkansas’s Metabolic Escalator™

1 Centers for Disease Control and Prevention2 National Institute of Health

living with

pre-diabetes1

of adults

overweight or obese2

70%living with

diabetes1

14% 37%

Foundations® Report

N AT U R A L LY S L I M ®

S t a t e o f A r k a n s a s

A R B e n e f i t s P S E & A S E

P r o g r a m S t a r t D a t e

1 0 / 8 / 2 0 1 8

OURGOAL

Measurably improve the health of ARBenefits plan members.

1. Foundations™ Phase Outcomes

2. Testimonials

3. Next Steps ARBenefits

Objectives:

Purpose of this report:

Achieve measurable weight loss, significant program engagement and

receive positive member feedback to aid in positioning Naturally Slim as a value-add to

benefits for ARBenefits plan members.

PARTICIPATION

Participation

Overview

Number of individuals that applied

and were accepted.

AcceptedNumber of individuals that were

accepted but never started.

Never StartedNumber of individuals that were

accepted and started Week 1 of

program.

Started

2,905 3052,600

90%

Started

Demographic Highlights

The average age of the U.S.

Workforce is 41

Average AgeNormal: BMI 18.5 to < 25.0

Overweight: BMI 25.0 to < 30.0

Obese: BMI > 30.0

Average BMIOn average, male participants lose

more weight than female

participants.

Participants

10%Men

Women

48 34.9

90%

Participation ReportWe e k l y e n g a g e m e n t f o r t h o s e p a r t i c i p a t i n g i n a t l e a s t t w o w e e k s

88%81%

73%68%

62% 61%56%

50%

2128 1870 1718 1555 1455 1319 1288 1193 1062

2 3 4 5 6 7 8 9 10

Week

WEIGHT LOSS

1.5

2.7

3.5

4.35.0

5.5 5.76.4

7.2

9.3

2 3 4 5 6 7 8 9 10

Avg

. W

eig

ht

(in

lb

s.)

Week

Weight Loss by WeekF o r a c t i v e p a r t i c i p a n t s

Total Weight Loss Greater Than 12,600 lbs.

6-m

on

th p

roje

ctio

n

Weight Loss by PoundsP e r c e n t a g e o f t o t a l p o p u l a t i o n r e c o r d i n g w e i g h t m o r e t h a n o n c e

N=2233

8%

48%

27%

15%

2%

Gained (173) Lost 0 to less than 5(1069)

Lost 5 to less than 10(610)

Lost 10 to less than20 (331)

Lost 20 or more (50)

381 ind iv iduals lost

more than 10 pounds

32% of individuals lowered their

diabetes risk.

* Refer to “Federal Treatment Guidelines: How much weight loss is

clinically significant?” slide in the glossary for further explanation

Post

Foundations™

Quality of Life

Survey

Feeling Weight is Out of Control

58%

25%

H o w h a s y o u r f e e l i n g t h a t y o u r w e i g h t i s “ o u t o f c o n t r o l ” c h a n g e d

c o m p a r e d t o b e f o r e s t a r t i n g t h e N a t u r a l l y S l i m p r o g r a m ?

17%

No ChangeVery Much Improved|Improved

83% o f ind iv idua ls fe l t

more in Cont ro l o f

the i r we igh t

Energy LevelH o w h a s y o u r e n e r g y l e v e l c h a n g e d c o m p a r e d t o b e f o r e s t a r t i n g t h e

N a t u r a l l y S l i m p r o g r a m ?

56%

5%

39%


61% o f ind iv idua ls

exper ienced a

newfound burs t o f

energy.

Self-ConfidenceH o w h a s y o u r s e l f - c o n f i d e n c e c h a n g e d c o m p a r e d t o b e f o r e s t a r t i n g t h e


56%

8%

36%



exper ienced a boos t

in con f idence .

Physical ActivityH o w h a s y o u r l e v e l o f p h y s i c a l a c t i v i t y c h a n g e d c o m p a r e d t o b e f o r e

s t a r t i n g t h e N a t u r a l l y S l i m p r o g r a m ?

56%

7%

37%

Quite a Bit More|Slightly More

No Change


inc reased the i r leve l

o f phys ica l ac t i v i t y.

IndigestionH o w h a s y o u r i n d i g e s t i o n c h a n g e d c o m p a r e d t o b e f o r e s t a r t i n g t h e


42%

16%42%


58% o f ind iv idua ls ’

i nd iges t ion has

improved.

TESTIMONIALS

“I have lost 10 pounds. I am not craving sugar as before, I am

eating slower, and I have increased my exercise activity. My

clothes are fitting more loosely and I have lost some of my belly

area. This program has made me see food as a source for energy

and not as a mood enhancer.”

-ARBenefits Participant

“When I first began it was tough, but now that I've completed week 7, I've

noticed a few things: When I get up in the morning I'm normally starving, now

when I get up in the morning, I'm mainly thirsty. As a diabetic, I've took on a job

duty that requires me to walk....a lot including climbing stairs. I don't feel as tired

as I used to be. I only eat when I'm hungry. I monitor my glucose level daily and

notice a HUGE difference. I eat my favorite food first and by the time I do eat my

next item, I'm comfortably full. I think the segment that caught my attention is the

video about the sugar intake. I actually tried mashed cauliflower, similar to

mashed potatoes. I don't think I'll ever eat mashed potatoes again. Thank you

for this program.”


