CUCEA-CUCRA UC Medicare Choice 4.30.20 Final...
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1 Systemwide Human Resources Benefits Programs & Strategy CUCRA CUCEA Joint Meeting UC Medicare Choice April 30, 2020 Susan Pon-Gee Benefits Programs & Strategy, Systemwide HR IN STRICT CONFIDENCE – DO NOT FORWARD
Transcript of CUCEA-CUCRA UC Medicare Choice 4.30.20 Final...
1Systemwide Human ResourcesBenefits Programs & Strategy
CUCRA CUCEA Joint Meeting
UC Medicare Choice
April 30, 2020
Susan Pon-GeeBenefits Programs & Strategy, Systemwide HR
IN STRICT CONFIDENCE – DO NOT FORWARD
� Pre-enrollment� 2020 OE Migration� Metrics � Tracking Plan Performance
Agenda
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� Retirees� 5 Teleconferences: 713 participants� 52 Town Hall meetings: 2,667 attended
• 79% UC B&G• 10% UC Medicare PPO• 5% Kaiser• 87% reported positive experience and better understanding of plan
Pre-Enrollment Education
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“I like the no referral and in-and-out-of-network benefits.”“Seems too good to be true.”
“Extra benefits are nice.”“I would have liked to have premium information at the meeting.”
Pre-enrollment
� Providers� 10 Top providers utilized by UC retirees� 119 Telephonic outreaches to out-of-network (OON) facilities� 6,235 educational mailings to in-network providers� 3,349 educational mailings to OON providers
2020 OE Medical Migration – Retiree
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� 9,728 Retirees defaulted to UC Medicare Choice from HealthNet Seniority Plus
� 1,355 Retirees elected UC Medicare Choice � 1,037 from UC Medicare PPO� 181 from UC High Option� 122 from Kaiser Senior Advantage
� 16, 054 Total enrollment including dependents
2020 OE Migration
1/01/20 January February March16,054 16,071 16,112 16,157
� Membership demographics� 73.8 Years average age� 57.9% Female; 42.1% Male
Customer Service Metrics – Q1 2020
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Call Metrics
Total Calls Handled 13,470
Service Level88.5% of calls
answered within 30 seconds
Average Call Handle Time 14.52 minutes
Average Speed of Answer 24 seconds Call Drivers (YTD)
6.3%
7.4%
11.3%
11.4%
22.5%
Update Email and Phone
Perform MaterialsFulfillment
Manage AuxiliaryPersons
Find a Provider
View/Validate Benefits
Member Satisfaction
95.9% are completely or very satisfied with their experience
Metrics
Website Utilization (Jan-Feb)
35.59%
22.70%
15.67%
15.37%
10.67%PharmacyLocatorWellness
Benefits
Claims
My Account
Top 5 pagesvisited
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Metrics
� 11,097 visits� 6,263 unique users
Connecting Virtually
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Member Email Addresses on file
8,141Email address on file
� Email address used for focused e-delivery of plan material
� Retirees have access to information at fingertips
� Results through Feb 2020
Online Registration
6,677Registered Users
� Interface with links to self service options
� Immediate access to information, anytime from anywhere
� Results through Feb 2020
Paperless Opt In
3,976Paperless Opt Ins
� Immediate access to information; anytime from anywhere
� Reduced costs for postage/paper allow additional investment in plan benefits
� Results through March 2020
Mobile Visits
1,116Mobile Visit
� Registered users accessing information via mobile device
� Results through March 2020
Metrics
Medical Utilization
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Metrics
HouseCalls� 413 visits scheduled� 386 visits completed and gift cards sentPlan data is immature; results may not reflect behaviors or encounters for this group as time and data presents itself; Visits or admissions and counts through Feb represent totals not unique members
Metric Jan-Feb 2020 % of members
Acute admissions 330 1.9%
Outpatient surgeries 1,022 5.4%
ER visits 529 2.9%
Urgent care visits 448 2.5%
Physician visits 44,556 70.4%
Top 10 Medical Diagnosis
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Key findings
86%costs are contained withinten diagnosis categories
92%claimants had at least one
diagnoses listed year to date
13%claimants had at least four
of these diagnoses year to date
Musculoskeletal System and Connective Tissue $3,578,000 3,724
Neoplasms $3,550,000 1,996
Circulatory System $3,451,000 3,418
Nervous System and Sense Organs $2,050,000 3,649
Injury and Poisoning $1,664,000 997
Digestive System $1,313,000 1,165
Infectious & Parasitic Diseases $1,189,000 1,627
Respiratory System $1,155,000 1,888
Genitourinary System $1,007,000 1,708
Endocrine, Nutritional, Metabolic Diseases and Immunity Disorders
$925,000 3,368
Top ten total $19,882,000 11,033
Cost ($ allowed) Claimants
Diagnosis description Jan-Feb 2020 Jan-Feb 2020
Metrics
Note: Claimant is counted for each identified diagnosis
Note: Plan paid values are prior to reflecting rebates, performance fees, or reinsurance.
RX Utilization (Jan-Feb)
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� 13,149 (81.6%) Members utilize RX� 128,876 Total Scripts
� 9.8 Average Scripts per claimant� 110,659 Generic (85%)� 19,804 Mail order (15%)
Top 5 Drugs by Plan Paid
Metrics
Drug Primary Use Claimants Plan Paid
Eliquis Stroke Prevention 479 $536,000
Revlimid Cancer <20 $505,000
Xarelto Stroke Prevention 277 $323,000
Stelara Psoriasis <20 $318,000
Januvia Diabetes 208 $259,000
Tool Plan Efficiency
Access to/ Quality of
Care
Member Experience
HealthNet Seniority Plus data collection as baseline X
Plan utilization reports (e.g. Care coordination, preventive, chronic care management, etc.) X X X
UHC member surveys X
Audits (Implementation and claims) X X
Appeals and escalations X X
Performance guarantees X X
Annual UC CAHPS and ECHO surveys X X
Benefits community, RASC and retiree association X X X
Tracking Plan Effectiveness
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Plan Performance
� Implementation audit completed with strong positive rating� Data requests to HealthNet and UHC to build metrics
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