City of Los Angeles 2019 Annual Review Agenda Executive Summary - PowerPoint PPT Presentation

JUNE 4, 2020 City of Los Angeles 2019 Annual Review

Agenda  Executive Summary  Utilization Review - Exam Utilization - Network Utilization  Working Together  Performance Guarantee Review  Questions C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole use of t he intended recipient (s). D isclosure or distribution t o and 2 rev iew or use by any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

Executive Summary • At t endance at Cit y Wellness Fest ival • Part icipat ed in Service Provider Out reach/ Engagement Summit • Delivered 4 weeks of Popup Clinics – 95% Member sat isfact ion Key activities • Act ive part ner wit h Cit y of Los Angeles during implement at ion of Morneau Shepell • Secured 24- mont h vision plan ext ension wit h added Diabet ic benefit s effect ive in 2020 • Part icipat ing present er in t he Mat ernit y Wellness Workshop • Overall eye exam ut ilizat ion of 32% , which is consist ent wit h 2018 • EyeMed exam ut ilizat ion increased by 5% as compared t o 2018 Vision plan • EyeMed exam ut ilizat ion increased by 18.2% during t he cont ract period January 2017 – December 2019 assessment • The posit ive increase in exam ut ilizat ion t rend indicat es t he Cit y of Los Angeles membership is adapt ing t o a st andalone vision program Focus on vision healt h result ed in an increase in overall eye exams over prior year. EyeMed saved Cit y of Los Angeles members $5.8 Million ret ail in 2019; t his represent s an 11.5% Summary savings increase over t he prior year. On average members saved 70% ($246) on rout ine vision services and mat erials. C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole use of t he intended recipient (s). D isclosure or distribution t o and 3 rev iew or use by any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

Utilization Review

Growth in Vision Exam Utilization City of Los Angeles Contract Period of January 2017 – December 2019 Calendar Year Mem bers Exam s Utilization (EyeMed + Kaiser) Combined eye exam ut ilizat ion 2017 57,239 17,605 30.8% grew by 3.9% 2018 56,978 18,083 31.7% since January 2017 2019 57,484 18,580 32.0% 2020* 59,413 18,700 32.2% Focus on wellness contributes to increases in exam utilization Since EyeMed’s introduction as the City’s standalone vision program in 2017, eye exam o utilization has consistently increased. The City and EyeMed’s prom otion of annual eye exam s has contributed to an increase of 975 o eye exam s between 2017 and 2019. * Enrollm ent forecast based on average m embership increase of 3.4% Q1 2020 vs Q1 2019; exam utilization forecast based on 2019 growth rate of 0.9% C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole use of t he intended recipient (s). D isclosure or distribution t o and 5 rev iew or use by any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

EyeMed providers account ed f or over 75% of exam s in 2019; EyeMed 24.6% , Kaiser 7.4% Utilization Rate Exceeds ut ilizat ion of Exams EyeMed book of Materials business f or em ployer paid groups 40% 40% 32.0% 31.7% 30.8% 28.0% 26.2% 26.3% 25.1% 24.2% 20% 20% 0% 0% 2017 2018 2019 EyeMed* 2017 2018 2019 EyeMed* o Wellness emphasis on EyeMed eye exams revealed o Overall eye exams have increased by 3.9% since 2017 4.4% of EyeMed members have a high- risk condit ion o Members elect ing t o use EyeMed providers have increased by  273 unique members ident ified/ referred wit h 18.2% since 2017 markers for High Blood Pressure  177 members ident ified/ referred wit h markers for o Wellness init iat ives like t he Pop- up Clinics have cont ribut ed t o Diabet es t he increase in EyeMed provider ut ilizat ion  15% response rat e t o high- risk mailers Based on your 2019 calendar year end data for in and out-of- network claim s * EyeMed book of business data for non-voluntary/ employer paid client accounts C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole use of t he intended recipient (s). D isclosure or distribution t o and 6 rev iew or use by any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

A Network of Choice and Convenience COMPOSITION EXAM & MATERIALS UTILIZATION Your I n-network Utilization EyeMed I nsight Where Your Em ployees Network Choices are Going I ndependent 55% Ret ail 24% LensCraft ers 21% 96 % Target 9% Retail is a valuable component of netw ork: Other retail 8% 3 8 % of all eye exams I ndependent performed and 4 4 % of OON 4% 76% materials w ere purchased in a retail JCPenney* 2% setting Sears* 2% Based on your 2019 calendar year end data * No longer part of EyeMed network, effective February 2020 C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole use of t he intended recipient (s). D isclosure or distribution t o and 7 rev iew or use by any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

How Choice Connects with Savings Your average frame price by location* Value of integrated system : $250 • $150 fram e allowance $209 $200 • 40% purchase fram es within $180 $175 $167 their allowance $152 $142 $143 $150 • EyeMed providers are $121 contracted to m aintain and $100 display a m inim um of 100 fram es which retail for $130 or less $50 • $150 allowance provides $0 access to over 500 fram es covered in full, on average, across the network * Based on your 2019 calendar year end data; fram e only, does not include lenses C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole use of t he intended recipient (s). D isclosure or distribution t o and 8 rev iew or use by any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

Maximizing Your Vision Experience

Results from Your Pop-up Clinics  4 clinic weeks  Figueroa Plaza  Central Library  Public Works  City Hall East  239 exam s perform ed  68% utilization of appointm ents  95% m em ber satisfaction  5% of patients received first eye exam  30% of patients were overdue for an eye exam prior to Pop- up Clinic₁  2020 clinics rescheduled in 2021  Figueroa Plaza  Central Library  Public Works  City Hall East 1 Based on survey results for 2019. C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole us e of t he intended recipient (s). D isclosure or distribut ion t o and review or use by 10 any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

Supporting City of Los Angeles Wellness I nitiatives 9 % of EyeMed book of business and only one of the City’s peers offer Diabetic Benefits Engagement Retinal Imaging Diabetic Benefits • Covered with $10 copay • Continued participation with • NEW! For 2020 • Maps inside of the eye in Service Provider sum m its • Office visits and diagnostic detail, assists with early • Support of wellness workshop testing once every 6 m onths detection of high-risk • Participation during wellness fairs • Gonioscopy conditions • Working group with Sum m it on • Extended • Received by 2 6 % of City of Diabetic com m unication ophthalm ology Los Angeles m em bers in 2019 • Fundus photography • Scanning laser Less than 1 0 % of the EyeMed book of business includes coverage for Retinal I maging Confidential Notice: This docum ent contains privileged inform ation and is for the sole use of the intended recipient( s) . Disclosure or 11 distribution to and review or use by any unauthorized Luxottica EyeMed associate( s) and external parties is prohibited.

Delivering on Key Performance Metrics  100% of I D cards m ailed in 10 days  100% of eligibility files updated in 2 days  100% claim s financial accuracy  100% claim s processing accuracy Direct im pact on m em ber  100% of claim s paid in 10 days satisfaction  9 seconds average speed of answer  0.6% call abandonm ent  100% com plaint acknowledgment in writing within 3 business days  100% com plaint resolution within 30 days  97% m em ber satisfaction C it y of Los Angeles 2019 c alendar y ear end results C onfident ial N otice: T his docum ent contains privileged information and is for t he s ole use of t he intended recipient (s). D isclosure or distribution t o and 12 rev iew or use by any unauthorized Luxot tica EyeMed associat e(s) and external parties is prohibited.

In Closing … • We appreciate your business • We invest in innovation to make the plan better for your members • How can we improve? NOW LET’S JUST TALK