“This is my first post, and I'm in Week 4. I've lost 8.4 pounds so far. My goal is to

lose 15 by the end of the 10 weeks. I've lost 3 inches in my waist already and 2

inches in my hips. When I start to think that 15 pounds isn't that much weight, I

look at my cat. He is 16 pounds, and he is a really big boy. When I think about

how much he weighs and my goal, it really puts in perspective how much weight

15 or 16 pounds is. The 10-5-10 skill has been really eye-opening and life-

changing. I can't believe how much food I have left when I do that, and yet I'm

comfortably full and completely satisfied. I'm eating about half of what I was

before I started the program. Really, I'm probably eating less because I'm not

snacking between meals. I feel like I've found the Holy Grail of weight loss

programs!”


“This is the first Christmas that I can remember that I have NOT

packed on 5-10 pounds. I actually lost a tenth of a pound, & I’m

very happy about that!”


NEXT STEPS

Potential Initiatives

1. Pre/post program biometrics analysis with Catapult to review clinical improvement among May 2018 participants

2. One-year follow up survey with May 2018 participants

3. Partnering with EBD to offer Naturally Slim as behavioral alternative to bariatric surgery program

4. Celebration video produced in conjunction with onsite event at Arkansas State Capitol for local participants

CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL1

A National Preventive Healthcare Practice

State of Arkansas - 2018


Welcome!

▪ Participation

▪ Satisfaction

▪ Clinical Results

▪ Catapult Enhancements


Participation


Participation Metrics

RESULTS

Eligible Participants 86,286

Checkups delivered 35,315

Participation rate 40.9%

Locations served

ASE = 198

PSE = 276

474

Outstanding/Good rating 94%

Congratulations on a very successful year!


Satisfaction


Patient Satisfaction

94% Rated Catapult

Outstanding/Good


Insightful Comments from Participants

“Excellent program. Very personal treatment. Everyone took even extra time to make sure I understood everything and went above and beyond to ensure I had the best treatment possible. I highly recommend them to all my colleagues that didn't set an appointment.”

“I have never seen a medical program of this caliber that operates in this capacity. I was more than impressed with the overall system (a medical pop-up shop). To setup a medical office in a classroom where they take your vitals and blood, and moments later to video conference with the nurse practitioner who already had all of your information let me know of the level of intentionality that went into this process. It was one of the most efficient and effective things I have seen in a while.”

“As a first timer experiencing this, I was very well pleased. I currently don't have a PCP and this was a great step in that direction! Hope you all return next year.”

“This was absolutely the best for a wellness check up!!! The results were quick and the technician was so nice! The Nurse Practitioner was very nice and helpful! All the tests that are required were run without me having to pay extra at my regular doctor for the cholesterol results as I have had to do in the past. AND....I didn't have to pay a co-pay!!!! It was a win-win in all areas! I hope we have the privilege of having this service every year!!!! Thank you!!!!”


Insightful Comments from Site Coordinators

“I’ve heard nothing but great reviews of how successful the Catapult checkups went. Thank you for making everyone’s experience a great one! We look forward to another one for next year.”~Mayflower School District

“I have praised you all to the highest to anyone that would listen!! Thank you for being efficient and professional!!! There is not a lot about the health assessments that are easy for me since we have a couple hundred people on the insurance, but this was totally painless!!”~White Hall Schools

“I can honestly say that I did not hear one complaint about the Catapult Clinic. I received a ton of kudos. People loved the ease of scheduling an appointment online. There was an overall theme of shock and awe by how fast and efficient the process was. I received multiple comments on how nice and personable the nurses were. That is a point in which I whole-heartedly agree.”~AR Crime Lab

“Everyone was bragging about how much easier it was to do this instead of going to their Doctor and hope we do it again next year. The staff was very pleasant, courteous, and helpful.” ~Harrisburg School District


Clinical Results


Population Health Report Demographics


Metabolic Syndrome

Metabolic Syndrome is the name for a

group of risk factors that occur together

and increase the risk for coronary artery

disease, stroke and type 2 diabetes.

Catapult Average = 24% Metabolic Syndrome

n = 28,480

38.3%

25.1%

36.6%

0-1 2 3+

Non-Fasting Patients


Blood Sugar

Fasting Patients (n = 28,480)

618 newly assessed with Diabetes

3,481 with history of Diabetes

62.1% effectively managing Diabetes

37.9% not effectively managing Diabetes

Non-Fasting Patients (n = 6,835)

