Meeting of the Group Benefits Advisory Committee October 7, 2019 - PowerPoint PPT Presentation

Meeting of the Group Benefits Advisory Committee October 7, 2019

1. Opening Remarks Dr. Janet Bezner, Chair

2. Legislation Impacting the GBP Diana Kongevick, Director of Group Benefits Blaise Duran, Actuarial and Reporting Services, Group Benefits

86 th Legislative Session Summary Update  HB 170 – Requires coverage of diagnostic mammography at the same benefit level as screening mammography.  HB 392 – Relates to ERS establishment of an individual long term care insurance program.  HB 1584 – Prohibits the use of step therapy for drugs prescribed for the treatment of stage four, advanced, metastatic cancer. 4

86 th Legislative Session Summary Update  SB 1264 – Applies to GBP health plans (except Medicare Advantage plans) and prevents surprise billing (also known as balance-billing) for: out-of-network emergency services, o out-of-network facility-based provider performing services at an in-network facility, o and out-of-network diagnostic imaging provider or laboratory provider performing o services in conjunction with an in-network provider. The law does NOT apply to non-emergency health care services when a health plan participant has chosen to:  seek care from an out-of-network provider and  received a written disclosure in advance about all the out-of-network providers who will be involved with the service and the estimated costs. 5

86 th Legislative Session Summary Update  Rider 10.06 – Directs the University of Texas Health Science Center in Houston to provide data analysis and individual agency benchmarking for HHSC, ERS, TRS, and TDCJ.  Rider 15 – Directs ERS to maintain competitive and favorable contracted provider rates with Health Related Institutions receiving appropriations.  Rider 16 – Directs ERS to incentivize participants to shop for lower cost healthcare through the use of shared savings. 6

Questions & Discussion

3. Wellness Discussion: Assess, Manage, Prevent Lacy Wolff, Health Promotion Administrator

Health and Wellness Report Cards 9

Health and Wellness Report Cards Why?  Shows ERS’ commitment to improving health and wellness  Gives directors data to understand the health of their agency or higher education institution  Provides goals to increase engagement in wellness initiatives  Measures change 10

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AMP Wellness Campaign  A ssess - % of participants that have taken online health assessment  M anage - % of participants that have enrolled in weight management program  P revent- % of participants that have completed annual preventive screening 12

A ssess health online Goal: 25% FY18: 3% 13

Where to take an assessment 14

Manage and Prevent Obesity 15

Manage and Prevent Obesity 16

M anage Goal: 10% FY18: 1.7% 17

40% of U.S. adults live with obesity 2015-2016, age 20 and older 28% 40% Healthy Weight: BMI ≤24.9 32% Overweight: BMI = 25-29.9 Obese: BMI ≥ 30 Source: Centers for Disease Control: “Selected health conditions and risk factors by 18 age, Table 53.”

Preventive screenings yearly 19

P revent Goal: 70% FY18: 51% 20

AMP Wellness Campaign  A ssess - % of participants that have taken online health assessment  M anage - % of participants that have enrolled in weight management program  P revent - % of participants that have completed annual preventive screening 21

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Discussion Questions  What would motivate our plan participants to complete a health assessment?  What barriers might prevent participants from getting their recommended screenings?  How do we encourage participants to engage in weight management programs? 23

4. Tobacco Certification Policy Keith Yawn, Director of Strategic Initiatives

Texas Insurance Code, Section 1551.3075 TOBACCO USER PREMIUM DIFFERENTIAL (a) The board of trustees shall assess each participant in a health benefit plan provided under the group benefits program who uses one or more tobacco products a tobacco user premium differential, to be paid in monthly installments. 25

Tobacco Certification Policy Approved August 2011 “ Tobacco Product ” is defined as cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip or any other products that contain tobacco. The term does not include an electronic cigarette or e- cigarette that does not contain tobacco and is designed expressly for the purpose of smoking cessation. 26

Tobacco Certification Statement “ Tobacco Products ” are cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip or any other products that contain tobacco and a “Tobacco User” is a person who has used any Tobacco Products five (5) or more times within the past three (3) consecutive months. 43,272 certified tobacco users (8% of population) More than 69,000 potential tobacco users (based on national statistics) 27

