ALC-Employee Benefits Division Oversight Subcommittee

Okay members will call the meeting to order. Mr wallace you want to come forward you'll be first and you know the know the drill if you don't mind just introduce yourself on every year before you begin. Grand wallace director of EBD. Came members will begin with your company with be one. Okay so for b one what I would like to ask for is approval of the concept of to allow us to move forward on an rf for a consultant to help work with us to develop an RFP for the third party administrator contract that's the incumbent right now it's health advantage. And quite honestly I don't know what I don't know and I don't want to do what has been done in the past have just destined off and old or an expecting different results I think work would be behoving of myself and in the state is to have a consultant to out there who understands the latest and greatest that's going on in this space and utilizing that information and that intelligence to draft a rfp that. It is the best for the state when it comes to looking at such a large contract as the third party administrator of our health benefits so with that and answer any questions okay members you've heard the explanation of this and this will require a uh it's an action action item so are they questions regard to this. My safe just saying one I guess there are plenty of those out there there that were pretty sure that we'll get multiples to reply to the rfp of that nature i've already been approached by two so yes I would expect that there be you know three to five probably and state board of finance did they actually had an approval on this bright the advisory commission's and state board of finance of both approved this when did they approve it they approved it yesterday yesterday okay that. Reps I think you're up yet how much are we talking about when what are you asking for it is for his cost I would expect it would be a hundred and fifty two hundred thousand maybe I don't. To find by feedback it's going to be on that heard that we're really looking for sixty thousand so zero would be nice. Alright anything else. Okay we have a motion to approve our motion I have a second mac sooner call well all in favor say in your pose that motional next is going to be b two so on item between this is a request for approval to go into an RFQ for a high claims audit there's a lot of work that's been going on in this space and i've been approached by several companies that would be willing to look at our high claims caused these would be like a hundred thousand dollars plus and they would go back and review those bills and in all of that processing to make sure that everything was build appropriately and that the charges are in line with acceptable coding in in acceptable billing practices the idea would be that we would present ten to fifteen of those high costs claims these companies would then review them and then offer us what their best ability to recoup money for the state would be and then whoever had had the most we probably enter into some sort of pilot agreement with them and let them to continue to do that work in I can't anticipate what they would recoup but if they didn't find anything the state would not be out any money they would only get a percentage of what they did recover for the state. Okay are you finished with the yes okay senator boyd thank you mister chair will we're looking at exhibit b three a right too i've got a question for b three thank ok. The. The. Anyone else. So how how long do you think that would they continually stay on or how long what china you're thought so the argue would be just kind of an initial given you know four weeks or whatever a month whatever to review that and then if they did when we would come back and say hey let's extend this for one year or some other time period that we would kind of negotiate with them to bring back to you offer approval at that time you'd have what the percentage you know correct correct all right any other questions interest double field europes are thank michelle a grant if these chance people don't find anything that looked out of out of normal they just go away correct yet if there's no problems then there's no problems with a yes sir anyone else gay do I have motion to approve motion we have a second have a second all in favor say I in your pose. The hours have that's also approved all right now we're now we're going to go to b three missed wallace will let you present it and then center board will let you a bit burst okay so these are the normal drug formula reviews that we have been doing we've got the months of november december and the one that's labeled navigate signature select that's the all encompassing wind that will talk about more in depth and get there so let's start with three a which is the normal october that was approved in november that the normal review that was done in november. Be glad to answer any questions soon a boy did you have questions on that sir okay you're recognized when every ready okay I just want to make sure I understand so on brio elector it's a tier too and the recommendation is to change it to not covered. No the current setup is that it's not covered the recommendation would be moving it to tier to okay so this is where I have a question I wanna make sure I understand what's going on with that brio has better rebates and that's why we want to do that versus the generic advert I mean what what rationale that we want do we have to want to change brio which is a brand name drug to something that now has a generic drug it actually has multiple generics including some branding general it would be adding the brand on it but with the rebates there are rebates that are in consideration with adding that one but it's not removing any generics so the generics would still stay on okay so are we adding it so that we can get the rebates off a brio or a week adding it because we just think briose a better drug think we're adding it just to be able to if anybody does prescribe it to be able to get those rebates okay because i'm gonna be interested in how the per member per month goes on this because i'm concerned that we're chasing rebates when there are other less expensive options and so we can report that we saved all this money or got brought on all this revenue from rebates but at the end of the day we spent more money than we would have if we did just go with generic options thanks. Thank you sir any other questions this is also an approval item do I have a motion to approve we have another reps any beats yeah sorry I