0 newly assessed with Diabetes

700 with history of Diabetes

39.3% effectively managing Diabetes

60.7% not effectively managing Diabetes

Catapult Averages = 18.1% Pre-Diabetes5.2% Controlled3.8% Uncontrolled

Fasting Patients


Blood Pressure

Key Findings

11,148* newly assessed with Hypertension

11,316 with history of Hypertension

22.6% not effectively managing Hypertension

77.4% effectively managing Hypertension

3,035 with Elevated Blood Pressure

*Stg 1 - 8,742; Stg 2 - 2,367; Crisis - 39

Catapult Averages = 32.8% Uncontrolled21.6% Controlled10.0% Elevated


Blood Lipids

Key Findings

7,296 newly assessed Dyslipidemia (abnormal lipids)

7,705 with history of High Cholesterol

6,934 not effectively managing lipid condition

771 effectively managing lipid condition

Catapult Average = 12.7% Controlled Dyslipidemia37.9% Uncontrolled

n = 28,480


Body Mass Index & Abdominal Circumference


Depression

Key Findings

105 = Severe Depression

269 = Moderate Depression

406 = Mild Depression

291 = Minimal Depression


Preventive Care

Key Findings

1,603 men reported that they did not have a PCP

1,081 women reported that they did not have a PCP


Preventive Care

Key Findings

3,402 women were overdue for a Mammogram

4,440 women were overdue for a Pap Smear

3,748 women were overdue for Clinical Breast Exam

9,674 ages 50+ were overdue for a Colorectal Exam


High Risk Patients

Emergency Referrals 159High Risk Referrals 2,310

Avg SBP 141.7 High 233Avg DBP 88.9 High 140

Avg GLU 131.8 High 661Avg A1c 9.6 High 14.9

Avg TGS 196.0 High 500

Emergency ReferralsBP ≥ 220/120

Active Heart Attack Symptoms

Active Stroke Symptoms

Active Seizure ≥ 2 min

Elevated Glucose with Emergency Symptoms

High Risk ReferralsBP ≥ 160/100

Triglycerides ≥ 500

HgA1c ≥ 10

Glucose ≥ 400

History of Chest Pain

History of Shortness of Breath


ASE/PSE Observations

ASE PSETotal 12,541 22,774Females 59% 73%Average Age 46.3 46.0

High Risk Referrals 8.4% 5.5%Emergency Referrals 0.6% 0.4%

Metabolic Syndrome 33.6% 27.1%Diabetes 14.6% 10.5%Hypertension 68.9% 60.6%Lipid Disorder 51.2% 45.8%Obesity 58.8% 49.3%Depression 4.1% 2.5%Smoking 13.4% 7.3%Smokeless 6.3% 3.4%


Catapult Enhancements


Addressing Opioids

Filled Prescription Import

Catapult

Enhancements

CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL23 CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL

Empowering Individuals to Improve their Health

Trend Experience

& Updated Projections

Gaelle Gravot, FSA, MAAA

John Colberg, FSA, MAAA

Arkansas State Employees

& Public School Employees

Health Benefits Program

March 15, 2019

Benefits Committee Meeting

3/15/2019

Topics

Page

1) Background and Current Assumptions 3

2) Migration Patterns 10

3) Medical Trends 12

4) Pharmacy Trends 16

5) Trend Considerations for 2020 22

6) Updated Projections 23

Appendices

A. 2019 Final Rate Details 26

B. 2019 Plan Design 30

C. Use & Disclosures 32

2

3/15/2019

Background

• Definitions

– Trend: The change in costs (medical or

pharmacy) measured on a per person – or per

member per month (PMPM) – basis

– Plan Paid: The cost of services paid by the

plan

– Allowed: The cost of services after reflecting

provider discounts and plan limits but before

subtracting amounts paid by participants

(deductibles, copays, coinsurance)

3

3/15/2019

Projecting Costs

To project costs we reflect anticipated changes due to

• Plan Design

• Vendors/Network

• Demographics

• Migration (people changing plans)

• Geography

4

Experience period

(e.g., 4/1/2018 –3/31/2019)

Rating Period(e.g., 1/1/2020-

12/31/2020)

• Utilization

• Unit Price Changes

• New Services

• Leveraging

Trend assumptions generally includes

just the items in red, but historical data

usually also includes the other factors

3/15/2019

What is leveraging?

• If copays (or deductibles or out-of-pocket

maximums) remain fixed, plan paid costs

will generally increase more than the

underlying allowed cost trends

– Example: $25 Generic Drug

- $15 Copay (Premium Plan)

$10 Plan pays

$30 Generic Drug

- $15 Copay (Premium Plan)

$15 Plan pays 50% increase

5

If drug price

increases

20%

3/15/2019

Assumptions used for 2019 rates

2019 annual

trend assumptions

• 5% Medical

• 8% Pharmacy

Additional adjustments to reflect:

• Plan Design

• Vendors/Network (e.g., PBM change)

• Demographics

• Migration

(Geography is negligible for ASE/PSE)

6

Utilization

Unit Price Changes

New Services

Leveraging

3/15/2019

How do we set trend assumptions?

• Plan History

– Adjusting for changes in plan design, vendors/network, demographics, migration, etc.

