ALC-Employee Benefits Division Oversight Subcommittee

OK, members, uh, if you don't mind taking your seats, uh, we'll call the meeting to order. OK, the, uh, first item that we have is the diabetes management program study. Uh, we have Siegal here with us, so if you all don't mind coming to the table. And I think you know the drill, if you can just, uh, introduce yourself and uh. Then you'll be uh welcome to begin. Members, uh, let me kind of, let me kind of say this, of course, we've, as most of you all know, we've done this because of legislation and this committee is going to be required, uh, to either offer, offer up a recommendation at some point. Now we don't have to vote on that today, but we may have to do it next month. So the thing is, is we can leave it the same. Or if we want to do something different, we can do that, but we will have to, uh, uh, do some stuff in writing and uh have a vote on that. So just to let you know that's, uh, that's why we're doing all this. So you all are welcome to, uh, to begin. I'm Patrick Klein with Siegel. Seagull. You want to begin? OK, so. Uh As we have met many times so far and discuss this diabetes study. We were asked to kind of come back and Uh, kind of predict what the cost would be, what the engagement of members would be, so I'm just going to give you a little refresher of what we talked about. So what these diabetes programs we talked about them, they're called those point solutions that only target the diabetic people. And then they do variety of. Interventions like the sending the uh blood glucometer to people's homes and those glucometters are directly connected with the health coach, the health coach will be calling the patient. They will be sending a weighing scale at home because weight management is a big part of diabetes as well. There is some nutrition counseling, behavioral counseling, uh, physician management, different pieces to what how the programs work. And. We divided the program into two. Buckets. There are light touch programs we call that light program, and then there are very high touch programs which we are calling intensive programs. And the way they differ is light touch programs kind of focus only on like educating the member on what, how to monitor their disease and maintain their medications going forward and then moderate lifestyle changes. Uh, so you get more engagement from people with the light touch program. And then the intensive program is way more rigorous in terms of dietary management, uh, you're supposed to eat certain things and not eat certain things. Big involvement of the coach in terms of uh. The nutrition and dietary changes, the goal is to make the patient less reliant on prescription drugs, so they work on ultimately getting them off the drug. And then intensive lifestyle modification. So you get modifications. So you get less engagement in this high touch programs because people simply don't like. To change their entire lifestyle for anything. That's a given. So, that's why you have low engagement in the intensive program. Higher engagement in the light touch program. So the way we did this here is you have About 9000 diabetics in the population. And so we predicted what the participation would be. These numbers come from some of our national research and data that the vendors publish, as well as our own experience with our book of business. So the low engagement in the light touch program will be around 10 to 20%. And the uh sorry the engagement will be 10 to 20% from low to high. And then the same engagement will be only 3 to 7% in the intensive programs. So that is, that gives you a number of participants. And then the fees are usually charged on those who participate only, so you're not paying for the whole population, you're not paying for all 9000 diabetess, you're only paying for those who are engaged in a program. And the light touch programs kind of started about $75 per engaged member per month? And the intensive program costs a little higher, but you get low engagement, so they, they start at 2:50, but then the low engagement brings that annual cost down to $800. So if you compare the low engagement cost of both programs is almost equivalent. It's around 825,000. And if you kind of predict. Higher engagement from your population, which is. Usually welcome because you want more people to take advantage of the diabetes management program, but it does cost your plan a little more. And then you can see that number is somewhere at 1.6 for the light program, 1.9 for the light program. So that's the investment that you will be making annually for having a diabetes program in place, and that's kind of the, the cost, uh, portion of it. Yes, so that's the cost piece we also anticipate that there'll be some savings that, that offset those costs. So, before we can do anything we establish a baseline cost for the The period and what we did was we took the 2022 diabetes specific data, and we trended that to the projection period. So you can see the baseline numbers below. We also break this out by service category because we know that the programs will have different impacts on professional services versus outpatient inpatient, and then on the diabetic drug piece of this as well. Uh, typically we see the individuals that opt into these programs are higher cost than your normal diabetic. So we did assume a 30% increase than the average cost, and those are all shown here below. So here's where we put everything together. We've got 2 slides where we're showing the ROI. The first slide is for the light program, and we've broken this up to 2 tables where we have the low estimate, low, lower participation, lower savings, and then a high estimate with higher participation, higher savings. So the top part of the table, if we just look at year one. We can have the eligible members of 9000. That's the number of diabetics in your population, we assume 10% enroll in the program, so about 920 participants at $75 per per participant per month. That leaves a cost of $826,000. And that's constant throughout the whole life of the program. So then we get into the medical cost or savings, so the first year what we see is that there's more. Professional visits so people are going to see their PCP more, uh, there can be an uptick in in the medication that they're using. Uh, so there's actually a loss or a cost in that first year and then years 234, and 5. In future years, we start to see inpatient admissions go down, lower utilization on the outpatient side. Um, And so in the first year, you can drop to the bottom. We have a net cost of $1.2 million. That net cost decreases each year, and then if you look at year 4, we start to see some savings. So $150,000 in year 4 and that savings grows over time. The total 5 year cost is in this top table is $1.8 million. So if you stretch this projection out to year 10, that's when we finally see a break even. And then years 1112, future years, you'd see some net savings. We drop down to the the table below. There's more savings, there's more engagement. So in this example, you see that in year 3 at the bottom, the net savings of $43,000. So you see savings faster and then those savings grow quicker and, and then you have a break even at year 7 for