Spring Tour 2010
Montana University System

OPEN ENROLLMENT PERIOD for benefit year beginning July 1, 2010

Agenda

• Escalating Healthcare Cost
• How is “our” MUS plan absorbing these cost increases
• Specific benefit changes for July 1, 2010
• Time frame to complete and submit changes
  

Escalating Healthcare Cost

National Healthcare Reform - Political

• Many have been watching and hearing Congress debate Healthcare Reform.

National Healthcare Reform - Reality

• Few have been monitoring the true source of Healthcare Reform in the U.S.
  • Center for Medicare/Medicaid Services (CMS)
  • Dept Of Labor
  • IRS

Example :
- The American Recovery and Reinvestment Act allocated…….

$1.1 billion toward Comparative Effectiveness Research (CER) – clinical guidelines
$19 billion to facilitate the shift from paper to Electronic Health Records

New reform is forcing a “restructuring” of the delivery side of healthcare services.

• The development of Integrated Delivery Systems, Medical Homes, Accountable Care Organizations (ACO), etc.
  • These delivery models are made up of Coordinated Treatment Teams, Electronic Medical Records, Enhanced Access to Care, etc.
  • Examples of these programs are based out of Mayo Clinic, Geisinger Health System, Keiser, Cleveland Clinic, etc.

This level of integration, supported by sophisticated information technology, means that the patient, along with her/his appropriate medical information, can move smoothly from the clinic to the hospital or from primary care to specialty care.

NOTES: Clinical Pathways that lead to more effective healthcare. These new delivery models cost money to “build”. New software, developing the records…

This “restructuring” costs $$$$.

Medicare/Medicaid pay a flat fee for services.

Where does this $$$$ come from??

US – Employer Sponsored Health Plans like ours.

NOTES: Medicare/Medicaid pay a flat fee for services. There are no funds in that to assist in build of new delivery model that cost! So – Plans like ours absorb that cost.

Number of Units x Price per Unit = Plan Costs
NOTE:  MUS data.
Decline in hospital days is good! More effective care, getting to people before they are sick.
Keep small issues small.  Handle issues outpatient.  We would hope that then cost go down but not so…

Number of Units x Price per Unit = Plan Costs
NOTE:
MUS data.
Costs of hospital stays going up.
Costs of outpatient visits also going up.

Number of Units x Price per Unit = Plan Costs
Plan Costs = 22% Increase in the last year and a half
22% Increase = Higher Premiums/Decreased Benefits

NOTE:
MUS data.
Costs go up daily.
To absorb the costs we must adjust our benefits.

SO– how are we (MUS) trying to make this new world work for us??

We are developing contracts with Accountable Care Organizations/ Medical Homes and calling these  programs  Quality Care Choices. You will be hearing more about Quality Care Choices later in the presentation

In the mean time…..How is “Our” MUS Plan Absorbing These Cost Increases

1. Increase to Deductibles and Coinsurance Maximums

2. Decrease the Subsidy for Spouse and Dependent Coverage

NOTE:  A slide to show what this looks like is coming up.

Increase to Deductibles and Coinsurance Maximums

• Deductible – a fixed dollar amount the Plan Participant is responsible for paying in a Benefit Year before the Plan begins paying benefits on Covered Medical Expenses.
  • Increase by $50 per year
• Has not been raised in 4 years
• Remember – if a benefit has a copayment vs. coinsurance, you do not meet a deductible first. Ex:  Managed Care provider/specialist office visit - $15 copay

NOTE:  Increase of $50 per person per year to the medical plan deductable.

Increase to Deductibles and Coinsurance Maximums

• Coinsurance Maximums – is the Plan Participant’s accumulated Coinsurance obligation. Is an out of pocket “safety net” with in-network providers.
• Increase $1000 Traditional Plans / $250 Managed Care Plans.
• Has not been raised in 4 years

NOTE: Very important to stay in-network or your costs will be high!
If you stay IN NETWORK, the plan pays 75%, you pay 25% after deductable, UP TO Coinsurance max.  See the example on this slide. 
See Choices workbook for more detail.

Decrease the Subsidy for Spouse and Dependent Coverage

National Average             Employee Only Premium vs.
National Average             EE + Family Premium
% Difference is 175% ========> These % must come closer together

NOTE: Our health plan has 4 tiers – first box.
Our MUS plan subsidizes spouses and families way more than national average.  We need to adjust.   As you can see, it is only about $100 to add a spouse, an increase of just 18% to your premium.  Only an additional 36% to add an entire family.  The national average is much higher.  We need to come closer to national average.
See Choices workbook for exact amounts.

• What This Means:
• Employees with Spouse and Dependents enrolled on our plan will see a larger premium increase than the Employee Only Policies
• Dependent Premium Waiver:
• Montana University System will maintain our premium waiver program for the cost of enrolling children on our plan for employees making $30,000 or less on an annualized full time salary basis.

NOTE:  See Choices book for details.

Additional Benefit Changes for 7/1/2010
Employer Contribution Increases from $679 to $733 a month

* Mandated Benefit

NOTE:  Note employer contribution increase this year.  $679 to $733.
MUS Benefits works hard to keep good benefits in place and costs down. 
We have a new Prescription plan this year called Urx.
The Premium dental plan has a slight increase in cost this year.
MUS Benefits and wellness will add two new programs this year – future slide will show info. on these.
If you want to continue or start a Flex plan – you must enroll each year.  Active employees only.