• National Benchmarks

– CPI-Medical (generally unit price only)

– Kaiser Family Foundation (includes plan design and other changes)

– Other publications (e.g., ESI report for pharmacy trends)

• Marketplace Knowledge

• Stress Testing

7

3/15/2019

Historical Trend Data

Factors to remember

• Demographics

– Have lowered PSE non-Medicare (actives &

retirees) medical by 1.0% per year and

pharmacy trends by 1.3% per year for the last

6 years

– Have increased PSE Medicare trends by

approximately 0.9% per year for 2012-2016

then little change for 2017and 2018

– Have not significantly affected ASE trends

8

3/15/2019

Historical Trend Data

Factors to remember

• Plan Design – Changes effective in 2015

– 2019 Changes to PSE not yet reflected in historical trends

• Plans/Vendors– Elimination of silver plan affected PSE in 2015

– PBM change lowered costs 8% effective July 2016(half in 2015-16 trends and half in 2016-17 trends)

– Potential minor impact in 2019 due to change from Qualchoice to Health Advantage for certain retirees

• Migration– Does not significantly affect ASE

– Potentially significant impact on PSE

9

3/15/2019

2018 to 2019 PSE Migration patterns

Migration between plans tends to be offsetting;

Classic most commonly chosen by new hires

10

3/15/2019

2018 to 2019 ASE Migration patterns

Premium continues to dominate enrollment;

Growth in Classic/Basic comes from new hires

11

3/15/2019

Medical Trend: PSE

12

Actives & Non-Medicare Retirees Medicare Retirees

Keep in mind that demographics have lowered PSE non-Medicare (actives & retirees) medical by 1.0% per

year for the last 6 years and have increased PSE Medicare trends by approximately 0.9% per year for

2012-2016 (then little change for 2017and 2018).

3/15/2019

PSE Claims by Diagnosis

13

3/15/2019

Medical Trend: ASE

14

Actives & Non-Medicare Retirees Medicare Retirees

3/15/2019

ASE Claims by Diagnosis

15

3/15/2019

National Pharmacy Trend Forecast

16

Sources: http://lab.express-scripts.com/drug-trend-report

2018

2016

2017

3/15/2019

Pharmacy Costs

17

PSE ASE

3/15/2019

Pharmacy Trends

18

3/15/2019

19

Generic Utilization Growth

3/15/2019

20

Combined ASE/PSE Pharmacy Trends

3/15/2019

21

Adjusted Combined Pharmacy Trends

-2.0%

3/15/2019

Trend Considerations for 2020

• Medical trend (5% used for 2019 rates)– Was higher than 2016-2017 trends

– Will PSE demographic improvement continue?

– Possible market pressures for increasing trends

– Considering 5.5% trend assumption

• Pharmacy trend (8% used for 2019 rates)– National forecasts have come down and the last

couple of years of data is supporting lower trends

– Generic utilization steady at 91.5%

– Specialty drugs will drive the pharmacy trends

– Considering 5.5% trend assumption

22

3/15/2019

PSE Projections

23

ACCOUNTING BASIS 2019 2020 2019 2020

State Contributions for Plan Year 88.1$ 88.1$ 88.1$ 88.1$

Minimum District Contributions 89.3 89.3 89.3 90.2

Participant Contributions 131.7 132.8 132.2 132.9

Other Income 13.8 13.8 13.8 13.8

Reserve Allocated 12.7 25.3 12.7 27.1

TOTAL INCOME 335.6$ 349.3$ 336.1$ 352.1$

TOTAL EXPENDITURES (330.9)$ (349.3)$ (337.4)$ (352.1)$

NET PLAN GAIN / (LOSS) 4.7 -$ (1.3) -$

PLAN ASSETS (END OF YEAR)

Net Assets (Prior to Reserves Allocated) 152.5$ 127.2$ 146.5$ 127.2$

IBNR Reserve (29.0) (29.0) (29.0) (29.0)

Catastrophic Reserve (58.5) (58.5) (58.5) (58.5)

Reserve for Future Premiums (12.5) (22.6) (12.5) (24.4)

NET ASSETS AVAILABLE 52.5$ 17.1$ 46.5$ 15.3$

ENROLLMENT

Active Employees (includes COBRA) 46,750 46,750 46,722 46,722

Retirees 16,397 17,161 16,383 17,083

TOTAL ENROLLED 63,147 63,911 63,105 63,805

TOTAL INCOME PEPM 443$ 455$ 444$ 460$

TOTAL EXPENDITURES PEPM (437)$ (455)$ (446)$ (460)$

Dates for Medical Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18

paid through Jan-19 Jan-19 Feb-19 Feb-19

Dates for Pharmacy Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18

Census Data through Jan-19 Jan-19 Feb-19 Feb-19

Financial Statement Data through Dec-18 Dec-18 Jan-19 Jan-191 1 The IBNR Change reflects only the June 30 modification shown on the financial statements.