this, for this light program. And as you noticed in the, the RX cost savings bucket, there's no change, because in this program, It's really about staying on the same drugs, right? So, yeah, and with the high touch or the intensive program. The goal is to get these members off their diabetic medication. Uh, so. And this piece you've got less participation, so 3% on the low estimate, but a higher cost of $250 per participant per month. So the annual fee on this is, is about the same, uh, but in here you get some pharmacy savings and you get more dramatic medical savings. So there's greater offsets on the inpatient and outpatient in the future. So in the in the low estimate top table, we see a break even at year 7, and then the high estimate below. We, you can see on the table that after year 5, the total savings is about $1,000,000 and that savings would continue to grow in year 6 and year 7 and And some of the vendors who provide the intensive program will put some money at risk. To in performance guarantees, so they'll get a certain number of people off the drug and achieve their diabetes maintenance or remission status, and they will put money at risk. So we've seen that and we have used some of their performance guarantees too. You know, help, uh, pay for the cost. So yeah, relatively speaking, this, this whole program, it's, it's not a huge cost because you're only covering the people that want to join, and we know that there's some savings on the back end, and we know that there's some performance guarantees to to protect some of those savings, so, um, and, and again, as you see in the numbers, we don't anticipate magn huge savings, uh, early on, uh, over time, if you continue with the program, there should be. Some savings that offset cost, um, But yeah, it's not a silver bullet. It's not gonna really change the financials or the reserve much either way. I would say the the positive about having a program like this is helping the few members who really want to. Be helped in terms of managing their disease condition, which usually doesn't happen with their doctor. The doctors don't have time to give to the member other than writing the prescription and sending them home. So these are the company's point solutions that can come in and. Provide that health coaching, the nutrition advice, the lifestyle change advice that a member might need. So that is a positive about this program. And then If there are no questions on that, we can move on to the wellness part let's do one at a time. OK, give me a second here. Senator Irvin, you're gonna be first. You should be on. Thank you, Mr. Chair. Just a quick question, outside of the programs, has there ever been where plans, um, actually then would provide an incentive or an extra. Um, Payment to the doctors and the primary care providers who are seeing these patients for this type of thing outside of contracting with a program that does happen with some health plans when they have this what they call the um. Um, the ACO, the Accountable Care or ACO is accountable care organization within a health plan, they may have a select few physicians who get extra reimbursement for doing the right things for the members, but what we have seen so far is the ACO uh. Number of physicians who actually are enrolled in SU are very, very, very small, simply because the physician officers don't have the resources to engage in these extra conversations with their members beyond what they just see the member in for 20 minutes of whatever that monthly visit is, so they don't, they simply are not staffed enough to do that. But there are, there are examples of. Of that being done as well. Well, I mean, I think it's all go back to payment, right? I mean, if you're only paid a certain amount of money, then you have to, you have to operate your business and you have to, you know, Create a schedule and fit people into that schedule in order to make enough money to cover your bills and all that. What I'm saying is, like, apart from this, is there any plan that would just give primary care providers. The ability to Build in an extra visit or anything like that because I mean, They, they've most likely have been through a ton of medical training and education, they can provide that same level of Um, management, they just aren't paid to do it. So that's done very well by someone. With their own set of clinics, so it's called, we call that on-site clinics when you have a primary care physician that's dedicated to a certain population that's designed to do exactly what you're saying, but not in when they are part of a large network and they're taking every member that comes from the community, no, I, I get it. I was just thank you, appreciate it. Representative Beck you recognized. Thank you, Mr. Chair. Uh, my question is related, and I, I, I may have just missed it in your presentation, but is there any data related on like the, the average age of someone that actually embraces these, these programs, uh, are they older, you know, are they, are they the, the younger generation, do y'all capture any of that? because this is specifically for type 2 diabetes, it is usually the. 40 plus is the age I think I would say 48 is probably the average, because that's when people with their Certain lifestyle and, uh, physical stature get. Type 2 diabetes. Type 1 diabetes, on the other hand, is a different story where you have a lot of younger population, but type one diabetes is usually well managed through there, even starting with their pediatricians, so we are not talking about that population here. Another Just follow up so. I guess what I'm drilling out a little bit is, is there an advantage to, you know, maybe that type one diabetes level to put additional things there that might prevent type 2 diabetes, no prevention is that's the I mean prevention is mainly based on, uh, actually many factors, but. Obesity and and uh. kind of lifestyle. Adoption is the main reason for somebody to develop type 2 diabetes. There is a huge genetic component to that as well. So it cannot all be prevented, but in general we know that the type 2 diabetes exists in. People with a certain BMI. Body mass index then uh this. The less than 30 BMI. They are more subject to. Get type type 2 diabetes wouldn't it be better to engage people as far as lifestyle changing early on. That's then you're talking about a wellness program that. Happens for certain lifestyle modifications before even somebody develops a disease. It's a different program. I think we're going to one of our last slide is on that. Thank you. Thank you. The center headgear I asked for a comment. OK, uh, any other members have any questions. Again, as, as I stated at the beginning of the meeting, this is, uh, you know, we're going to be required to, uh. Have some motion, uh, to make some recommendation because of that statute back to the legislature. Uh, You know, again, that's up to you all. Uh, I can give you my opinion on the thing. I mean, of course, just to kind of point a couple, a couple of things out. On page 2, I think it's important under the notes that you look that it says that all this is going to be dependent on how the program is communicated in a financial incentives are offered. So the thing is, is you've got, if