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PEBB Board Meeting Minutes, July 18, 2006
Public Employees’ Benefit Board
Tuesday, July 18, 2006 1 to 5 p.m. - Minutes
PEBB Board Room
775 Court St NE, Salem OR
Approved 08/15/06
Board Members Present
Diane Lovell, Chair
Peter Callero
David Hartwig
Rocky King
Rep. Jeff Kropf
Sue Nelson
Paul McKenna
Rich Peppers
Jeanene Smith

PEBB Staff Present
Bobbie Barott
Dena Comer
Tera Cushman
Kellie Hargis
Lisa Krois
Cheryle Lawrence
Lydia Lissman
Ingrid Norberg
Rick Schoonover
Scott Smyth
Jean Thorne
Consultants Present
Pam Hodge, Aon
Dennis Tierney, Aon
Guests Present
Barbara Christensen, Providence Health Plans
Vickie Gates, Regence BCBSO
Sally Hill, Providence Health Plans
Diana Jones, Regence BCBSO
Bill Lindekugel, Kaiser Permanente
Scott Loftin, ODS
Paul Pfinster, AFLAC
David Scearce, The Standard Insurance Co.
Dr. Joe Siemienczuk, Providence Health Plans
Diane Skutack, BenefitHelp Solutions
Deborah Tremblay, Oregon Judicial Dept.
Kim Waldroff, BenefitHelp Solutions
Ryan Webster, Providence Health Plans
Dr. Rick Wopat, Samaritan Health Systems
Welcome and Approval of Minutes
Overview of Meeting
Implementing the Vision – Discussion with Providence
Implementing the Vision – Discussion with Samaritan
Process to Review Timing of Board Decision-Making
Flexible Spending Account Administrative Costs
Process for Review of Rural Subsidies
Report on Smoking Cessation
Possible August-December Agendas
General Public Comment
Other Business
Welcome and Approval of Minutes
Diane Lovell called the meeting to order.
David Hartwig moved to approve the minutes from the June 20, 2006 meeting.
Rocky King seconded the motion.
Hearing no further discussion, the motion passed unanimously.
Diane Lovell welcomed Sue Nelson as the newest Board member, confirmed by the Senate on June 21.
Overview of Meeting
Jean Thorne explained that Providence and Samaritan will have a discussion with the Board regarding their progress, challenges and feedback in implementing the Vision. The Board will have an initial discussion on the process to review timing of their decision-making, make a decision regarding the administrative costs of Flexible Spending Accounts, and have a discussion on rural subsidies. Data will be presented on the Free & Clear Quit for Life program including a report on the first quarter of 2006, and the Board will discuss the updated 2006 meeting agenda followed by other business.
Implementing the Vision – Discussion with Providence
Barbara Christensen of Providence introduced Dr. Joe Siemienczuk, Ryan Webster, and Sally Hill.
Dr. Joe Siemiensczuk explained that Providence embraces the Board’s Vision and considers it a privilege to participate with PEBB. Providence has accomplished a medical home for 68% of enrolled PEBB members. Providence is the first plan nationwide to accomplish Electronic Medical Records (EMR), which is the cornerstone of disease management. Providence is also moving towards pay-for-performance and has established quality measures toward the management of chronic conditions, including clinical outcomes for various diseases and generic prescriptions. The current generic prescribing rate for PEBB is 67%. Additionally, PEBB members have been assigned account managers, and all senior managers are incented and rewarded for integrated system approaches.
Future developments include:
  • Electronic messaging capability by 2007, which will allow members to communicate with their physician and schedule appointments electronically and participate in e-visits.
  • A newly designed Health Risk Assessment (HRA), utilizing input from PEBB’s Council of Innovators.
  • Opening 6 clinics within the next 2 years, adding to the distribution of 29 clinics currently located through the Portland area.
Barbara Christensen reported that Providence has established a phone service team specific to PEBB members, and feedback so far has been positive. Members can now use a PIN and access their personal account and see their claims, provider directory, and benefit summary, as well as build information on areas of interest. 99% of claims are processed within 30 days, and 95% are processed within 15 days. The payment delivery system has been improved, as well. Additionally, Ryan Webster has been visiting all clinics and training front line staff about PEBB. Improvements are being made to Providence’s Website functionality, and Select a Medical Home online is being made more user-friendly. Improvements to the WebMD-based HRA Website are being developed, but it will remain until a new one is developed.
An additional feature exclusive to PEBB members is “Life Balance”, which will have its own login early next year, and will be more specific to wellness, healthy lifestyle, and goal setting. Life Balance is a Portland-based operation and includes a network of providers with discounts to approx 2,000 services including health club memberships and incentives.
Providence’s primary challenge is getting to the critical mass of 3,000 members. Enrollment is currently at 1400 members.
Dr. Siemiensczuk explained that Providence is able to demonstrate service outcomes with the current membership, but they would like to demonstrate medical outcomes, as well. This will be difficult without the critical mass.
Barbara Christensen described Providence RN, a unique nurse advice line staffed by Providence nurses 24/7. This can be accessed as often as needed at no charge The nurses are electronically linked to the Providence system and have access to eligibility, limited medical information, and claims information. The nurses can also assist members to make an appointment in a clinic for the next day. Additionally, they have immediate connectivity to the member’s primary care provider or their on-call physician. She invited the Board to visit the Beaverton facility at any time.