Presented in Feb. Updated

3/15/2019

ASE Projections

24

ACCOUNTING BASIS 2019 2020 2019 2020

Employer Contributions 174.4$ 174.4$ 174.9$ 174.9$

Participant Contributions 96.5 98.2 96.6 98.2

Other Income 19.7 19.7 19.7 19.7

Reserves Allocated 21.7 13.2 21.7 15.7

TOTAL INCOME 312.3$ 305.5$ 312.9$ 308.5$

TOTAL EXPENDITURES (314.8)$ (334.7)$ (310.5)$ (331.5)$

NET PLAN GAIN / (LOSS) (2.5) (29.2)$ 2.4 (23.1)$

PLAN ASSETS (END OF YEAR)

Net Assets (Prior to IBNR) 79.6$ 37.1$ 84.5$ 45.8$

IBNR Reserve (27.1) (27.1) (27.1) (27.1)

Catastrophic Reserve (30.6) (30.6) (30.6) (30.6)

Reserve for Current and Future Premiums (15.3) (8.6) (15.3) (11.2)

NET ASSETS AVAILABLE 6.6$ (29.2)$ 11.5$ (23.1)$

ENROLLMENT

Active Employees (includes COBRA) 26,038 26,038 26,108 26,108

Retirees 12,737 13,196 12,693 13,143

TOTAL ENROLLED 38,774 39,233 38,801 39,251

TOTAL INCOME PEPM 671$ 649$ 672$ 655$

TOTAL EXPENDITURES PEPM (677)$ (711)$ (667)$ (704)$

Dates for Medical Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18

paid through Jan-19 Jan-19 Feb-19 Feb-19

Dates for Pharmacy Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18

Census Data through Jan-19 Jan-19 Feb-19 Feb-19

Financial Statement Data through Dec-18 Dec-18 Jan-19 Jan-191 1 The IBNR Change reflects only the June 30 modification shown on the financial statements.

Presented in Feb. Updated

3/15/2019

Cheiron (pronounced kī´· ron), the immortal centaur from Greek mythology, broke away from the pack and was educated by the Gods. Cheiron became a mentor to classical Greek heroes, then

sacrificed his immortality and was awarded in eternity as the constellation Sagittarius.

25

3/15/2019

Appendix A – PSE Actives 2019 Final Rate Details

26

Actives

Partially Risk

Adjusted

Total Rate

Direct State

Contrib. & FICA

Reserve Used

/ (Added)

School

District

Contrib.

2019

Employee

Cost

2018 Employee

Cost

Assumed

Enrollment

Premium

Employee Only $555.98 $200.15 $5.88 $159.00 $183.46 $183.46 $0.00 0% 13,987

Employee & Spouse 1,328.58 325.00 5.88 159.00 831.20 831.20 0.00 0% 250

Employee & Child(ren) 967.92 325.00 5.88 159.00 470.54 470.54 0.00 0% 2,149

Family 1,555.82 550.00 5.88 159.00 833.44 833.44 0.00 0% 442

Est. Monthly Total ($mil) $10.9 $3.8 $0.1 $2.7 $4.3 $4.3 $0.0 0% 16,828

Classic

Employee Only $313.40 $95.00 $5.88 $159.00 $46.02 $46.02 $0.00 0% 14,320

Employee & Spouse 717.00 190.00 5.88 159.00 354.62 354.62 0.00 0% 1,604

Employee & Child(ren) 520.80 190.00 5.88 159.00 158.42 158.42 0.00 0% 5,888

Family 900.70 370.00 5.88 159.00 358.32 358.32 0.00 0% 3,563


Basic

Employee Only $251.64 $68.00 $5.88 $159.00 $11.26 $11.26 $0.00 0% 3,429

Employee & Spouse 535.16 90.00 5.88 159.00 272.78 272.78 0.00 0% 276

Employee & Child(ren) 384.24 90.00 5.88 159.00 121.86 121.86 0.00 0% 512

Family 603.00 155.00 5.88 159.00 275.62 275.62 0.00 0% 386


Total (Monthly) ($ mil) $24.2 $8.3 $0.3 $7.4 $8.2 $8.2 $0.0 0% 46,807

Est Annual Total ($ mil) $290.8 $99.5 $3.3 $89.3 $98.7 $98.7 $0.0 0%

Total Active & Ret ($ mil) $333.3 $99.5 $12.6 $89.3 $132.0 $132.0 $0.0 0% 46,807 Employee Cost assumes wellness participation. Total employee cost reflects 10% assumed not to receive $75 wellness credit.

Change in EE Cost ($/%)

3/15/2019

Appendix A – PSE Retirees 2019 Final Rate Details

27

NME Retirees

Partially Risk

Adjusted Total

Rate

Direct State

Contrib.

Reserve

Used /

(Added)