you're wanting to look at it from a Complete financial impact, you know, we're going to have to do that and we're going to have to continue to do that, uh, throughout all those years, there, of course, those participants are, are not going to come in and, uh, not gonna stay with the program and it's just, it's never gonna work. So, you know, it's, you know, again, this is up to you all, but. From my standpoint, is, you know, we leave it the same and we don't do anything or if we were going going to do something. I personally think that probably you would want to look at the uh. Intensive program. Uh, you know, you're gonna get your most, uh, obese people with that. You know, maybe they're going to be more apt to, uh, uh, to stay with the program and actually our break even if that if you look his own, uh, we have, we get that if everything works and we communicate it correctly, you know, within 5 years. Everything else has got such a long break even point. I don't know if it's, uh, prudent to do that or not. Again It's up to you all, but uh. It's kind of the hand we've been dealt with the, the statute. And we'll tell you the same thing on the, on the wellness and a minute ago, although it wasn't a statute, this bottle, that one's coming up next too. We don't have, Mr. Chair, I mean, we don't have to, we don't have to make these recommendations, uh, today, we can wait a month and everybody can kind of discuss them and talk about it if, uh, you'd rather do that. Yeah, I, um. Thank you for that, uh, co-chair Hickey, um. You know, I know we've been talking about this for quite a long time. I would like. To make a recommendation on the wellness program, but I think we should wait a month, have the discussion. I think now that we've got a better idea too of, you know, when the break evens are on this, uh, on these programs, uh, you know, we have to make a recommendation next month because, because we're obligated to by statute, but, um, you know, I think everyone needs to be prepared for next month's meeting to be willing to vote on whether or not which plan we do, if we do any plan at all, um, to kind of echo what Senator Hickey said too, I do have a lot of concerns about such a long payback period and even 5 years when you think about this, um, you know, will we as a legislature still be on the same path of wanting to do this in 5 years. Um, so I just, uh, I, I want members to think about that as we move ahead. Thank you. Senator Hamber, you're recognized for a question. Thank you, Mr. Chair. um, I'd like to ask the presenters if, if I understand this, this is. If somebody chooses to participate in their, you know, we're aggressive in encouraging them to participate in the projected results should show savings. So we're down to the question then of those that will not participate. Uh, they're the ones that are gonna be the contributors to the higher cost because they refused to participate. Is that a fair assessment? Fair, yes, so in any of your dealings in any other states. Or limitations by federal or state laws or anything that we could do to impose a higher rate to those who choose not to participate in order to help offset the cost because they're not willing to do what they gotta do to help lower the overall cost or what's your experience in that area? I'm, I'm going to refrain to make any legal statement here because I'm not a lawyer, so I'm sure there are some laws that prevent discriminating people based on their disease condition to force them to participate in the program. So that part I'm not going to. Uh, opine on because I really don't know simply, but. It all depends on the benefits philosophy and there have been employers that I've seen who it's called a carrot versus stick approach. So there is a stick approach that has been used very effectively and increasing the premium on making the program available to everybody, but then increasing the premium, or rather giving a discount or incentive for somebody to participate. So if you don't participate, it costs you more, and that has been done, yes. I remember conversation last week we had Max with Blue Cross Blue Shield in here and, and the question was asked about, you know, we charge smokers more, it seemed like certain categories it's OK, certain categories it's not. Would this fall in the category where it would be OK that we could somehow or another. Uh, you get a discount if you do, but if you don't, you pay a higher rate kind of thing. Yeah, uh, so smoker surcharge is pretty common. Uh, anything like this that. Where you Forcing, you know, people to, to enroll. There needs to be reasonable alternatives. There's a lot of legal rules that protect. People from uh. Maybe not, maybe not force, but reward if we go in one direction. Yeah, either way, but like if you have a differential in the contribution, um, you need to provide reasonable alternatives for, for like a program like this. Thank you. Representative Collins, you're recognized for her question. Thank you. And just to follow up on that, aren't we kind of, uh, making a cost differential by saying that if you participate in the program, you get some kind of a reward or discount. I mean, isn't that what that is? In the diabetes program, we didn't, we didn't put any incentive. We'll talk about that overall wellness example that I we presented last time, and that's coming up. Could that be part of a diabetes program having an incentive in there? It can be, yes, but then you have to make that available to non-diabetics too, because you cannot discriminate that only the diabetess are going to get the incentive. So you have to figure out how to engage everybody else into that same incentive program. OK. Yeah. All right, I think we're ready to proceed to the, if there are no more questions to the wellness part. And like I said, we're gonna hold off and make a motion next month on the diabetes plan. Thank you slide 7 will answer a lot of your questions, especially the last two questions. So we talked about different samples or examples of uh. How the wellness program be administered and how that will be integrated with the diabetes program. This was our favorite example where. The annual cost of incentive to you will be $600. For those who participate in the wellness program. And for those who have diabetes can actually use. Some of the $600 for showing their participation in the diabetes program. And then the way we did this was, if you are eligible for a diabetes program, you enroll, you get $200. If you're eligible for a weight management program, you enroll, you get 200. But if you don't have any of those conditions, you just are identified uh, you, you just have to make sure that you engage in your wellness activities, which is your annual physical, your health screening and fitness plan and utilization of EAP program. You can give them various Options so that people get up to $600 in incentives. So this is the example where it integrates both. The wellness program for those without a disease condition and for diabetess with because they have a disease condition. But then this is going to cost you more because we're talking about 600 to everybody, and not just the diabetess, right? So then Patrick went ahead and did the uh. The projections on that