came in a little late the ones that are showing the ebd commission decision or says not covered what is the reason you're changing those i'm assuming from the current setup to not cover it's a cost in that there are other alternatives that are on formula that they're cheaper to use. And those would be like specialties that the tier four there has appearing quality limit tear force are specially so there would there is another alternative available but the reason you're deciding or whoever decided to not cover it is because it's expensive yes I always get confused a little bit about that whole relationship between a doctor in the patient in an insurance company it seems to me that a lot of times insurance companies are dictating what treatment they're going to provide or allow verses leading the doctor desired what's best so then that's all I have on that. Anyone else. You finished home on that on it all right again I need a motion to approve motion I have most driver second who have a second all if I ever say in the opposed okay that also curious. Oh next we'll grant if you're I think you're still up so if you want to go to say one so the. Well we're still on to be with the formulas were going to the december formula so that will be three b the december formulated again this is just the normal monthly we've got multiple yes there's three of them sir sorry so did everybody understand what we just have just approved approved the first one now he's going to present the december one the december I apologize for that so this is exhibit b three b. And again this is just the normal monthly review the bulk of these that you'll see kind of in the middle of the page the riber ven to the line a demand capsules were just encouraging the generic over the name brand and that's where there's changes are and reflected on that where and a lot of these other ones are still just using the lower cost alternatives that are already on formula. Yeah. And then taught some of thy just making sure that the prior authorizations have the first line or met and that these drugs are the really the second line option or the last choice to options when we go through that that process. Came members grant here's going to take take on this he just said in in separate deals so we'll be b three b do anybody have any questions to regardless of that. Helps kind of think in there I was looking at all of them at once but okay no no problems in the motion to approve a motion to prove to have a second of motion and second i'll in favor say I in your pose that also is approved so now we'll go to be three c correct correct date so this hand out in front of you. This is the large document this is the all encompassing so this would be two have the signatures as signature select formula which would start january the first this is the formula makeup that was used in the rfp and the bidding process this is what everything was based off so this is what has been agreed to that we would use starting january the first. Okay sender board thank you mister chair again I just want to call your attention to a norrow and our newty where there are generic options on those and I just want to make sure again if we're chasing rebate dollars am I want to see what the per member per month is because we we can wide up spending more money and not have enough rebate dollars even if the first year we look better off it's what happens years down the road because now we've got patience on these so would you help me with that yes I will think watch that thank you sir. Thank you center board anyone else. Kato emotion approve. Have a motion to have a second half motion a second all in favor of their in your post okay that's proved also so now I think we're gonna go to the go to c one is that correct yes okay okay see section see I just wanted to provide an update to the committee on the network negotiations that you have is ongoing with their two that are open right now the first one is st bernards up in northeast arkansas that contract ins april thirtieth of twenty twenty four those negotiations are still ongoing singing orange has created a dedicated phone line for our retirees that are on the united health care plan so that they are able to get all the updated information and understand their benefits do keep in mind that even if these go out of network are maped plan has a provision provision in it that has no disparity between out of network and in network for our members as long as the facility and the provider still accept medicare as is a payment so we're really making sure that our members are educated on that and are aware that they can still both of these facility same bernards and baptises still said that they will accept our members and that they will work out all the billing with the united health care and it will not negatively impact our members so that is on st benords moving on to babed as medical you will see three letters that were included in the documents for this month the initial is the letter that baptists sent out early on stating that they were starting the negotiations with united health care but it was highlighted at the bottom that state employees would their state retirees. Well would still be treated at babies and would not be negatively impacted because of this nondifferential aspect. Unfortunately bad to send united health care we're not able to come to an agreement bad this will go out of network at the end of this month. United health care sin out a letter to our members notifying them of this right before thanksgiving I followed up with a letter to the same population reminding them of the nine differential aspect and that babist had agreed to still see them and that they would not negatively be impacted even if they went out of the network so that's the latest on those two facilities and their negotiations with the united health care. Okay members this was for. Okay representative to take your chair director wallace could you could you maybe. Can I walk me through this if they're going out of network do we anticipate. You know what kind of increase in costs would that be for for our plans I mean are we gonna see a dramatic increase if everyone still is continuing to go to bat bap is in these architect work down walk me through. Can I dooms day scenario of this so on this because they're under the united health care plan they are nights. Being paid the claims are not being paid for about this state united healthcare assume that liability that was part of the reason of going through these medicare advantage plans is it the claims are not paid for by