2019 Retiree

Cost

2018 Retiree

Cost

Assumed

Enrollment

Premium

Retiree Only $555.98 $0.00 ($85.16) $641.14 $641.14 $0.00 0% 484

Retiree & NME SP 1,328.58 0.00 (128.60) 1,457.18 1,457.18 0.00 0% 19

Retiree & Child(ren) 967.92 0.00 (224.68) 1,192.60 1,192.60 0.00 0% 7

Retiree & NME SP&CH 1,555.82 0.00 (452.82) 2,008.64 2,008.64 0.00 0% 4

Retiree & ME SP 747.16 0.00 (47.96) 795.12 795.12 0.00 0% 46

Retiree & ME SP & CH 1,159.10 0.00 (187.48) 1,346.58 1,346.58 0.00 0% 1

Est. Monthly Total ($mil) $0.3 $0.0 ($0.0) $0.4 $0.4 $0.0 0% 561

Classic

Employee Only $313.40 $0.00 $40.10 $273.30 $273.30 $0.00 0% 1,871

Employee & Spouse 717.00 0.00 151.22 565.78 565.78 0.00 0% 257

Employee & Child(ren) 520.80 0.00 50.98 469.82 469.82 0.00 0% 60

Family 900.70 0.00 154.50 746.20 746.20 0.00 0% 38

Est. Monthly Total ($mil) $0.8 $0.0 $0.1 $0.7 $0.7 $0.0 0% 2,227

Basic

Employee Only $251.64 $0.00 $103.14 $148.50 $148.50 $0.00 0% 379

Employee & Spouse 535.16 0.00 265.44 269.72 269.72 0.00 0% 70


Family 603.00 0.00 267.28 335.72 335.72 0.00 0% 21

Est. Monthly Total ($mil) $0.2 $0.0 $0.1 $0.1 $0.1 $0.0 0% 495

Total (Monthly) ($ mil) $1.3 $0.0 $0.1 $1.2 $1.2 $0.0 0% 3,283

Est Annual Total ($ mil) $16.0 $0.0 $1.7 $14.3 $14.3 $0.0 $0 -$

Medicare Eligible

Partially Risk

Adj Total Rate Subsidy

Reserve

Used /

(Added)

2019 Retiree

Cost

2018 Retiree

Cost

Assumed

Enrollment

Retiree Only $191.18 $39.62 $50.78 $100.78 $100.78 $0.00 0% 12,155

Retiree & NME SP 747.16 0.00 (36.76) 783.92 783.92 0.00 0% 74

Retiree & Child(ren) 603.11 0.00 (153.99) 757.10 757.10 0.00 0% 17

Retiree & NME SP&CH 1,159.10 0.00 (362.38) 1,521.48 1,521.48 0.00 0% 2

Retiree & ME SP 358.00 74.07 20.89 263.04 263.04 0.00 0% 1,072

Retiree & ME SP & CH 769.93 0.00 (118.65) 888.58 888.58 0.00 0% 0

Est. Monthly Total ($mil) $2.8 $0.6 $0.6 $1.6 $1.6 $0.0 0% 13,320

Total (Est. Annual) $33.3 $6.7 $7.6 $19.0 $19.0 $0.0 $0 -$

Change in Retiree Cost ($/%)


3/15/2019

Appendix A – ASE Actives2019 Final Rate Details

28

ActivesRisk Adjusted

Total Rate

State

Contrib. &

Other

Reserve

Used /

(Added)

2019 Employee

Cost

2018 Employee

Cost

Assumed

Enrollment

Premium

Employee Only $510.48 $355.50 $38.06 $107.92 $107.92 $0.00 0% 13,627 Employee & Spouse 1,138.22 660.35 78.41 390.46 390.46 0.00 0% 2,087 Employee & Child(ren) 851.64 561.03 65.27 216.34 216.34 0.00 0% 4,946 Family 1,479.40 865.90 105.62 498.88 498.88 0.00 0% 1,831 Est. Monthly Total ($mil) $16.3 $10.6 $1.2 $4.5 $4.5 $0.0 0% 22,491

Classic

Employee Only $446.18 $351.74 $37.56 $47.88 $47.88 $0.00 0% 1,360 Employee & Spouse 987.56 651.06 77.18 250.32 250.32 0.00 0% 163 Employee & Child(ren) 740.42 554.30 64.38 112.74 112.74 0.00 0% 348 Family 1,281.80 853.62 104.00 315.18 315.18 0.00 0% 217 Est. Monthly Total ($mil) $1.3 $1.0 $0.1 $0.2 $0.2 $0.0 0% 2,088

Basic

Employee Only $394.52 $348.40 $37.12 $0.00 $0.00 $0.00 n/a 1,175 Employee & Spouse 864.62 643.04 76.12 136.46 136.46 0.00 0% 126 Employee & Child(ren) 650.00 548.40 63.60 29.00 29.00 0.00 0% 229 Family 1,120.10 843.04 102.60 165.46 165.46 0.00 0% 148 Est. Monthly Total ($mil) $0.9 $0.7 $0.1 $0.1 $0.1 $0.0 0% 1,677 Total (Monthly) ($ mil) $18.4 $12.3 $1.4 $4.8 $4.8 $0.0 0% 26,256 Est Annual Total ($ mil) $221.3 $147.4 $16.7 $57.2 $57.2 $0.0 0%

Total Active & Ret ($ mil) $305.0 $185.4 $21.7 $98.0 $98.0 $0.0 0% 39,103

Employee Cost assumes wellness participation. Total employee cost reflects 12% assumed not to receive $75 wellness credit.

Change in EE Cost ($/%)

3/15/2019

Appendix A – ASE Retirees 2019 Final Rate Details

29

NME RetireesRisk Adjusted

Total Rate

State

Contrib.

