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FCCMA CONFERENCE June 1, 2018 FGHS: Florida Government Healthcare - PowerPoint PPT Presentation

Nov 13, 2022 •91 likes •387 views

FCCMA CONFERENCE June 1, 2018 FGHS: Florida Government Healthcare Solutions FGHS is a program designed to provide Florida local governmental entities a way to reduce administrative expenses and provide TRANSPARENCY, SAVINGS and CONTROL

  1. FCCMA CONFERENCE June 1, 2018

  2. FGHS: Florida Government Healthcare Solutions • FGHS is a program designed to provide Florida local governmental entities a way to reduce administrative expenses and provide TRANSPARENCY, SAVINGS and CONTROL over their health insurance • The goal is to use the collective purchasing power of the group to secure the lowest possible cost for employee health benefits

  3. Consortium Model – A History of Success Page 3 3

  4. Consortium History – Overview • Benecon is the general administrator of six local government health insurance cooperatives/consortiums • First Cooperative was formed in 1991 • Currently 382 local government entities are Members with 24,000+ covered employees • $53.8 million in surplus returned to Members last year • Model is built to benefit the MEMBERS! • 98% retention rate Ben enec econ on, , th the e le lead ader er in in dev devel elop opin ing g an and ma d mana nagi ging ng lo loca cal l go gove vern rnme ment nt he heal alth th in insu sura ranc nce e pr prog ogra rams ms . Page 4

  5. Benecon Public Sector Cooperatives • IIC – Pa. Boroughs/Townships/Authorities: 55 • PMHIC – Pa. Boroughs/Townships/Authorities: 268 • LGIT Health – Md. Cities/Towns/Counties: 22 • PCHIPC – Pa. Counties: 21 • PSHIC – Pa. School Districts: 11 • FGHS – Fl. Cities/Counties: 5 Total Municipal Members: 382 Total Employees: 24,123 Page 5

  6. Benecon’s Role in FGHS • Manage the Consortium through Board oversight • Structure the Self-Funding model • Provide actuarial staff in-house • Provide assistance with compliance issues such as the ACA • Provide claims assistance and reporting • Explore ways to reduce costs for Members • Nurse navigation assistance and wellness programs through ConnectCare3 and United HealthCare • Work collaboratively with our Members to grow the Consortium Page 6

  7. FGHS Overview • Established : July 2014 • Purpose: Provide a cost-effective approach to fund employee health care • Partnership : Members, Benecon, CIGNA, United HealthCare, and Brown & Brown • Governance: Policy and oversight through Board of Directors elected by Members • Current Membership : 5 Cities/Counties Page 7

  8. FGHS Membership Report Group Year Joined Employee Size City of Haines City 2014 230 Madison County 2014 180 City of Madison 2014 58 Lafayette County 2015 76 City of Belleview 2016 50 Total 5 594 Page 8

  9. FGHS Key Characteristics • Transparency • Self-Funding – Safe and Secure Environment • Excellent Network of Providers – Nationwide • Performance Data • Benefit Design Flexibility • Surplus Returns • ConnectCare3/Wellness Services • A Helping Hand: Affordable Care Act – Compliance Issues Page 9

  10. Mechanics of the Program • 10/1 common anniversary but can enter at any time • Full accounting of all costs that make up premiums • Deposits are maintained in interest-bearing accounts • Monthly reporting of claims • Detailed annual reports on medical and RX claims • No capital contribution to join program • Dollars remaining at year end returned to Members as a surplus distribution Page 10

  11. What are the key elements of the FGHS Model? SAVINGS PROTECTION FGHS CONTROL RESOURCES TRANSPARENCY Page 11

  12. FGHS Model Overview 12.7% Administrative Fund 19.5% Specific Stop-Loss Aggregating Specific Stop-Loss Cross 67.8% Aggregate Share Claim Fund with Corridor Stop-Loss Fund Member Surplus Claim Fund Great Year Expected Year Exhausted 12 Page 12

  13. Presentation – Case Studies • West Chester, PA 143 Employees • Lower Merion Twp., PA 355 Employees • City of Haines, FL 242 Employees Page 13

  14. Ernie McNeely Township Manager Lower Merion Township Montgomery County Pennsylvania Page 14

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  17. Success of the PMHIC Program • In 2017 PMHIC returned 27 million dollars to 80% of the members. • PMHIC grows approximately 10% each year from new Membership • The program offers flexibility in benefits which benefits our employees and offers management many options • Through PMHIC’s unique cross -share program reinsurance rates remain stable with no lasers • Board of Directors set policy and understand all facets of the program Page 21 Page 17

