Joint Health Care Committee (JHCC)

Joint Health Care Committee (JHCC) DRAFT AGENDA Wednesday 7 December, 2016 9-11a.m.

Dial: 866-832-7806; Participant Code: 5966472

Locations: Statewide Butro 202c, Anchorage Bragaw 205, Juneau HB 214, Ketchikan Paul 303

Telephonic: Dial: 866-832-7806; Participant Code: 5966472

COMMITTEE MEMBERS:

Unions: UNAC: Abel Bult-Ito (JHCC Chair),Soren Orley, Charla Brown, Robert (Trey) Coker (Alternate) UAFT: Rick McDonald, Heather Corriere, Tim Powers (Alternate), vacant Local 6070: Stephanie Grant, Charles Silva, Michael Koskie FFA: Ben Fleagle

Management:Gail Cheney, Tanya Hollis, Pat Shier, Ron Kamahele (Alternate)

Staff Alliance: Gwenna Richardson, Chrystal Warmoth, Elizabeth Winfree (Liz)

Ex-Officio: Erika Van Flein, Keli Hite McGee, UA CHRO

Staff: Timothy Armbruster, Cyndee West

Guests and Speakers: David Hinckley, Lockton

AGENDA:

9:00 a.m. Call to Order – Abel Bult-Ito

Meeting Notes from November 18th

9:10 a.m. Topics for discussion and Reports/Review:

FY17 1st Quarter Utilization FY16 Best Doctors Annual Report Decision Points: Continue with a program like this? Will need to RFP FY16 Retrofit Program Review and FY17 Proposal Decision Points: Continue this program in FY17? As proposesd or with changes? Plan Changes for FY18: Premera Programs: 1. Outpatient Rehab Prior Authorization with eviCore --See pg. 22 of KM Storybook --Cost is $19 per episode of care 2. Pharmacy Formulary Change to Essentials 1 3. High Risk Pregnancy/NICU Management --see pg. 16 of KM Storybook: 2 newborns in top 15 claims --2017 costs are: Maternity Risk Assessment (per case) $106.00 Maternity Case Management (per case) $502.00 NICU (per case) $1,570.00 --Experience for Premera’s Book of Business (BoB): Below are standard projections that Alere uses for commercial populations for maternity program. This would use data from across the nation. Projections per 25,000 commercial members:

 1.3% pregnancy rate: 325 pregnancies per year (for expected pregnancies – if you convert this to per 1,000, that would be 13)

 25% enroll in risk assessment: 81 RA participants

 40% of RA trigger for CM and 50% of them enroll in CM: 16 CM participants Information from our KM team about Premera’s book of business (BoB) deliveries per 1000 in Alaska (we don’t have a calculation on pregnancy but rather on the delivery). AK BoB includes small groups, large groups, and individual plans in AK excluding Medicare Supp plans. There were 11.7 deliveries per 1,000 members for PBC AK BoB for the reporting period of 5/1/15-4/30/16. They do report a NICU savings of 1 day and gives an average cost of 1 day in NICU, so you could probably use that for these two babies as well. From Premera: Alere tells us that in general, there is an average length of stay reduction of 8-12% with Alere NICU case management. If that’s the case, we could hypothesize that for the two babies on the top 15 large claim report in the FY16 Storybook, and if we take the more conservative 8% reduction, then the #3 large claimant would go from 52 days to 48 days (4 days savings), with a potential savings of $24,000 off what we paid (we paid $314,923.38, which is $6,056/day). The #15 large claimant would go from 35 days to 32 days (3 days savings) with a potential savings of close to $15,700 off what we paid (we paid $183,448.50, which is $5,241/day). These are purely hypothetical scenarios only based on Alere’s claim of an 8-12% length of stay reduction in NICU.

Member Comments

Spring Semester Schedule

11:00 a.m. Adjourn