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Board Meeting, March 21, 2006
Public Employees’ Benefit Board
Tuesday, March 21, 1 to 5 p.m. - Minutes
Willamette Education Service District, Marion Room
2611 Pringle Rd SE, Salem OR
                                                                                                                                                         
Board Members Present
Diane Lovell, Chair
David Hartwig
Rocky King
Rep. Jeff Kropf
 
Paul McKenna
Rich Peppers
Jeanene Smith

PEBB Staff Present
Dena Comer
Bobbie Barott
Lisa Krois
 
Ingrid Norberg
Jean Thorne
 
Consultants Present
Pam Hodge, Aon
Dennis Tierney, Aon
 
Guests Present
Brenda Bassett, Benefit Help Solutions
Dotha Canning, Samaritan Health Services
Sally Hill, Providence Health Plans
Gordon Hoberg, ODS
Diana Jones, Regence BCBSO
Amy Koopman, Providence Health Plans
Bill Lindekugel, Kaiser Permanente
Andrew Lum, M.D., Kaiser Permanente
Julie Marshall, Cascade EAP
 
Megan Myrick, Willamette Dental
JoAnn Olney, Regence BCBSO
Paul Pfinster, AFLAC
Kim Waldroff, BHS
Larry Wheeler, Kaiser Permanente
Don Wiggins, The Standard Insurance Co.
Cheryl Willcoxen, SEIU
Maureen Wright, M.D., Kaiser Permanente
Denise Yunker, Oregon University System
Agenda
Welcome
Overview of Meeting
Plan Responses to 2004 Disease Management Report
Patient Safety Commission
Board Decision-Making Processes, Board Structure and Leadership Structure
Context/Principles for Development of Performance Measures
Parameters of Wellness Plan
Other Business
  • Bariatric Surgery Reporting Elements
  • Possible Uses of Stabilization Fund
  • Resolution of Issue Related to Continuity of Coverage for Member
  • Preview of April Meeting
  • Other
  • General Public Comment
Welcome
Diane Lovell called the meeting to order and explained that a sign up sheet is available for those visitors who wish to provide public comment on the agenda items.
 
Overview of Meeting
Jean Thorne explained that in response to last month’s Aon presentation on the 2004 Disease Management report, all four plans will describe how their Disease Management programs work, as well as their strategies to improve performance on clinical measures. Jane Moore from DHS will provide information regarding the future disease management efforts of Public Health. Regence will provide suggestions for reporting on short-term activities and long-term outcomes for bariatric surgeries. Jim Dameron of the Patient Safety Commission will present an update on activities. The Board will have a discussion regarding its general processes for addressing certain issues. Additionally, there will be initial discussions about the context and principles around the plans’ performance measures and an outline of PEBB’s wellness plan.
 
Rep. Jeff Kropf stated his appreciation for the performance measures and emphasized the importance of having working and valuable measures.
 
Plan Responses to 2004 Disease Management Report
Representatives from the medical plans distributed copies of their responses to the 2004 Disease Management report and provided overviews of each. (Attached presentations: Kaiser; Samaritan; Providence ). They also outlined their program changes for 2005 and action items for 2006.
 
Dr. Prows of Regence reported that performance has improved steadily over time for almost all measures. He explained that the reports are based off of claims data. Washington PEBB’s performance measures also include chart reviews and have proven to be better when compared with Oregon’s, which include only claims data.
 
He reported that program changes for 2005 included improved identification protocols and initiated joint management of diabetes and heart conditions, recognizing comorbidities. Action items for 2006 include AdviCare, data improvements, and clarification of nephropathy testing criteria.
 
He explained that ER usage for diabetics programs has gone up and Regence’s disease management program will identify diabetics at high risk for hospitalization. He also explained that since members receive routine eye care through VSP, it would be valuable to coordinate with VSP to complete the data on eye exams for diabetics.
 
Dr. Hickey of Kaiser explained that they have a significant program for chronic pain. 100,000 members are signed up to access their account through KP.org. He expressed concern about the performance on the beta blockers measure. He commented that there is no question that it’s appropriate, and he will personally review PEBB members’ charts to determine if the data has been captured accurately.
 
He explained that as an HMO, HEDIS has very strict requirements about how to measure, and commented that Regence as a PPO may not be measuring the same way, so comparisons may not be valid.
 
Jane Moore of DHS reported that her department is working on the third review of the diabetes and asthma guidelines and is considering convening a group to look at heart disease and depression management.
David Hartwig asked the plans to discuss at a future Disease Management Workgroup what types of patient incentives are working.
 
Bariatric Surgery Reporting Elements
Jean Thorne explained that the goal is that the Board agree on the types of data to be reported.
 