Health Plans & Networks
The better you stay in-network – the better the benefit
New West  1-800-290-3657, www.newwesthealth.com
Blue Choice   1-800-820-1674, www.bcbsmt.com
Allegiance  1-877-778-8600, www.abpmtpa.com/mus
Peak  1-866-368-7325, www.healthinfonet.com
MAPP  1-888-873-8049
NOTE:  MAPP is for Medicare eligible retirees. 
Some plans have increased networks, additional hospitals and doctors!  Give them a call to explore.  All contacts are on the back of the Choices workbook.

1. We are trying to take   advantage of  the new health  care delivery model.
2. Present Programs for Oncology,   Infusion Services,  & Autism   Services– Orthopedic Services   is under construction.

Does not matter what health plan chosen.
See Choices web site for more details - (www.mus.edu/choices )

NOTE:   It does not matter what plan you are on for QCC. 
Evidenced Based Clinical Guidelines:  the best way to treat a condition for the best outcome.
$0 Benefit Design Steerage:  $0 cost to you. No co-pay, no deductable or co-insurance.
$0 Member Compliance: If its too expensive, members may not follow through with the treatment plan.
This remedies that issue – there is no member cost.
Plan Cost:  The bottom line. We expect good care and good outcomes.
Eliminate Admin Issues:  Cost is set up front. Eliminates all the issues and confusion over these issues.  All one cost      for the plan.
Case/Claims review:  Payer and Payee meet and evaluate regularly.
In the middle is the Doctor and Patient – the most important.
See the Choices website for additional information on this program!

URX
This should not be new to anyone by now.
See Urx podcast on Choices website if you have questions.

NOTE:  -URx groups drugs into tiers based on how well they treat disease first, then on the drugs overall value. (efficacy plus costs).
-More drugs will be covered under URx than in the past. 
-Drugs that were not previously covered, may be an F, but you can take advantage of the negotiated discount on pricing.
-Certain OTC (over the counter) drugs are now covered (baby aspirin 81mg, omeprazole, pre-natal vitamins) with a prescription from your doctor.
-No deductibles for prescriptions this year!

How Will URx Work For Me???? THE URx 4 STEP
-There are 4 steps, we will show you how to access the drug list in steps 3 and 4.

STEP 1

• Review Your Medications – Know what they are………..
• Complete Name
• Dosage – i.e. 10mg, 20mg. etc
• Frequency – i.e. Once daily, Twice daily, etc.

STEP 2

• Find out what tier your drugs received under the URx drug list.

STEP 3

• If they are D or F, you can find out about potential alternatives in classes A through C to discuss with your doctor. Call Ask-a-Pharmacist at 1-888-5-ASK-URX (527-5879) for assistance if needed.
• We will be mailing letters to members who have D and F drugs beginning in April and again throughout the year to assist you with learning about your drugs and potential alternative drugs.

STEP 4

• If there are documented medical reasons why you cannot take one of the alternative drugs with a higher grade, MUS Benefits staff can work with you to see if you are eligible to receive a better benefit for a lower grade drug. Have your PROVIDER complete and submit a Plan Exception Request form (available on-line, campus HR, or call MUS Benefits).
• -the Plan Exception form is on the Choices website.

• How do I find out my drug tier?
• There are several ways to look up the tier of your drugs and potential alternatives:
• Call general information at URx 1-877-501-1064
• On the internet go to www.mus.edu/choices. Note NEW! URx

If you are established on certain types of drugs, you can  continue on those drugs with an enhanced benefit.  Examples include specialty drugs, transplant drugs, and certain neurological drugs such as anti-depressants (Grandfathering).

Where do I go to fill my prescriptions ???

• You can still use all of the same retail pharmacies and Ridgeway mail-order pharmacy. A new mail-order pharmacy called URx MedVantx will also be available for you to use. (MedVantx is located in South Dakota.)
• Diplomat Specialty Pharmacy is the URx provider for Specialty Drug Services. If you are currently in the specialty drug program, Diplomat will be in contact with you prior to July 1, 2010. We will maintain our current $0 Protocall program through Diplomat.

NOTE:  -Effective July 1, Caremark is no longer available as a mail order option.

NEW Program:  WellHeart

1. Target those with current cardiac risk factors, such as high blood pressure (via letter and/or phone call)
2. Effective July 1, 2010

More Information Ê www.montana.edu/wellness

Coming July 1, 2010.
The Tobacco Cessation program is offered to tobacco users who want to quit, and are insured with the MUS health care plan.  It is a once-in-a-lifetime, one year benefit.  Participants have one year from the date they start to use this benefit.
This program is a partnership with the MT Tobacco Quit Line (QL). 
For information on this program and its reimbursable products and services, go to the Choices website or call 1-877-501-1722.
www.mus.edu/choices

Retiree Updates

• Managed  Care  Offerings  are all one price.
•  MAPP – Expanded service areas                                                                    -  SAME  RATE  AS  LAST  YEAR.
•  Look for updates mailed  to  your  home or attend

   a campus presentation.

•  All Forms for any changes must be received by May  21st  to the appropriate address listed on your enrollment  form.

If  NO CHANGES  – you don’t need to do anything
NOTE:  Attend a MAPP presentation in your area.  Call or email HR for details.

CHANGES to CHOICES
Please watch for campus mailings/information  regarding  dates  benefit  changes  must  be submitted  by.
No changes submitted – present options will be maintained.  With the exception of Flex Dollars -Amount of dollars you want to put into a  Flex account must be submitted every year.

NOTE: 
Check with your campus about deadlines for benefit changes. 
Remember to re-enroll for the flex plan each year if you are eligible!