cost, two different. Ways that you can earn incentives here. The first. Which is a requirement for the, is the the 1st 200 is for participating in your annual exam and a health screening. So that's worth $200. That's basically what you had before in your prior, uh, wellness program a couple of years ago, and we saw the participation levels were at 75%, so we assumed that would be about the same percentage of of people that would participate this time around, um, so that piece alone, you're looking at spending like. $1.7 million. Um, if you drop down to the second part of the table, that's where the. The second piece of the incentive, another $400 can be earned. So it really depends on where you're at, if you're healthy, there's wellness activities you can enroll in, um, if you have other issues, you can enroll in the disease management program or the weight loss management program, and that gets you the other $400. So that's, there's a little bit more to do there. So we assumed a lower participation rate, 45%. So the cost on that piece of the incentive we're assuming to be around $13 million total those together. We're looking at a total cost of the program. Close to $24 million. So, um. Like the disease management, we've seen studies where we can kind of quantify the savings offset and figure out what the break even is. The wellness, it's, it's pretty difficult. So we do think there would be some savings, but you're never gonna have a long term ROI, uh, there is no break even on the wellness program. There's just so much cost, um. For a large portion of your population that is healthy, that you can't really make it all back. I almost consider wellness as one of your perks. Not something that you're spending on just a perk for people to engage in their healthy lifestyle. So it's like a, you know. Your vacation or something, it's a perk that costs you money. There are some prediabetics that you'll catch, you know, to the, to the point that we were talking about before and that would mitigate costs down the road. So long term, I think there is more and more savings that, you know, you may bend your trend curve a fraction of a percent, but, uh, you're not gonna offset that $24 million. Uh, Representative Brown, you recognized for her question? Thank you, Mr. Chair. Um, If we implemented just the, uh, weight loss program. I'm trying to parse this out in my mind, but people who would modify their diet and behaviors. For weight loss. would also improve their outcomes for diabetes, heart disease, and just about anything else, correct? Certainly, yes. So if we, but, but the weight loss program would only apply to people who have a weight, um, have. Right above their optimum. Yeah, a BMI over 30 usually is considered we would not be included in that group. Correct. Thank you. Senator Dismay and you're recognized for her question. Thank you. And just to refresher. How many people participate, you know, so we no longer have the incentive for the wellness visit. How many people, what's the percentage, and we had 75% participation when we did that incentive, how many people are now actively doing an annual wellness visit. Oh, we could, we could take that back and, and run the numbers and see how it changed, you know, before and after, um. I don't have that offhand. OK, I, I mean, I think that's kind of, that's probably a critical number because if 10% of the population, you know, we go from 75 to 10 just making it up. That's a significant number of the population that's not going in annually, and you know I mean that's anywhere from skin cancer to colon cancer to you know, pre-diabetic to whatever that's not getting identified, so it's greater than the scope of what we're talking about here, and I think that's what ultimately. I mean, that would have some long term implications on our cost if there's been a substantial decrease in the participation. By the members in the wellness screening, um. Yeah, if you see their behavior, yeah, so it's really, you know, the people that we're going to go see their doctor annually anyway, and to your point, if you don't see any change, then you're just kind of giving them the $600 but, uh, if we see a dramatic. Reduction in the utilization of that annual exam because they're only doing it for the Cash incentive then yeah, I think it is. Yeah, I do believe that, I mean, whether we have a penalty because they don't have the wellness visit or we create an incentive because that it's all one and the same. It's costing somebody something, then, but I mean anecdotally, I, I think that there's been. There's not the urgency. I mean, there was an urgency, I would think most of the folks, you know, that were on the plan felt the need to to go get this done. There's a deadline. We have to do it by such and such a date and. Um, that doesn't exist anymore. And it, and so I think without that, I would be interested in knowing. What what participation looks like I'm assuming there's some coding we can tie back to, uh, for a wellness visit, um, and find out, but I. I would think before we scrap the idea of a wellness plan or a wellness visit at a minimum. We need to know what. What the outcome's been since we have done that, we should, we'll have the data. Is there anything I need to clarify on that or that makes sense. OK, I'm just trying to think of the, the data that we have if we have both years, you know, the before and after, um. If not, we may just need a request some of that information and your vendor would probably would definitely have it too, so uh we could work with EBD to get that data. If we don't have it in the data that we've already been provided. Yeah, we'll have to request, but we are 75% is spot on because that's what we are using with the incentive, it will go up to 75, yeah. Uh, Senator Irving, you're recognized for a question. I, I think just following up on what Senator Disma was saying cause a little bit back to my, my line of questioning was. Working with our current insurance provider that's providing the plan designing a wellness visit. Of an incentive for the existing healthcare workforce that's seeing this patient population versus adding a whole another vendor contract with health coaches and nurses and all of that. Why can't you, why couldn't you design a plan that incorporated this within the existing structure. That that's what I'm trying to understand because I think if you, if you gave the existing healthcare infrastructure that's taking care of these people. The communication and the ability to, to work that in as a wellness program, then it would be beneficial in work because you already have a relationship and a connection with those people. They're just not paid to do this, right? I mean, they just, they can't afford to do it because they, they're not paid to do it. So, why couldn't you fix that portion of the existing plan? And have you seen that in other states? I like your question because conceptually it makes perfect sense. Uh And it is commonly done with a fully insured health plan. I don't know if I have to have the time to get into the discussion of fully insured versus self insured. You're self-insured. Meaning They just administer your claims and then you pay for. Whatever doctor that they go in, in that arrangement. The health plan, the insurer has no control over physicians. 