the state they are paid for the united health care and however they're billing in their funding is so it would not negatively impact the state there would not be any increased liabilities or anything like that through this direct I think I was included my question so for united though what are they anticipating for the negative impact of their plan I mean obviously this is part of the contract if this happened but i'm just kind of curious. You know I mean these companies are pretty smart making it up on the back in somehow and so on and kind of curious what they're just being there hits going to be for united in that out I do not know II don't have reach into that I would anticipate that they have like you said they know how to work out their funding and in maintain there business operations I just don't have information on that thank you britain. St urban. Thank you following up on a representative looking at sign of cash only what is the impact though and you're out of not work for the individual so walked me through that as much as you know what's the impact on our members because we are the fiduciary I mean where the for the company said a speech there are the members it's our job to make sure that. We have a product that they can use and use a effectively. And so want me through that yes so they do not experience any difference so their cope is still zero dollars whether it's in network or out of network that was one aspect of the the plan that was created and agreed to so they there is no financial impact to them as again as long as the provider in the facility still accepts medicare it is still willing to accept them they do not have any any financial difference. Okay what is the financial difference though when you're out of network and what you're getting being paid. If you're an out of network from unit in other words that may you may be able to say that but you know they have every right the provider has every right if i'm there's a reason why the contracts won't signs right because they're lowballing them on reimbursements that's why about as health as night signing these contracts can't wait regionals night signing the contract or whatever they they're like we can't this is ridiculous we're not going to see your patience because you're a lowballing are some on the reimbursement we can't will lose money seeing your patience that that's why these contracts are not being started. So there is going to be a negative impact at some point to these people. And in the non the provider side I can't speak to that aspect I just know what united has agreed to and what these both of these facilities have agreed to still continuing to see our members and it will not have a negative finding of the impact to our members and in what they have to come out of pocket with. Right so there's it's one thing if it's a facility what if it's a physicians that are aligned with that they still have the ability to say yes or not at. Right they can they can say we're not gonna ex we want cu and that some of the experience that we had with calmly regional is that some of those facilities and providers that were not going to see these patients that was a little different scenario under this at least they are still willing to see our patient our members and still make sure that they do not have a disruption right made at the end of the day I want to make sure that everybody's clear and that we're community communicating clearly to these individuals that it's not the provider's fault. And there's a reason why they're not seeing you and it has nothing to do with them it has everything to do with united health care. So I just want to make sure we're very clear about this conversation because to me this is this is a big deal and what I don't want to see is somebody winning a contract with the state of arkansas and then using that as muscle. In contract negotiations will inside i've been very clear with united healthcare from from the conway regional experience on that my anticipation is that they do the best they do what is best for our members and I have constantly doing best for our members is actually paying the people doing the work and appropriate amount of money that is what's doing that is what's doing best for our members yes because I don't I mean that dad at the end of the day is where we have to step up and say hey you need to pay an appropriate amount for our people to be able to see quality health care or seek quality health care and these are are cancelled there are kansans and conway regional is an arkansas institution that does help is an arkansas institution st vence arkansas institution these are are kansas so at the end of the day we've got to make sure that we are not you know treating these people on this plan or letting united health care treat these people on this plan you know as ls as somebody who we don't care about quality and so that has to be part of this conversation in my opinion thank you mister chair. Thank german representative thank you s the senate actually may be think of a question about earlier and I forgot to ask obviously groups like chic vincents were able to find contracts with the united other hospital groups as well do we about it in the inside on why they were able to make a deal with united and and these two institutions were not I mean is there a maybe that's proprietary information i'm just. You know i'm i'm worried about the deserts like bad southern stuck guard that will be able to see the I mean they can still see the page they get it but to the senator's point but then also when I think about it like well a lot of these members can just go to c HI you know it here in low rock or north la rock are they got a mercy and fort smith they can't go the battery silly there. But i'm just kind of wondering you know I mean these margins are really tight and so i'm curious why the systems were able to be able to make deals with united bed the largest health care system outside of our hospital suspense at a us was was unable to so and I don't have any inside that the only thing I would say is that I have worked with united health care in any instance where we have found that there was a gap where there were not providers for our members trying to create a list and really keep up with that to where they can build out their network to more adequately serve or members under this plan so that is something that we have both eb and united healthcare of committed to working on to make sure that you know we don't have these gaps in in providers or facilities that are members can access gadget and just want