Reserve

Used /

(Added)

2019 Retiree

Cost

2018 Total

Retiree Cost

Assumed

Enrollment

Premium

Retiree Only $510.48 $215.55 $28.53 $266.40 $266.40 $0.00 0% 1,635 MethodRetiree & NME SP 1,138.22 402.99 53.35 681.88 681.88 0.00 0% 313 Premium ChangeRetiree & Child(ren) 851.64 317.35 42.01 492.28 492.28 0.00 0% 95 Classic ChangeRetiree & NME SP&CH 1,479.40 504.81 66.83 907.76 907.76 0.00 0% 41 Basic ChangeRetiree & ME SP 910.66 349.60 46.28 514.78 514.78 0.00 0% 181 Not UsedRetiree & ME SP & CH 1,251.82 451.40 59.76 740.66 740.66 0.00 0% 9 ME ChangeEst. Monthly Total ($mil) $1.5 $0.6 $0.1 $0.8 $0.8 $0.0 0% 2,272 Not Used

Classic

Employee Only $446.18 $211.78 $28.04 $206.36 $206.36 $0.00 0% 46

Employee & Spouse 987.56 393.70 52.12 541.74 541.74 0.00 0% 15


Family 1,281.80 492.54 65.20 724.06 724.06 0.00 0% 2


Basic

Employee Only $394.52 $208.45 $27.59 $158.48 $158.48 $0.00 0% 39

Employee & Spouse 864.62 385.68 51.06 427.88 427.88 0.00 0% 9


Family 1,120.10 481.96 63.80 574.34 574.34 0.00 0% 2


Total (Monthly) ($ mil) $1.6 $0.6 $0.1 $0.9 $0.9 $0.0 0% 2,391

Est Annual Total ($ mil) $18.9 $7.5 $1.0 $10.4 $10.4 $0.0

Medicare Eligible

Risk Adjusted

Total Rate

State

Contrib.

Reserve

Used /

(Added)

2019 Retiree

Cost

2018 Total

Retiree Cost

Assumed

Enrollment

Retiree Only $400.18 $206.08 $27.28 $166.82 $166.82 $0.00 0% 7,407

Retiree & NME SP 910.66 289.97 38.39 582.30 582.30 0.00 0% 339

Retiree & Child(ren) 796.34 356.45 47.19 392.70 392.70 0.00 0% 90

Retiree & NME SP&CH 1,369.10 495.35 65.57 808.18 808.18 0.00 0% 23

Retiree & ME SP 776.00 332.35 43.99 399.66 399.66 0.00 0% 2,564

Retiree & ME SP & CH 1,172.16 482.72 63.90 625.54 625.54 0.00 0% 32 Est. Monthly Total ($mil) $5.4 $2.5 $0.3 $2.5 $2.5 $0.0 0% 10,455

Total (Est. Annual) $64.8 $30.4 $4.0 $30.4 $30.4 $0.0


Retiree CostChange in Retiree Cost ($/%)

3/15/2019

30

Appendix B – 2019 PSE Plan DesignBenefit Option Name: Premium Classic Basic

Last Modified: 1/1/19 1/1/19 1/1/19

Provider Network: Health Advantage Health Advantage Health Advantage

In-Network (INN) Benefits

Deductible (Individual / Family) $750 / $1500 $1750 / $27503

$4000 / $8000

Coinsurance 20% 20% 20%

Coinsurance limit (after Ded.) Individual/Family $2500 / $5000 $4700 / $6925 $2450 / $4900

Copays

Office Visit - Primary Care (PCP) $25 Ded. & Coins. Ded. & Coins.

OV - Specialist Care Provider (SCP) $50 Ded. & Coins. Ded. & Coins.

Urgent Care (UC) $100 Ded. & Coins. Ded. & Coins.

Emergency Room (ER) Non-admitted $250 Ded. & Coins. Ded. & Coins.

Emergency Transportation-Ambulance $50 Ded. & Coins. Ded. & Coins.

Hospital Facility - Inpatient & SNF (Co-pay/Admission)4

$0 Ded. & Coins. Ded. & Coins.

Hospital Facility - Outpatient - Co-Pay4


Out-of-Pocket Max (Individual / Family)2

$3250 / $6500 $6450 / $96753

$6450 / $129003

Out-of-Network (OON) Benefits 1

Deductible (Individual / Family) $2000 / $4000 $3000 / $60003 Not Covered

Coinsurance 40% 40%

Out-of-Pocket Max (Individual / Family)2 Unlimited / Unlimited Unlimited / Unlimited

Annual Maximum INN / OON Unlimited Unlimited Unlimited

Prescription Drugs

Separate Deductible then the following Copays: None Included with Medical Included with Medical

Retail (31 Days) - Generic/Formulary /Non-Form./ Specialty $15 / $40 / $80 / $100

Mail Order (93 Days) - Generic/Form. /Non-Form./Specialty $45 / $120/ $240/ $300

Non-Formulary Covered Yes No No


$3350 / $6700 n/a / n/a n/a / n/a

Selected Detail Benefits

PsychiatryINN: $25 Copay;

OON: Ded & Coins. Ded & Coins. Ded. & Coins.