0 They have no control over what the physicians are doing. In the even if they're in their network. In a fully integrated system like a Kaiser is a great example. Kaiser is the insurer. And it's an integrated system where they actually employ physicians. To deliver care to your members, and they achieve exactly what you're saying. Kaiser physicians. Have the incentive to do that go that extra mile. And actually deliver any kind of a wellness advice or a disease management service, or a diabetes uh discussion with the member because they have incentives built in into the plan. That Kaiser pays the physician directly because they're employed by a health plan. So there's a huge difference in how health plans work. On a Self-insured side versus fully insured and Uh, with, with your large population, fully insured sometimes is monetarily prohibitive because you are kind of being extra for a very large population. So there is a there is a little disconnect in how our system works, but that's kind of the biggest problem. That's why what I mentioned earlier about if there is a, you know, a clinic or a set of clinics that some of our clients have, and then they have physicians on staff, their own staff. Who deliver these kind of primary care services to those who come to the clinic, there you can exert a lot of control over services like this. Any more questions? Not seeing any, I believe, uh, Senator Hickey, you have a motion? on the wilderness. Uh. Yes, um. I'll make a first motion on the wellness plan to not proceed. Um, I've got a second, all in favor, say aye. I'll pose. Motion passes. But Yeah I called it, but we can, we can take it back and yeah. Sorry. To this man you recognize. I mean, I'm not sure that we had all the information. I mean, I understand the $400 portion of the program and even to some degree the $200 portion, but I think as far as scrapping the idea of a wellness visit altogether without understanding what it, what's happened with participation in annual wellness visits. would probably be a little. Uh, We wouldn't have full knowledge to even make that decision. I mean, even if Even if we reverted back and created a penalty that it cost someone more. Um, I don't think, I mean, is that what we're doing with that motion or? What, what did we just do with the motion then is that this ends the discussion on the entire wellness conversation altogether, not proceeding with the idea of doing a wellness plan because we, we hadn't had one, we brought it back up for discussion, discussing the ideas. I think the reason and and. I I'm just speaking for myself here as I think we constantly heard that we'll spend this, you know, millions of dollars and not get the kind of return that we're hoping to get, which I think is what we were, we're trying to do. I, I understand you. Your questions and, um. But they, I think they've just said they didn't take that into consideration. Because they didn't know what the decline in participation was. For the wellness program since we've ended our. Wellness program. Or our wellness visits them and I think that's the most important component. Well, we can move on and do whatever you want, but I don't think that we have the full information to even know. I mean, I think most of the healthcare community would agree that if someone waits 5 years to go. To see their primary care that's probably going to be a problem, depending on their age. And their health status. Um, I mean, deferred. You know, maintenance of an individual. I mean that that's very costly, but again, I, I understand you've already called it. We had no discussion. That's fine, but that's kind of what I was waiting on with some discussion about should we get that additional information? That's the reason I asked for it. But well, that'll work. If I can make a motion to reopen for a discussion, I mean, I wasn't trying to shut to shut you down, Senator Disman that wasn't my intention at all, so we just would discuss this for a while and was wanting to get to the next items on the agenda, so, excuse me for my impatience. OK. Uh, I'll make a motion to reopen the discussion of the wellness plan. To have a second? OK your second. All in favor, say aye. I oppose. Motion passes. Senator Despan your record. I mean, I, again, I, I completely understand if we want to make a motion to, you know, on the, the wellness program part, not the health screening, then I understand that if we want to say that we're not going to create a financial incentive for getting your annual wellness visit, but we'll have an increased premium then I understand that. But I do think we need to understand, we need to have a better idea of what's happening. With the annual wellness visit since we've done away with the wellness. Program and incentive, that that's it, um, because I, I think it's important. Um, and I don't, wouldn't want to pull the room because I, I don't think we'd like the outcome of how many people are going and seeing their doctor once a year for a wellness visit to see what's going on, um. But, but I think it's critical for maintaining a long term cost. Aside from Whether or not we give a $200 200 dollars incentive before we, you know, through the increased cost to encourage people to go. Thank you, sir, that's fine. I, I would argue that I, I understand the point you're making. You need to have The set of data to understand the fall off, but I think the ultimate issue is, and as you heard the consultant say before, is this really just is a perk. It's not something that's actually going to change the cost curve. Uh, I understand that you disagree, uh, but I think a lot of times through various health plans you'll see people dropping their wellness programs when they need to control costs and obviously, I think for myself, and I can't speak for the rest of the committee. I maintaining the lower cost is ideal, $23 million is a lot of money to spend, uh, on this. So I just, I think. That's why I, I feel the way I do about this, so just wanted to state that for the record. Senator may you recognize. And just to clarify, I'm not advocating that we spend the 24 million and, and, and again, have conceded that. You know, it doesn't appear that there's a benefit to the ROI for the program on the $400 you know, my concern is participation in annual wellness screenings and what's happening because I don't think there's much of an argument to be had that people need to visit their primary care physician. Annually to see what's going on. Uh, with their health, um, and, and deferring that. Leads to major cost to our program. I mean, not being able to identify someone that's pre-diabetic, um, is a problem, um. Not not identifying, you know, a skin tech cancer is a problem, not identifying lots and lots of what is, you know, very easy to maintain issues that turn into big problems, uh, will have a much bigger cost in the long term for us. And, and I don't think we can know that we made, the data may come back and say that 75% or even now 90% of the people are out there getting their wellness screenings. That's great. Then this conversation's over, but if we find out that 25 to 30% are now participating in that, that's a problem. Senator