  18. Tavia Conner Office of Management and Budget Director City of Haines City Polk County Florida Page 17

  19. City of Haines City FGHS CLAIM FUND PERFORMANCE REPORT 2014-2015 2015-2016 2016-2017 2017-2018 Claim Fund Deposits $896,503 $1,099,086 $753,547 $676,148 Reinsurance $104,402 $273,008 $560,394 $549 Reimbursements Claims Paid $874,756 $1,550,892 $991,749 $531,378 Cross Share $12,615 $0 $0 $4,090 Surplus $88,105 ($178,799) $322,193 $141,229 Performance Ratio 94.5% 127.89% 63.0% 86.4% * $410,298 TOTAL SURPLUS *Through March 31, 2018 Page 18

  20. Savings for Haines City 2014-15 Plan Year FGHS Actual Fully Insured Savings/ (Cost) Total Cost $1,198,251 $1,700,137 $501,886 Assumed Increase 5.0% 2015-16 Plan Year FGHS Actual Fully Insured Savings/ (Cost) Annualized Estimate $1,536,774 $1,785,144 $248,370 Assumed Increase 5.0% 2016-17 Plan Year FGHS Actual Fully Insured Savings/ (Cost) Annualized Estimate $1,557,647 $1,874,401 $316,754 Savings since joining FGHS $1,067,010 In 2017, Haines City paid $250k of stop loss premium and had over $1m of claims paid. Page 19 Page 20

  21. Example of Detailed Claim Data City of Haines: 2016-2017* Subscriber Spouse Dependent/Other Total Benefit Type Payments Payments Payments Payments Prescription Solutions/OptumRX $135,852.78 $89,527.21 $2,869.49 $228,249.48 Inpatient Hospital Room & Board $330,186.35 $0.00 $0.00 $330,186.35 Inpatient Hospital Miscellaneous $349,225.48 $0.00 $0.00 $349,225.48 Outpatient Hospital Miscellaneous $30,694.59 $1,452.13 $3,919.52 $36,066.24 Emergency Room $73,139.51 $18,998.79 $13,884.00 $106,022.30 Surgery $40,883.38 $1,133.34 $404.64 $42,421.36 Anesthesia $18,667.13 $342.14 $0.00 $19,009.27 Assistant Surgical $1,010.51 $0.00 $0.00 $1,010.51 Inpatient Medical $51,288.57 $0.00 $0.00 $51,288.57 Outpatient/Professional Medical $57,594.75 $7,392.26 $5,974.72 $70,961.73 Other Medical $2,851.69 $0.00 $0.00 $2,851.69 Outpatient X-Ray and Lab $64,099.96 $6,398.10 $1,222.61 $71,720.67 Outpatient Psychiatric $1,317.00 $40.00 $55.00 $1,412.00 Comprehensive Medical Expenses $0.00 $0.00 $12.00 $12.00 Pharmacy - Health $4,058.14 $259.90 $0.00 $4,318.04 Total $1,160,869.84 $125,543.87 $28,341.98 $1,314,755.69 *Through 5/31/17 Page 20

  22. Success of the FGHS • The 5 Members have saved over $1.5m in the first three ( $2,500 per employee) • 2017 plan year---A great year to be part of FGHS – Funded $3.9m to pay claims – Model paid $4.2m in claims on behalf of FGHS – Returned $380k in surplus • As a member we receive much more data with our program compared to our previous fully insured program • We have ownership in this program and by working together we reduce costs and save on administrative expenses • Statement of actuarial soundness reviewed annually and approved by the Florida OIR Page 21 Page 22

  23. ConnectCare3 services offered through FGHS Available to all employees and family members enrolled in FGHS Nurse Navigator • When primary care physician refers to a specialist for a non-work related condition Certified Health Coach • Can help patients achieve wellness goals – weight loss, conditioning, improving diet, etc. Page 22 13

  24. Healthy Goals helps you set and achieve goals so you can live a healthier and happier life Work one on one with a certified health coach to achieve reasonable goals with a step-by-step program customized to your needs http://connectcare3.com/healthy-goals-success- stories/ Healthy Goals is a service of

  25. Success Stories • http://connectcare3.com/healthy-goals- success-stories/ • http://connectcare3.com/ Page 24

  26. Benefits of the FGHS Model • Funding model designed to benefit group , not insurance carrier • Return of unused claim fund dollars – surplus • Eliminates insurance company profit margin and risk charges • More flexibility & control over benefit designs • Totally transparent …know where every dollar goes Page 25 Page 26

  27. Additional Benefits of the FGHS Model • UHC Network – Nationwide • Direct savings from Wellness Programs and wellness dollars • You become a decision maker in FGHS • ConnectCare3 helps to lower costs and provide outstanding care for your employees Page 26

  28. The Benecon Group The leader in municipal health care Consortiums Experience & Expertise ‒ Over 25 years experience and 15 established consortiums in public and private sectors ‒ Professional expertise in-house: Former Municipal Manager, Actuaries, Compliance Attorneys, Financial Experts, Nurses and Account Managers We look forward to working with you in managing your health care costs Please contact: Claudia Burchstead: cburchstead@Benecon.com Page 28

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