MONTHLY  MEETING  RECAP    August  2015  

 Board  of  Managers    

The  August  meeting  was  cancelled.    

Quality  Committee    

Quality  Coordinator  Update  Ms.  Rutherford  provided  an  update  as  follows:  Aetna  Metrics  &  Targets  (handout):  I  have  requested  a  list  an  adverse  events  numerator  from  Aetna,  however,  I  haven’t  received  anything  just  yet.  

 Generic  Dispensing  Rate  (handout):  Based  on  Aetna  data  and  our  best  claims  data,  this  shows  the  prescribing  habits  of  our  primary  care  providers.    What  reasons  to  you  see  providers  prescribing  generic  only?  By  default  –  drug  first  came  out  name  brand  only,  however,  once  a  generic  became  available,  the  system  wasn’t  changed  so  it  is  still  defaulting  to  name  brand.  Lack  of  information  –  provider  learned  how  to  use  the  brand  name  and  doesn’t  know  how  to  changes  to  generic  –  hasn’t  studied  enough  to  feel  comfortable  switching  to  generic.  Not  available  –  still  many  drugs  not  available  in  generic.  

 How  do  we  change  habits?    Can  we  expose  the  data  and  hope  for  changes?      • Give  them  the  practice  manager  and  let  them  distribute  to  their  providers    • Provide  a  blind  data  comparison  chart  • Create  a  list  of  the  Top  25  drugs  with  generic  suggestions  (Dr.  Buehrens  has  volunteered  to  do  this)  

 HCA  Quality  Plan  &  Metrics  Will  bring  the  HCA  workplan  quality  data  to  the  Quality  Committee  on  a  quarterly  basis  to  review.  

 Quality  improvement  plans  There  are  multiple  service  lines,  all  based  on  Bree  Collaborative.    Julie  Sylvester,  from  VM,  is  the  PSHVN  Account  Manager  coordinating  our  deliverables  for  the  HCA  contract.    Wellcentive  Last  week,  our  implementation  team  was  on-­‐site  for  2  days  working  through  the  roll  out  plan.    Some  interfaces  are  ready  to  go  live.    Payer  feeds  are  almost  complete,  validating  and  ready  to  test.    Plan  to  move  care  managers  onto  the  system  in  mid-­‐September  with  the  first  PCP  on-­‐line  in  late  October.    

Payer  Committee    

EH  2014  performance  plan  payout  • Gregg  reported  that  the  First  Choice  reported  numbers  have  been  verified  by  AON/Hewitt  and  the  EH  finance  department.  • As  approximated,  plan  savings  of  $780,696  were  generated,  resulting  in  a  distribution  to  EHP  providers  of  $390,348  • Sara  is  computing  the  individual  payouts  which  is  expected  to  occur  on  time  by  the  end  of  July.  

 EH  2015  performance  plan  budget  • Gregg  reviewed  the  First  Choice  analysis  of  2014  claims  with  5  complete  months  of  claims  run  out.  • With  the  change  in  stop-­‐loss  definition  from  $150K  to  $275K  as  approved  previously  in  the  EHP  payout  memorandum,  the  

number  of  effective  stop-­‐loss  cases  changed  from  20  to  8.  • Adjusting  for  those  outlier  cases,  the  2014  PMPM  cost  was  $439.09;  after  applying  an  AON/Hewitt  recommended  

budgeted  increase  of  5.7%,  the  target  PMPM  becomes  $464.11.  • This  amount  was  approved  by  the  EHP  payer  committee.  

 2015  funds  flow  model  • Tom  reviewed  a  projected  income  statement  for  EHP  showing  the  revenue  and  expenses  through  2016.  

• He  also  covered  the  proposed  principles  for  payout  along  with  corresponding  chart.  • The  group  asked  for  a  couple  of  items  to  be  brought  back  to  the  next  meeting  (September):  

o Creation  of  a  diagram  to  show  the  flow  of  funds  o Development  of  some  scenarios  

 Cigna  CAC  reports  from  May  quarterly  meeting  • Gregg  reviewed  some  summary  reports  from  Cigna’s  last  quarterly  joint  operating  committee  meeting.  • The  next  set  of  reports  will  be  presented  in  August  and  will  be  distributed  to  the  payer  committee  by  email.  • Gregg  shared  how  the  utilization  and  financial  stats  are  looking  good  for  the  forthcoming  settlement.  • Work  prior  to  June  30  focused  upon  the  quality  indicators  and  closing  the  care  gaps;  Cigna  stated  previously  that  this  

would  help  increase  the  PMPM  care  management  fee  from  the  current  $1.50  to  $4.11  of  we  meet  enough  quality  improvement  targets.  

• Upon  review  of  the  pharmacy  reports,  the  group  agreed  that  efforts  should  be  made  to  improve  the  generic  rates  for  cost  savings.  

 HCA/PEBB  funds  flow  –  withhold  model  • Gregg  shared  a  working  document  that  the  PSHVN  is  using  to  determine  an  appropriate  withhold  model  and  distribution  

of  upside/downside  risk.  • Gregg  also  shared  that  latest  analysis  regarding  provider  network  adequacy  and  the  potential  shortages  of  providers  in  

certain  specialties.    

Premera  ACO  implementation  • Gregg  shared  the  email  from  Premera  regarding  starting  work  to  implement  the  new  ACO  product  for  1/1/16.  • Work  meetings  will  be  scheduled  and  members  of  the  payer  committee  will  be  invited  and  kept  posted  on  developments  

 

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