Irving, you recognize. Thank you. I would, I would just make a suggestion that we, um, get this information that's been requested by Senator Dismay and, um, for the next month's meeting because You know, if you go down to $100. For just the wellness exam. And you're at 75% of the total, that's about a $7 million number from based on your information that you gave us, um. And how, you know, and I'd like to hear from our current vendor that is, um, paying the claims on our self-insured plan and from the director of EBD to see if we could, um, if we could design that within our plan, um, and not have to contract with an outside vendor on a wellness program, but how could we be creative in designing a wellness annual visit. How do we And maybe it's not even $100 maybe it's something less than that, but. But I think he has a very good point of just that annual checkup is really, really important and I'm just, I, I think we're just missing, we're looking at this all comprehensive wellness program, which I appreciate and I love and in the great, I'd love to be able to do this. It just comes down to money and I don't think we can afford it. But I do think there is value in, in, in an annual visit, that should be something that we should. absolutely strive to emphasize. And so I just don't feel like maybe we have enough information. So I, I think we're missing. A discussion that's really needed. In regards to an annual visit, like what Senator Disney is talking about, but I think we should be able to design that within our own plan and utilizing our own healthcare workforce that's already seeing our patients to achieve that. That shouldn't be that daggum hard to do. And that's what I want to talk about the next meeting. So, if you need that in a motion, I'll be happy to make that motion, but I would just defer to the chairs on that. I think it's reasonable. But Well, I mean, the thing, at least from my standpoint, I mean, I think that the motion that's done, we'd have to have an expungement on that, or we can just go for, we can go forward and say, well, we're not going to do the, uh, wellness plan, if we want to try to develop something else, we could have an, have an additional motion as, as you all have suggested, and asked Siegal just to go back and try to gather that information and, and see because we could always reopen this because the wellness part is not a stat, was not a statute that came out of this committee, uh, to do it. So, I mean, again, we can reopen that at any, at any point. So we were just trying to comply with the committee because we said we would try to do it at the same time as the diabetes program, which again, we're putting the diabetes off for a month because that was under statute just to get some Uh, more information from you all on what you wanna do. So, personally, I just, uh, I would think that, uh, And again, it's whatever you all want to do, but I'd say that the motion stands and then we could have another motion to have them to gather information and then we can try to analyze it. Yeah. Well, real quick, I just want to get to Representative Beatty. He's, he's been the queue and then we'll, we'll come back to you, Senator. Uh, thank you, Mr. Chair. I think the points made by, uh, Senator Dismay or valid points, my, my, my question is right now we don't have the wellness program, so it's not a benefit that we're providing, uh, to members. I, I think having more information is always useful to see what that downturn from the, the baseline of folks that were participating when we had that benefit to see where it is now that we're not having that benefit. But in the end, I, I guess the bottom line for me comes down to. Uh, we're not providing it now. And it's gonna cost us, uh, based on these projections, 24 to, uh, 23 to $24 million a year to add that. What's the uptick in participation going to be on that as well. Um, so I, I think you have a valid point. I, I think more information is helpful, but I think in the end, it does come down to that $24 million investment and. From that number that we had when we were offering the program to where we are now without offering. What, what do you think that uptick could, could go back to? Could it go up or could that just be, um, uh, money that we're, we're expanding. And I do want to state that a wellness visit, uh, nobody likes surprises. I don't like surprises and that wellness visit can ensure that you're not going to be dealt, uh, an oncoming, uh, train that you're not running into that and gonna have a crisis. So, um, I I, I, I do agree that it's important to have that information, but I think that I agree with, um, uh, Senator Hickey that we should just let this go and, uh, deal with diabetes next month. Thank you. Senator Irving you recognize. Thank you. Just for point of clarification, it would not be the 24 million. I'm looking at only the annual exam, which is at $100 incentive through this, I think that it could be changed or we could set that at anything. I'm just going off of what this says, but I think at $100 per year is the only thing I'm looking at is an annual exam, which and if at 75% of the membership participated, it's about 7 million. So that's again 7 million, but again, it's being able to have that discussion to see in utilization. Decline and then just looking at the annual exam portion of what they have presented in the wellness program. That's, that's what I'm, I'm. So I just want to make sure that people understand the numbers. And so my motion would be to, to have them bring that information back next month just on utilization of an annual exam if we could figure that out today, meaning what's, what is the utilization now? Yeah, that we don't have an incentive. OK, so can we show that there's a decline. From when we had one we may have the request it from uh EBD and from the medical vendor. I'll I'll see we have detailed claims, but it's a limited time period, so I don't know if we have that comparison. It shouldn't, it should be something the vendor tracks and should be fairly easy reporting to get back. OK. I mean, just it's for discussion, that's what I'm saying. My motion is really just for discussion, not that we're actually doing this or not doing this. It's just so that we can have that information at the next meeting. And discuss just having this as an incentive, but not even defining the incentive, but trying to tailor it to what. We can tailor it to based on the information, the data that y'all bring us on decline and utilization of an annual visit. So that would be my motion. To proper motion do I have a second? All in favor say aye. All opposed. Motion passes. We'll have this for discussion next month. This information for Representative Tipy, do you have a comment or question? Oh, sorry, Collins. You recognize. Yeah, I do, you know, and just in this conversation about the cost, this $24 million is that all just being returned to participants in the plan, or are there overhead costs associated in here? Yeah, that's just the money that would be pushed back to the the member. So I mean, I guess I, I just wanna just. Recognize that that it's not like we're paying a vendor or paying employees, spending that money. I mean this is just returning it to people