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Medical Plan Analysis

Medical Plan Analysis. Review of Consortiums / TPA / Network / Stop Loss. March 2013. Agenda. Willis Public Sector Practice Group. Introductions. Ryan L. Barbieri – Sr. Vice President Member of the Willis Public Sector Practice Group

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Medical Plan Analysis

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  1. Medical Plan Analysis Review of Consortiums / TPA / Network / Stop Loss March 2013

  2. Agenda

  3. Willis Public Sector Practice Group

  4. Introductions • Ryan L. Barbieri – Sr. Vice President • Member of the Willis Public Sector Practice Group • Consultant for Katonah Lewisboro S.D. on medical and pharmacy coverage and leads efforts with carrier negotiations • Leads a team of insurance professionals • Sharon Schulteis – Sr. Client Manager • Sara Malchow – Marketing Manager • Luke Allenson – Underwriting Consultant • Kathy Dobrzynski – Sr. Vice President & Actuary

  5. The Willis Public Sector Practice Group • Dedicated team of professionals with more than 150 years combined insurance experience • Services Include: • Communication strategies • Facilitating employee benefits competitive bid process • Technical Claims Analysis • GASB and OPEB resources • Pharmacy consulting • Assisting with union negotiations • Work with public sector employers across the United States

  6. Purpose Of This Market Study

  7. Business Case • Rising Expense and Declining Revenue • Rising Cost Environment • Medical trend continues to run 5% above normal inflation • 7-8% Eastern U.S. Medical Trend • KLSD utilization trends over 3 years have been relatively high • 2012 – 2013 slightly better than normal • Alternatives have been considered at a high level in the past • Consortium Plans • PNW BOCES • SWSCHP • State Run Health Insurance Programs • NYSHIP • These options have historically shown lower premiums

  8. Due Diligence • As One Of The District’s Largest Annual Expenditures • Periodic Review Is Required • Evaluation of multiple options to control district expenses • Having the right program from a cost AND a benefit standpoint is critical • District Administration has tried to be as proactive as possible

  9. Scope of Project & Progress to Date

  10. Scope of the Market Study • Review All Viable Options • Third Party Administrator and Network Review • Third Party Administrators • Approached 6 TPAs • Pomco (Inc.), UMR, Meritain, Empire Blue, Alicare and Aetna • Admin quotes received from all parties • Approached 10 Stop Loss carriers for reinsurance • 5 carriers presented options and 5 declined to quote • Network Analysis • Considered four networks • Pomco Allied (Inc.), UnitedHealthcare, Empire Blue and Aetna • Conduct discount and disruption analysis

  11. Scope of the Market Study • Review All Viable Options, cont. • Review State and Consortium Health Insurance Plans • State Plan • New York State Health Insurance Plan (NYSHIP) • Two plans • Excelsior and Empire • Conduct cost benefit analysis • Consortium Plans • Putnam Northern Westchester BOCES Plan and Statewide Schools Health Insurance Plan (SWSCHP) • Conduct cost benefit analysis

  12. Progress To Date • Good Progress Has Been Made • Highlights Of The Market Study • Good response from all parties • There are multiple opportunities for savings with minimal member disruption • Evaluation continues on State and Consortium plans • Barriers to entry and exit may pose a challenge to consortiums • State plan offers multiple options • TPA options present some network savings with the addition of an integrated managed care program (Quantum Health)

  13. Next Steps

  14. Next Steps • Move Project To Completion • Finalize Disruption and Savings Analysis • Target completion by end of May • Network analysis • Lock stop loss terms • Discuss preliminary transition plans with all options • Understand the process to help determine additional barriers if they exist

  15. Questions?

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