more in to sign a contract with the united are they still negotiations right now I had not had any updates on your mess as soon as board. Thank you mister first I just wanted to publicly thank you for helping me out a constituent concern with this and that was very helpful to be able to relate that information and I appreciate thank you secondly I just want to reiterate senator evans concerns about not letting someone with a state contract use that is under significant leverage to her providers so but. Thirdly I just wanted clarity so like the do you have information that baptist in united health care the the talks are over and we just know that that because I understood you to say that nah i'd like to know if if we know that but you might not be the right person to stay definitively right the update I got from united health care yesterday is that they're still talking it's just that formal date of the agreement had will end so then they have not renewed any extent and made any extensions I fully expect conversations to still from both sides to still go wine and end for hopefully that some point in the next couple months that there is an agreement that's able to be reached and the babies does come back in the network somewhere to what the calmly regional experience was that would be my expectation in my hope but i've not heard anything contrary where people are walking away from the table no I think they're still at the table and still having discussions okay thank you for expanding on that thanks I appreciate a reps any profit you're recognized thank you mr chair. The. Mr wallace did I hear you correctly when you said. If they had taken the medicare advantage plan they would they would be covered. It's just the ebt part where they're not that I hear you know and i'm sorry for any confusion on that if the facility or the provider still accepts medicare it is a payment. Then united health care we are still are members who are on the united health care plan can still utilize that facility because of the way united healthcare does the billing and that the underlying aspect of it is the medicare that I heard something different I don't know if i'm getting my point across if they had chosen medicare advantage. Rather than staying with the state insurance then they would be covered. No I think there is some confusion on that that there's been two different plans it's kind of apples and oranges on that on what on the question that you're asking a little bit health advantage has their network united health care has its network in that's the difference it's going on in here so yes it if they were on the normal retirement they would still be in network because held advantage and babister still under contract and just in my mind in talking to retirees. This is just another echo they're gonna hear throughout. To force them to go with memphired bandage. Because. They're providers may not except. This. The unadded health care plan i'd I do appreciate the cinema and I will say that I have worked really hard to rebuild the trust enter earned the trust back of our members on all of these plans on and everything that we're doing from the pharmacy benefits over to the map plan in the work that was done on that and it's one of those that I hope the members still go along with me and allow me to build that trust back so that when we say something we we mean what we say and we can back to that up and and that would that would be my answer to how that questions going. Sender hammer. Thank you mister chair as part of the original war of the contract where they suppose to provide adequate network coverage was that part of the terms of the contract yes so in the event they're not able to work out agreements with the entities that have been mentioned or anybody else for that matter or providers start to decline because of reimbursement rates at what point is the contract void because they're unable to provide adequate network coverage and what defines adequate network coverage I would just I don't have that specific language memorized so if I can follow up with you on that I can give you that trigger okay that they'd be great coz i'm just wondering there's as much pressure on them to make sure there's adequate network coverage as there is to provide good provider reimbursement rates is would be equal every journal. He thought on that I don't know how to answer that without having the specific contract in front of me II don't want to say something in a pocket miss share can I ask you a question yes sir appropriate time for us to ask him if he's got the numbers as far as who stuck with the traditional plans versus who went with united with open enrollment closed or close to closing her mad as well yesterday and II don't have that done I hope to have that within the next week or so but I will get that to you as soon as I do have them okay thank you thing this year and whenever you do that we send that to staff so that's where members can get yes or both both questions yes sir okay thank you sir. Anyone else. Do you have anything else mister walls dessert. Okay so that there's no approval item on that that was just for information purposes so we appreciate you being here agree. Sooner urban do you have question another question in regards to the sir yes okay go here so and looking at these these three letters the the first one okay so baptist send there's out of october thirteen. Then united november fifteen and then use that one out november twenty four. So. Their scott to be so much confusion happening right now with these folks and I think i'm just. Saying it may not be a bad idea to send something to them or somehow connect with them. A much when you read all three of these letters our be confused and sometimes you have a very elderly people that are scared and confused. So I just I think it's important that we bring that to your attention I know that you're aware of that but i'm not sure what else we could do but I would encourage us maybe to try to at least reach out to the folks that are on the plan that are elderly to make sure that they are fully understanding whether tuesday then doing I perceive that I will do a and open to any suggestion in recommendations I think this is probably an effort of over communicating and unfortunately that may cause some confusion to but I will continue to work on that yes go talk to your provider you know and they're like no so anyway thank you anyone else. Okay c nine your excuse me okay we're now day as any other business and these are coming before this body. Okay see you known we'll be adjourned.