in the plans that's just another way that's why Saddam was saying, saying it's a, it's a perk, you know, yeah. OK, thanks. Senator Hay, you recognized for comment, but just, just to know that that would then come out of our reserves, is that correct? So it would, as far as our plan goes, you know, because under that legislation we did in a special session, we were required to, you know, maintain those, uh, reserves like that. So, There are some other issues that are about to, you know, they're gonna be coming up to, uh, as far as this inflation reduction Act that's happened at the Fed level, which, uh, we're trying to work through that are going to increase uh some of our cost. So the thing is, and, and eat into our reserves there, so, you know, the more that happens, there would, there would at some point be a. be a time where we'd have to raise those premiums to start offsetting that. So that's a good point, uh, Representative Collins, you know, as far as it wouldn't be to pay a vendor, but in the end, it's still going to be a general revenue that we're gonna have to use to. To make that up or add back into the employee's premiums. that's how some people structure it so it's this is kind of the carrot look at it, but you could. I mean, sometimes we've seen employees increase their employee contribution $50 across the board and then put this in. So it's like, if you do everything, you're not any better off. You're only, you're worse off if you don't do it, so, so that. There's a lot of different ways you can structure it, but either way, this is kind of the cost differential between. If you have a program that incentivizes $600. This is the cost differential. It doesn't necessarily have to be a cost based on you design it. It's kind of if you go with the carrot or the stick method. All right, I think moving down on the agenda, we've got an item C, uh, sender Hickey recognize. OK, members, I'm gonna make a motion that we suspend the committee rules to to take up the following items, the way the agenda is, it, it has everything under D, but what I'm gonna say is that's gonna be without with an exception that we do not take up. D2B United Healthcare, uh, if any members, uh, want me to answer any questions on that? That's my motion. On the United Healthcare, and what, here, here's the thing under the inflation, uh, uh. Under the Inflation Reduction Act with the MAPD plan, our current provider, uh, of course, those are rights, rights are going to go up. The state board of Finance has already approved that. There's been some negotiations that have taken place since then that would put us in a more positive, uh. Uh, position So it's beneficial. So we're just trying to follow all the statutes that EBD gets everything that they have in writing back from United Healthcare, uh, and then I believe that they're gonna have to take that back before the state board of Finance and then bring it back to us again, it'll be a positive as far as uh. Uh, from where we were today to what you'll see later. We have a motion. Is there a second? Or sorry, any more discussion. On the United part. Seeing none, uh, do we have a motion for a second or Thank you, Senator. All in favor, say aye. I'll pose. Motion passes. All right, um, item E, other business. Is there anything else from the committee? We hear these Oh, sorry. Sorry, guys, that's been a rough morning. um. Item D, um, yeah, EBD you come forward please. Sorry. Yes, Senator Gilmore. Motion Thank you. Was that motion to suspend the rules that we just did. To take up the, the, this item. Yes, OK, so, so then there'll be further action on the actual item to. Review or prove correct. OK. Thank you for the point of clarification. Good morning, Amanda Land of Employment Benefits Division. You recognize, please proceed. Thank you. Before you are uh approximately 4 different, um, exhibits uh for formulary months that EBD has put through its advisory commission and board of Finance meetings for approval to, um, adopt the recommendations. For these drugs for our formulary and if you'd like, I'd like to just highlight a couple of drugs that have a little bit more of an impact, um, That are within these exhibits, um, and I can kind of go through the month, monthly exhibits if that's, if that's OK. So for the June pharmacy formulary, uh, that would be exhibit D1A. I'd like to point out the drug Repatha. We are keeping that at tier two, but we are changing it from a PA to, um, basically having to try a statin first, uh, the, the aim on this is to make it easier to treat um cholesterol and cardiovascular disease on our members. So, um, The additional, um, we're keeping the same quantity limit on that as well. Uh, moving on, the other drug would be adalimumab. We are moving that from um not covered to our specialty tier 4. And this is the 4th low-cost biosimilar we're adding um as a, as a biosimilar to Humira, so we continue to review biosimilars that come out, um, just to help, you know, make care more affordable for our members with respect to that. Uh, moving on, Paxlovid, we are removing this from the formulary, but I would like to note that this is just the emergency use authorization Pa level itself will continue to be on the formulary. But the emergency use authorization um is no longer on the market, so this is kind of just a clean up to take this off of our formulary. Any questions on those? See none. Please proceed. OK, moving on to exhibit D1C. I like to point out intivio, we are adding that to tier 4. This is already covered on our medical benefits. Uh, so, again, this is just adding it to the pharmacy benefit side. The aim is to make, uh, Getting treatment easier for our members to have it as a pharmacy benefit. And coverage will be the same. Um, moving on to exhibit D1D. I just like to note two drugs that we are continuing to keep excluded from our formulary A Tera. Um, There is still a biosimilar for this, so we're going to continue to keep that as excluded and then back, we are excluding that. It's a gene therapy drug, you know, the cost, um, so. Um, we're keeping that off of our formulary. And those were the Those were the drugs I wanted to point out for you all. Any questions on the last two items? Seeing none. Proceed. And we would just seek approval to add those to the formulary to approve those to add those to the formulary. Uh, Senator Irvan made made the motion to have a second Senator Caldwell's seconds all in favor say aye. I'll pose Motion passes. Thank you. Thank you. The next item would be an approval, we're seeking approval to enter into a contract with retiree first. I, I think for some reason, it's listed as Labor first. On the agenda, um, as a DBA name, but um it would be a 3 month pilot program. hoping to start that assuming it's the will of this committee to enter into that agreement. We would hope to start it as soon as possible before open enrollment and the January 1st year. Um, The aim of this is a pilot program for our retirees. It's an effort to increase enrollment in our UHC fully insured plan for Medicare Advantage Part D plans, um, and they are to act as a concierge service for our retirees, be that outreach proactively reach out to um our 65, our Medicare eligible. Retiree population, walk them through that