E-Cigarettes Definition  E-cigarettes produce an aerosol by heating liquid that can contain nicotine, flavorings, and other chemicals. Users inhale this aerosol into their lungs.  E-cigarettes are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS)” and can resemble regular cigarettes, pens, or USB sticks. 28

Tobacco Cessation The Food and Drug Administration (FDA) defines “tobacco product” to include e-cigarettes (electronic nicotine delivery systems), but does not include e-cigarettes as a tobacco cessation product or plan. HealthSelect plans offer:  Self-directed and interactive tobacco cessation and education programs through Well on Target  44 participants engaged in a Well on Target tobacco program in FY19  16% completion rate  Pharmacy benefits covering a variety of prescription and over-the-counter products to assist with tobacco cessation 29

Discussion Questions  Should ERS consider any updates to the Tobacco Certification Policy and/or Tobacco Certification Statement language?  Is it appropriate to fully include e-cigarettes in the definition of tobacco products, triggering a premium differential?  How should ERS communicate any potential change to our participant population? 30

5. Group Benefits Program Updates Diana Kongevick, Director of Group Benefits Blaise Duran, Actuarial and Reporting Services, Group Benefits Bernie Hajovsky, Enterprise Planning

HealthSelect Continues to perform well Cost trends for HealthSelect plans (HealthSelect) medical • and pharmacy plans are performing better than expected For FY19, combined medical and pharmacy trend is • projected at 6% HealthSelect provider networks are broad and larger than • in previous years Member cost-share remains flat (see next slide) • 32

Members’ Cost Share Is Steady The state is picking up most of the increase Total Cost Health Plan's Share Member's Share $8,000 $7,178 $7,147 $7,000 $5,815 $6,000 87.7% 87.3% $5,239 $5,000 83.7% $4,000 82.8% $3,000 $2,000 17.2% 16.3% 12.7% 12.3% $1,000 $0 2010 2013 2016 2019 Fiscal Year 33

HealthSelect HealthSelect Network continues to grow HealthSelect PCPs December 2017 % of POP July 2019 % of POP Participants who 347,762 86% 351,603 88% select a PCP Participants who do 56,576 14% 48,172 12% not select a PCP Total Population 404,338 100% 399,775 100% Participant access to closest PCP is, on average: • - 2 miles to 1 st closest PCP - 2.9 miles to 2 nd closest PCP - 3.4 miles to 3 rd closest PCP 99.9% of participants have access to a specialist • within 75 miles 34

GBP Optional Add-On (Voluntary) Plans Background Enrolled members pay 100% of the premium for voluntary benefit programs. Coverage Plan Type TPA / Insurer August 2019 # States Enrollment That Offer 49 PPO Delta Dental 332,476 Dental DeltaCare USA n/a HMO 115,660 Superior Vision Vision Vision benefits 224,276 43 Services Optional Life * Minnesota Life Group term insurance 216,891 44 (not including Insurance Co. dependent life) Minnesota Life Voluntary AD&D 26 Group term insurance 129,076 Insurance Co. Texas Income Short-term 112,632 39 Protection Plan ReedGroup Long-term 86,014 (disability insurance) Flexible savings TexFlex accounts 43 WageWorks 48,289 accounts HSA accounts for Health Savings Optum Bank 1,518 29 Account CDHS members** * Actives and retirees are pooled together with same rating ** State contributes $45 / $90 month to each HSA 35

GBP Optional Add-On (Voluntary) Plans Background GBP offerings • Current health-related voluntary plans complement the benefit design of the health plans, including basic life insurance that is part of your benefits package • ERS carefully considers the role and/or value any new coverage might have when evaluating options • ERS is exploring options for offering individual long-term care insurance 36

Other states’ supplemental coverages Type of Coverage Number of states 3 Universal life (with or without a long-term care rider) 2 Hearing aid benefit 1 Specified / critical illness* 2 Cancer* 4 Accident* 3 Hospital indemnity or hospitalization* 1 ICU* * Event-specific supplemental insurance that typically pays a flat amount upon occurrence 37