9/11/2014 Opportunities and Challenges under the ACA for Covered California, CalPERS, and Purchasing Pools Doug McKeever, Chief CalPERS Health Policy Research Division 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR CalPERS Overview CalPERS: • Covers nearly 1.4 million active and retired state, local government, and school employees and their families • Purchases health benefits for State of California and more than 1,100 public agencies and schools • Largest employer health benefits purchaser in California and second largest in the nation • Spent more than $7.5 billion in 2013 on health benefits 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING SEMINAR & TRAINING SEMINAR 1
9/11/2014 CalPERS Membership (571,800) (813,300) 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR CalPERS Health Plans • Six Health Maintenance Organization (HMO) plans – Anthem Blue Cross, Blue Shield of California, Health Net, Kaiser Permanente, Sharp, and United Healthcare • Two Exclusive Provider Organization (EPO) plans – Anthem Blue Cross and Blue Shield of California • Three self ‐ funded Preferred Provider Organization (PPO) plans administered by Anthem Blue Cross – PERS Select, PERS Choice, and PERS Care • Three Association member plans – California Association of Highway Patrolmen Health Benefits Trust – California Correctional Peace Officers Association – Peace Officers Research Association of California 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING SEMINAR & TRAINING SEMINAR 2
9/11/2014 Covered California: 2014 • First Open Enrollment • Health Plan Enrollment 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR 3
9/11/2014 Comparing Plans: Covered California v. CalPERS (2014) Health Plan Actuarial Value Covered California Platinum plan = 88% Gold plan = 78% CalPERS Kaiser 95% Blue Shield Access+ 94% Blue Shield Net Value 94% PERSCare 87% PERS Choice 84% PERS Select 79% 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR 4
9/11/2014 CalPERS Path Forward • 21 Initiatives • Survey/Focus Groups • Other Efforts 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING SEMINAR & TRAINING SEMINAR Health Benefits Purchasing Strategies & Initiatives Influence Healthcare Delivery Improve Health Outcomes Innovate/ Strong HIT Manage Promote Quality Prevent Experiment Infrastructur Disease & Safety Illness e Evidence Based 1 5 Incentives Uniform Medicine 8 Reduce Metrics For Value Based 10 Disease Unwarranted 2 Shared Purchasing 6 Mgmt. Care Wellness Decision-Making 11 Intensive Platform 3 Bundled 9 Case Mgmt. Payments 7 Integrated Transparency 4 Healthcare CalPERS Health …2012 …2015 … … Benefits Deliver Sustainable Dependent 16 Expand PA Programs 12 HMO Eligibility 20 Marketing Procurement Audits 17 Medicare A & B 13 Kaiser Contract Status Key Encourage Spousal 18 14 Regulatory PPO Surcharge Complete 21 Flexibility for Procurement Member & PAs 15 19 Risk Adjustment In Process Children Tiering Not Started Encourage Optimized Flex for Competition Eligibility Growth Not Pursuing 5
9/11/2014 Public Agency Health Benefits Needs Assessment • Purpose – Help CalPERS gain better understanding about public agency/member organization experiences regarding Health Benefits Program to better serve employers and members • Survey Duration – Released: January 31, 2014 – Closed: February 28, 2014 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING SEMINAR & TRAINING SEMINAR CalPERS Focus Groups • Feedback from focus group meetings consistent with survey responses. • Large desire amongst employer/member organizations for: 1. Implementation of State ‐ sponsored wellness plan 2. Health care cost savings for employers and member organization groups 3. Wider selection of benefit packages 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING SEMINAR & TRAINING SEMINAR 6
9/11/2014 Transparency Efforts • Cal Index • Castlight 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING SEMINAR & TRAINING SEMINAR Discussion 2014 FALL 2014 FALL CONFERENCE CONFERENCE & TRAINING & TRAINING SEMINAR SEMINAR 7
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