process of retiring, answer any questions they have about that as well as what Medicare can offer them and hopefully see a push to more enrollment on our MAPD plan, which we hope will kind of offset some of the liability for, um, What we see on the Health advantage plan when retirees remain on that plan. So. Hold on a second. Where and all that. Do we have any other questions on this item? Uh, Senator Gilmore you recognize? And we're sorry, on this other screen. I can't see who's over there behind that call. I'm sorry about that. Sitter hammer you recognize. Thank you, Mr. Chair. Do you have the, uh, numbers as far as the current. Members that are enrolled in the in the plan now. Yes sir, combined between both active or state employees in public school, it's about 16,000. Is the trend going up as far as those and have we been at it historically long enough to identify a trend of those that are switching over to go with the Medicare plans, the trend is moving in a positive direction, but we would like to see it go up a little bit more. Um, I can get those exact numbers to you on the trend if you would like. OK maybe let me ask you this way, are we, are we seeing those that went on the Medicare plan but wanted to come off for the movement back and forth, I guess is what I'm wondering about. For the most part, the people that are trusting the Medicare plan and making that leap over there, we're hearing positive feedback on it. Every once in a while, there is somebody who just wants to come back for, for whatever reason, but it's just we need a little bit more education, a little bit more, um, just proactive outreach just to continue to educate our members and just really convince them to make that. That switch over, so OK, nobody on staff currently is doing that or they're limited in the resources or our staff does do that. They, they answer questions not just for retirees but also the active population as well. So retiree first would be solely dedicated their their team, um, they won't have any other clients that they're answering questions for is my understanding, so they would be there. You know, 24 hours a day access to the retiree for whenever they want. a contract, right? This is not annual renewal. It's, it's a 3-month contract, through December. You're welcome. Representative Aker, you're recognized for a question? Thank you, Mr. Chair. Uh, wanted to ask the, what is the return on investment for the attempt of EBD, uh, and contracting out a third party to recruit members? Is there a certain risk that this third party has to achieve a certain number of successful enrollments in United Healthcare before they're paid, or is this a, how much money are we spending with the goal of how much to save? So there is no specific I guess, performance guaranteed as to the last point that you made, but we are. Keeping this contract very limited in duration to make sure that You know, this outreach can make the membership go up if it doesn't, then we have, you know, we are not obligated to continue to contract with them, but yes, to answer your question, the goal is for this outreach to increase that membership and what it does is it's loading people off of the health advantage plan. Which is our fully insured plan. So, to have them go to this, um, or I'm sorry, the self-insured plan to have them go to our fully insured plan. It's offloading the liability from the state. But we are taking on a liability for this vendor to complete this project. So do you have an estimate of the number of lives that they would have to transition for it to break even. No, not at this time, but I could attempt to get that for you. What's the cost for this vendor? Uh, it's at 49,500. OK. Yeah, Senator Hickey, you're recognized, if you'll just bear with us, the only thing that we're doing here is since you in the portal, you put one name and then on the contract, it's the other name. I see it's a DBA. I think so. I just want to make sure that you're not going to run into any problems because of who you're gonna have to make the checks through. I don't know, you know, so we have a staff member that works on this all the time. So I just want to make sure that we don't need to do an additional motion, uh, because of the retiree first and the labor first. It's a little diff it's just a little different because the Labor first has LLC up here and then again on the front of the contract, it has a retiree first and then towards the back it I've noticed that it does have LLC DBA so give us just a moment just to make sure we get that right. While we're waiting on that answer, do we have any more questions? No, let's just hang tight until we get an answer from staff. Thanks, everybody. Thank you for your patience. Senator Gilmore, you recognize. Question. Thank you, and, and not to. not trying to raise anything other than I'm just out of curiosity, um, not a huge fan of sole sourcing, but and you may have already stated it. What's the reason for the sole source and there's probably a great justification, but I'd just like to hear it. Yes, sir. Um, so we, we actually did a search. We actively searched for vendors that could do this really intensive outreach and we, we simply were not able to find any others that can do it, um, especially on this volume of our approximately 160,000 live plan. OK, so there was an active search though for vendors. Um Well, we did do our homework, but yeah, OK, thank you. Thank you. Representative Baker, you're recognized. Ms. Land. Hi, um, is there any sort of disclosure that the member has to give to be contacted by this, or is this just gonna be automatically? Their information will be received by this third party vendor to be contacted. Is there an opt-out or an opt-in program? That's something that we'll have to work through with implementation. Um, of course, we'll respect any privacy laws and, and what have you, but, um, I believe it would be an opt-in for the member. And in particular, they'll be, um, Targeting those in the teacher population, the retiree teacher population because we have seen That number lag a little bit more than. Than the state side. to turn over their contact information to a third party to be contacted about their medical benefit. Yes, some. Shicky recognized. I think we're gonna be fine. It looks like they're going to be interchangeable, but we've got two names first. We've got Labor first, like I said, and you keep referring to it as retiree first. And the the contract actually has retiree first somewhere and then Labor first, DBA is that. So, uh, I don't know who you're gonna make your checks to or how you're going to do it but they're all the same, they're all the same company. Do you know how you're going to make your checks? I do not. OK. All right. I, I say that we're OK to do this. It's just, you may want to work to make sure with our staff and things like that that we're not, not violating anything because of the way some of this has been entered. So I think we're good though. All right. Is there a motion, uh, to approve this amendment? Senator Hickey. 2. or representative Collins all all, yeah, sorry. It's been a morning, guys. I'm sorry. Uh, all in favor, say aye. All pose. Motion passes. Thank you. In the other business? Right OK alright.