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Board Meeting Minutes, Feb. 21, 2006
Public Employees’ Benefit Board
Tuesday, February 21, 1 to 5 p.m. - Minutes
Willamette Education Service District, Marion Room
2611 Pringle Rd SE, Salem OR
                                                                                                                                                         
Board MembersPresent
Diane Lovell, Chair
Peter Callero
David Hartwig
Rocky King
 
Paul McKenna
Rich Peppers
Sheryl Warren
PEBB Staff Present
Dena Comer
Bobbie Barott
Lisa Krois
 
Lydia Lissman
Ingrid Norberg
Jean Thorne
 
Consultants Present
Pam Hodge, Aon
Dennis Tierney, Aon
 
Guests Present
Karen Gracey, The Standard Insurance Co.
Thomas Hickey, Kaiser Permanente
Sally Hill, Providence Health Plans
Gordon Hoberg, ODS
Diana Jones, Regence BCBSO
Sherry Kowalski, Regence BCBSO
Renee McDonald, Regence BCBSO
Megan Myrick, Willamette Dental
Paul Pfinster, AFLAC
 
Ralph Prows, Regence BCBSO
David Rosenfeld, Oregon Health Forum
Helen Sherman, Regence BCBSO
Kim Waldroff, BHS
Ryan Webster, Providence Health Plans
Dallas Weyand, Legislative Fiscal Office
Kim Whitley, Samaritan Health Services
Cheryl Willcoxen, SEIU
Denise Yunker, Oregon University System
Agenda
Welcome and Approval of Minutes
Overview of Meeting
2004 Disease Management Report
Update on RegenceRx Exceptions Process, Reporting Elements
Parameters of Communications Plan
Revisions to Vision Statement
Board Structure
Renewal Requests – Medical, Dental
Other Business
  • Staff Update
  • Council of Innovators Update
  • Preview of March Meeting
  • Other
 
Welcome/Approval of Minutes
Diane Lovellcalled the meeting to order and explained the new meeting agenda format, and that a sign-up sheet is available for those visitors who wish to provide public comment on specific agenda items.
Paul McKenna moved to approve the January 17, 2006 Board retreat minutes.
Peter Callero seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Peter Calleromoved to approve the January 17, 2006 Board meeting minutes.
Rocky King seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Overview of Meeting
Jean Thorne explained that an overview of the information included in the Disease Management Report will be provided today, and representatives from Regence and Kaiser are present to answer questions. Next month all plans will provide information. Helen Sherman from Regence will provide a suggested template for future reporting on prescription drug activity and trends. The Board will also have the opportunity for an initial discussion regarding PEBB’s communications work plan. The Board will review the revisions to the Vision based on discussion at the December 20, 2005 retreat. Diane Lovell will lead a discussion regarding Board structure and how the Board will do its work. The Board will also have an opportunity to review the medical and dental renewal requests for 2007.
 
2004 Disease Management Report
Jean Thorne explained that given the Board’s increasing emphasis on health care outcomes, the Disease Management report provides an opportunity for the Board to both look at process and outcomes measures for PEBB members, but to also understand some of the limitations of the data, given the size of PEBB’s membership. That understanding could be helpful as the Board begins to expand performance measures for the health plans. She indicated that the charts in the PowerPoint presentation are likely more detailed than the Board would wish. This is because, for the first time, data for many of the denominators were run in two different ways:  1) looking at those members who were enrolled at any point; and 2) looking at those who were continuously enrolled for a specified period (usually 24 months). The Disease Management group has not yet decided the appropriate methodology to use in the future, so it was necessary to show both so that there will be comparative data in the future.
 
Pam Hodge referred to Bd attach.4, which highlights the findings from the 2004 Disease Management report. The report includes information on disease prevalence, program participation, clinical measures and cost and utilization trends. The report also includes next steps for program focus and for further refinement of measures and methodologies. The health plans will return to next month’s meeting to describe their programs in more detail and to discuss steps they may be taking to improve performance on clinical measures identified as needing additional focus.
 
Rocky King commented that it would be helpful to know what PEBB is paying for disease management in order to determine if the outcome is worth the cost.
Peter Callero asked whether the data could be displayed by county so that there can be a determination of whether there is variation. The problem with that approach is that the numbers may be so small that valid comparisons cannot be made.
Diane Lovell noted that the Board would like the health plans to return next month with specific strategies for improvement in clinical measures.
 
Update on Regence Rx Exceptions Process, Reporting Elements
Helen Sherman distributed a template of Regence’s suggestions for reporting information to the Board regarding prescription plan performance. Reporting elements could include generic drug utilization, trends in the use of evidence-based medications, and the utilization of mail order prescriptions. She explained that Regence would return to the Board in the fall to present six-to-nine months of data. She also agreed to provide a breakout of generic, preferred, and non-preferred brands by mail order and non-mail order.
 
She reported that as of this morning, Regence has received 2205 copay exceptions requests. Regence is providing a 48-hour turnaround, and it is anticipated that this will be reduced to 24 hours. Exception denials seem to occur in cases where alternative medications have not yet been tried. After an exception request is made and all information from the doctor taken into account, the member is called the day the decision is made, and the provider and the pharmacy are also notified.
 