Rehabilitation (i.e., speech, occup. physical):INN: $25 Copay;

OON: Ded. & Coins. Ded & Coins. Ded. & Coins.

ChiropractorsINN: $25 Copay;


Non- Medicare Benefits Covered: Yes, same as NME

Non- Medicare Providers Covered: Non-Par & Non-Accepting

Pharmacy Covered: Non-Par & Non-Accepting1When an in-network provider is not available within 50 miles for a hospital and 25 miles for all other providers, then in-network benefits apply.

2OOP Max includes the deductible.

3 A $2,700 embedded individual deductible maximum applies for family coverage.

4Deductible and Co-Insurance also applies

3/15/2019

31

Appendix B – 2019 ASE Plan DesignBenefit Option Name: Premium Classic Basic

Last Modified: 1/1/17 1/1/17 1/1/17

Provider Network: Health Advantage Health Advantage Health Advantage

In-Network (INN) Benefits

Deductible (Individual / Family) $500 / $1000 $2500 / $50003

$6450 / $12900

Coinsurance 20% 20% 0%

Coinsurance limit (after Ded.) Individual/Family $2500 / $5000 $3950 / $7900 n/a / n/a

Copays

Office Visit - Primary Care (PCP) $25 Ded. & Coins. Ded. & Coins.

OV - Specialist Care Provider (SCP) $50 Ded. & Coins. Ded. & Coins.

Urgent Care (UC) $100 Ded. & Coins. Ded. & Coins.

Emergency Room (ER) Non-admitted $250 Ded. & Coins. Ded. & Coins.

Emergency Transportation-Ambulance $50 Ded. & Coins. Ded. & Coins.

Hospital Facility - Inpatient & SNF (Co-pay/Admission)4


Hospital Facility - Outpatient - Co-Pay4



$3000 / $6000 $6450 / $129003

$6450 / $129003

Out-of-Network (OON) Benefits 1

Deductible (Individual / Family) $2000 / $4000 $4000 / $80003 Not Covered

Coinsurance 40% 40%


Unlimited / Unlimited Unlimited / Unlimited

Annual Maximum INN / OON Unlimited Unlimited Unlimited

Prescription Drugs

Separate Deductible then the following Copays: None Included with Medical Included with Medical

Retail (31 Days) - Generic/Formulary /Non-Form./ Specialty $15 / $40 / $80 / $100

Mail Order (93 Days) - Generic/Form. /Non-Form./Specialty $45 / $120/ $240/ $300

Non-Formulary Covered Yes


$3100 / $6200 n/a / n/a n/a / n/a

Selected Detail Benefits

PsychiatryINN: $25 Copay;


Rehabilitation (i.e., speech, occup. physical):INN: $25 Copay;

OON: Ded. & Coins. Ded & Coins. Ded. & Coins.

ChiropractorsINN: $25 Copay;


Hearing Aids No Copay; Limit of $1400

per ear every 3 years

Ded. & Coins.; Limit of

$1400 per ear every 3

years

Ded. & Coins.; Limit of

$1400 per ear every 3

years

Durable Medical Equipment (DME) Ded. & Coins. Ded. & Coins. Ded. & Coins.

Monthly HSA Contributions N/A $25 Single/$50 Family $25 Single/$50 Family1When an in-network provider is not available within 50 miles for a hospital and 25 miles for all other providers, then in-network benefits apply.

2OOP Max includes the deductible.

3A $2,700 embedded individual deductible maximum applies for family coverage.

4Deductible and Co-Insurance also applies

3/15/2019

Appendix C – Use & Disclosures

• The assumptions and methods for updated projections are as described on our

monitoring reports dated February 2019 unless otherwise indicated. All projections for

2018 are illustrative and are not intended to convey any projected rate changes.

• In preparing the information in this presentation, we relied on information (some oral and

some written) supplied by the EBD and the Plan’s vendors. This information includes, but

is not limited to, the plan provisions, employee eligibility data, financial information, and

claims data. We performed an informal examination of the obvious characteristics of the

data for reasonableness and consistency in accordance with Actuarial Standard of

Practice No. 23. This presentation does not reflect future changes in benefits, penalties,

taxes, or administrative costs that may be required as a result of the Patient Protection

and Affordable Care Act of 2010, related legislation, or regulations.

• Cheiron's analysis was prepared exclusively for the Employee Benefits Division of the

State of Arkansas for the specific purpose of providing projections and options to the

Arkansas State and Public School Life and Health Insurance Board. Other users of this

document are not intended users as defined in the Actuarial Standards of Practice, and

Cheiron assumes no duty or liability to any other user.

• The figures in this presentation are preliminary and subject to change or modification as

more detailed information is gathered and depending upon decisions made by the

Board.

32

John L. Colberg, FSA, MAAA

Principal Consulting ActuaryGaelle Gravot, FSA, MAAA

Principal Consulting Actuary

AGENDA - transform.ar.gov · Naturally Slim Update by: Sandy Schenck, Naturally Slim Schenck...

Documents

Transcript of AGENDA - transform.ar.gov · Naturally Slim Update by: Sandy Schenck, Naturally Slim Schenck...