Dr. Prows of Regence referred to Regence’s PEBB bariatric surgery reporting, (attached). It was suggested that the following be added:
  • Cost data
  • Type of procedure
PEBB staff were asked to check past meeting minutes to determine what was said regarding the specific bariatric surgery procedures to be covered. Jean Thorne indicated that she would follow up with the other plans to see if they could report similar types of data.
 
Patient Safety Commission
Jim Dameron updated the Board on the current status of the Patient Safety Commission’s work. He reported that the Commission is building reporting programs for all six types of facilities in the state, starting with hospitals. Additionally, the Commission is the field coordinator for the Institute for Healthcare Improvement’s 100,000 Lives campaign.
 
The Commission opened its doors for business in February, inviting all hospitals to participate in a voluntary program to report negative events. Of the hospitals enrolled in February, 31 have verbally agreed to participate thus far. The Commission’s next step is the reporting process, which involves gathering all the components of patient safety resulting from the hospitals and sharing the information.
 
Diane Lovell stated that the Board is interested in being a champion of the Commission’s efforts and in partnering with them.
David Hartwig concurred, adding that the partnership would be a good opportunity for PEBB to communicate and educate consumers.
 
Jim Dameron will keep the Board posted on future Commission activities.
 
Board Decision-Making Processes, Board Structure and Leadership Structure
Board Structure
The Board discussed whether a second meeting per month would be necessary. Issues included:
  • Sufficient time for in-depth discussions, not just for receiving reports;
  • Concern over not discussing issues “to death”;
  • If the decision were made to have a second meeting, it would only be held if necessary;
  • If the decision were made to have a second meeting, decisions could be confined to one meeting per month, and:
  • Concerns about the amount of staff work necessary to support two meetings per month.
There was general support for a second meeting if necessary.
 
Diane Lovell asked the Board for their comments regarding sending liaisons to the various PEBB committees. Comments included:
  • Communication Advisory Committee: The name should be changed to include “engagement”, no liaison should be sent
  • Agency Wellness Coordinator Group: Yes, send 1 liaison
  • Disease Management Work Group: Yes, send 1 liaison
  • Council of Innovators: Yes, send 1 liaison
 
Diane Lovell will follow up with the Board to determine who will fill the liaison roles. PEBB staff will notify the Board when these meetings occur, and the Board will notify staff if they will attend.
 
Board Decision-Making Processes
Jean Thorne referred to Bd attach.2 and provided an overview. Staff will add a piece on “Board identifying issues” to the matrix.
 
Diane Lovell would like the John Carver document brought back in to help the Board with its decision-making processes.
 
Context/Principles for Development of Performance Measures
Jean Thorne referred to Bd attach.3 and provided an outline of the background. The Board agreed with the framework and principles. PEBB staff will return to the Board with proposed performance measures.
 
Parameters of Wellness Plan
Lisa Krois referred to Bd attach.4 and outlined the strategies to reach the goals of the wellness plan. PEBB staff will return to the Board with information, and were asked to consider the following as they develop a wellness plan:
  • How can unions be involved;
  • Analyze the gap between what members lost with the closure of the Health Center and the impact of the plans’ wellness activities;
  • How to involve small agencies;
  • Could education be delivered on a regional basis, and;
  • Make sure that evidence supports whatever is proposed.
 
Other Business
Possible Uses of Stabilization Fund
Jean Thorne explained the historical uses of the Stabilization Fund, and asked the Board to brainstorm regarding how the fund should be used. Responses included:
  • Whatever would move the plans forward with wellness;
  • Potential performance fund for the health plans;
  • Wellness included if the evidence supports it;
  • Follow-up survey to the 2005 survey of 2000 employees;
  • Mining PEBB data to determine procedures that may be appropriate for evidence-based reviews
  • Support to Health Resources Services and/or Commission to help undertake these reviews; and
  • EMR projects, either rural demonstrations or support to interconnectivity.
Jean Thorne will return in April with these ideas fleshed out for further consideration by the Board.
 
Resolution of Issue Related to Continuity of Coverage for Member
Jean Thorne presented the request to continue medical insurance coverage for a member’s spouse who is on Medicare and COBRA. The COBRA coverage will end on February 28, 2006. Due to a series of events and PEBB errors, the spouse failed to enroll in Medicare Part B until recently. The Medicare Part B coverage will not be effective until July 1, 2006. Without PEBB intervention the spouse will be without those services provided under Medicare Part B which includes such things as doctor visits, outpatient services, etc from March 1, 2006 until July 1, 2006. The member is appealing to PEBB to arrange for health insurance coverage for the spouse for this four-month period. She also outlined internal steps being taken to assure these errors do not occur in the future.
 
Rocky King moved that PEBB should enter into an agreement with Regence to cover the member’s claims costs for a four-month period.
David Hartwig seconded the motion.
Hearing no further discussion, the motion passed unanimously. 
 
Preview of April Meeting
Jean Thorne outlined the agenda items for the April 18 Board meeting.
 
General Public Comment
None.
 
Meeting Adjourned