Paul McKenna expressed concern that new members are not being informed of the exceptions process.
Jean Thorne explained that PEBB will likely include information about the exception process in every newsletter, with an emphasis on members checking with their providers about the lowest cost drug.
Helen Sherman added that Regence’s formulary and price list are posted on their website. The providers were also sent a letter informing them of an exceptions process linked to PEBB members.
Jean Thorne explained that PEBB Benefits manager Bobbie Barott will be establishing a call-tracking method for capturing information regarding members’ concerns.
Paul McKenna asked if there’s any way to capture those members who switched medications without filing an exception process.
Helen Sherman replied that this information is difficult to determine, but as preferred and generic medications increase this will be evident.
 
Parameters of Communications Plan
Jean Thorne referred to Bd attach.5 and explained that David Lansky’s work carried the Board through last summer’s discussions. She recommended reestablishing the Communications Advisory Committee to update the communications plan. The plans have been asked if they have staff who could attend, and the Council of Innovators has also expressed an interest. She suggested members might be other state government members, particularly those in the communication field. The Board noted that more changes may occur in the future and that members need to be prepared for that.
 
Regarding who should serve on the Committee, the Board suggested:
  • Representatives from each plan
  • Someone with skills in social marketing
  • Someone from the Lottery’s Marketing department
  • Additional member from OUS
 
It was also suggested that the Board have regular contact with certain legislators, and that the PowerPoint presentation and talking points be updated for use by Board members.
 
Revisions to the Vision Statement
Diane Lovell referred to Bd attach.6 and asked the group if they any additional concerns.
 
Rocky King moved to accept the revisions to the Vision as determined at the Board’s November 14, 2005 retreat, including today’s suggestion to change “the employer” to “their employers”.
Rich Peppers seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Board Structure
Jean Thorne updated the Board on the first meeting of the Council of Innovators (COI). The COI is not a decision-making body, but the plans have been asked how they could collaborate in a competitive market. They responded that the group should be kept to two representatives per plan, and they want to work on what they can do together and with PEBB. They would like to support wellness. They would also like to explore additional performance measures for disease management that would be appropriate for the PEBB population. She explained that she and members of the COI are also in the Health Care Quality Corporation’s Common Measures workgroup, which is developing common quality measures for ambulatory care. The COI is also interested in working together and with PEBB in communication with members. As the Board moves through the 2006 agendas, the COI members will be asked to provide input to PEBB so that it can bring recommendations to the Board.
 
Diane Lovell asked the Board to consider to what extent the Board wants to attach itself to other activities and working groups. Those groups include:
 
  • Operations Subcommittee
  • Healthy Worksites Initiative (monthly, DHS public health is leading)
  • Wellness Coordinators (quarterly, Lisa Krois is leading)
  • Communications Advisory Committee
  • Council of Innovators
  • Chronic Disease Management workgroup
 
Board members discussed how they could interact with the various groups, but also expressed concerns that the Board needs more meeting time.
 
Diane Lovell asked the Board to consider an expanded leadership model. Traditionally, the Board has had a Chair and a Vice Chair. The expanded model would include three members, so that someone would always be either training another or being trained. The past Board Chair would remain for a term of one year, for the purpose of mentoring the incumbent Vice-Chair before they actually take the formal role. Two positions would rotate, but the leadership would include the Past Chair, Chair, and Vice Chair all the time. She explained that the current system includes a leadership conference call the Friday following each Board meeting to debrief, and an in-person meeting two weeks prior to each Board meeting to create the agenda.
 
This Board will continue its discussion on structure at the next meeting.
 
Renewal Requests – Medical, Dental
Pam Hodge outlined the medical and dental renewal process.
 
Based on the Board’s approval at today’s meeting, the renewal letters will be sent to the carriers tomorrow.
 
 
 
Other Business
Jean Thorne provided updates on other business.
 
Staff Update
Bobbie Barott began on February 6 as the new Benefits Manager. Amy Boughton also began on February 6 as the new Customer Service Coordinator.
 
Other
Jean Thorne, Diane Lovell, and Sheryl Warren participated in a meeting last week with a team from the Robert Wood Johnson (RWJ) Foundation. The team visited Portland to investigate ways to support market-based approaches to quality in certain markets across the States. They’re looking at possible technical or financial assistance they could provide to Oregon. While in Portland, they met with the Oregon Business Council and the Oregon Clinical Health Information Network. They first met with PEBB, followed by a meeting with the Oregon Health Care Purchasers Coalition (OCHCP) and the Oregon Healthcare Quality Corporation regarding efforts toward quality.
 
On March 22, the OCHCP will hold an event in Wilsonville highlighting the PEBB RFP. Jean is a presenter, and all four medical plans have been invited to attend and present their responses to the RFP and their efforts toward quality.
 
Preview of March Meeting
  • Plans will provide reports on their efforts around disease management
  • Jim Dameron will report from Patient Safety Commission
  • Initial brainstorming on possible budget packages
  • Reporting elements around bariatric surgery
  • Discussion on the parameters of a wellness plan
  • Continuing discussion on Board structure
 
Public Comment
None.
 
Meeting Adjourned