Peter Callero asked if there are any trends in PEBB complaints.
Barbara Christensen replied that early on members were not selecting a medical home. Providence is now sending letters as members access care to verify their medical home and this appears successful.
Rocky King asked if the clinic or the doctor becomes the medical home when a member accesses care.
Barbara Christensen replied it’s the clinic, but members can select the doctor if they wish.
Diane Lovell asked Providence if there are any obstacles or barriers to enrollment.
Barbara Christensen explained that the 3,000 critical mass is essential. Providence needs help to determine incentives that will increase enrollment, and they could use the Board’s assistance in spreading the word about the value of a medical home.
Jeanene Smith asked how soon a client can expect to wait for a first appointment at a Providence clinic.
Dr. Siemiensczuk replied that the data isn’t available yet, but access is extremely important. Providence is adding providers and the online scheduling will improve access. If a member can’t see a particular doctor in the same day, they could still be seen by the clinic.
Rocky King thanked Providence for their commitment. He expressed his interest in addressing longer-term issues (not specific to Providence) such as pay-for-performance as related to ASOs. There are no incentives for ASO plans for managing care as it relates to quality and cost. Another issue is the change in incentives and contributions over the coming years.
Diane Lovell stated that it’s been a pleasure to work with Providence and thanked them for their efforts.
Jean Thorne commented that Providence’s participation in PEBB’s COI and technical work group has been very helpful.
Implementing the Vision – Discussion with Samaritan
Kelley Kaiser of Samaritan stated that working with PEBB on its Vision is a great opportunity. Samaritan is focused on integrated systems, medical home and care management, and having good relationships with out-of-network providers has been key. They are making improvements to their Website and additional links are coming. They are moving forward with their data warehouse to combine pharmacy and medical claims data in order to have the member’s “full picture”. Samaritan sees the HRA as having potential to be a great tool and the opportunity to discuss this with PEBB’s Council of Innovators has been very helpful. Samaritan has claims staff specific to the PEBB population, and claims turnaround is currently 10-15 days. They report a less than 4% abandonment rate on phone calls, and complaints have been very low. They are also working on the development of Electronic Health Records (EHR).
Dr. Rick Wopat explained that PEBB has helped Samaritan to accelerate the things that they would also like to accelerate. He reported that 60% of primary care providers are now using EHR, up from 5% last year, and all providers will be using EHR by the end of 2007. Samaritan was recently awarded a grant to develop a regional chronic disease management and education system in concert with Linn and Benton counties, and they also plan to collaborate with Lincoln County (also a grant recipient) in this effort. Developing a working relationship with providers in the region will allow Samaritan to further develop its EHR system. Samaritan has come a long way in tracking, measuring, and developing reporting systems for physicians and clinics, which includes incentives. They are focused on improving efficiency and access, and the electronic availability of expert information electronically will help. Samaritan is also working on the development of pharmacy solutions and methods for innovative tracking of pharmaceutical usage (overuse and underuse) to ultimately improve care.
Kelley Kaiser explained that the biggest challenge is the funding of the infrastructure. The PEBB Vision is a culture change, which has caused Samaritan to shift to such areas as wellness. Also challenging is maintaining the contractual elements with PEBB while staying true to the Board’s Vision.
Dr. Wopat added that it’s difficult to motivate physicians to foster wellness in a disease-driven world without some type of incentive. There are currently very few incentives for physicians to focus on wellness.
Diane Lovell complimented Samaritan on its EHR improvement.
Rich Peppers would like to look at models to encourage a shift in focus from disease management to wellness.
Jean Thorne asked if there is a good way to show the value of the Samaritan delivery system over the long term.
Kelley Kaiser replied that Samaritan internal medicine and family care are fully integrated with the hospitals now, so this could be helpful.
Jean Thorne thanked Dr. Wopat and Kelley Kaiser for their participation in PEBB’s Council of Innovators, adding that they have had the farthest distance to travel.
Process to Review Timing of Board Decision-Making
Jean Thorne referred to Bd attach.2 and explained that after the Board’s 2005 decision-making process (for 2006 benefit plans), the interim DAS Director asked that the Board revisit the timing of its processes, especially in odd-numbered years, when both collective bargaining and legislative decisions related to benefits are also being made. Some Board members also expressed concerns about the Board’s timelines for decisions, given their own involvement in collective bargaining.
The Board’s 2006 workplan includes establishing a work group to review this issue in July, with a final decision to be made by October. (If a decision is made to move up the Board’s process in 2007, then work on 2008 renewals would need to begin late fall of 2006.) She outlined the current processes and problems, as well as some potential implications of moving up the process 2-3 months. She suggested that the Board discuss whether the issue has been fully defined, and asked for their suggestions regarding who the stakeholders might be.
Paul McKenna stated that a work group isn’t necessary to make the decision.
Diane Lovell concurred, but added that a workgroup would bring stakeholders into the conversation. It is important that the Unions have an opportunity to talk about their side, and the Board to talk about theirs.
Rocky King said it is important to understand the impact to rates if the timeline is changed.
Diane Lovell suggested the Board determine the minimum amount of lead time that may be necessary, and that it could be less than 3 months.
Rich Peppers suggested 1-2 months.
Paul McKenna suggested that 1 month may be adequate, and that it would be best to have a broad representation from unions.
Rich Peppers concurred, suggesting that DAS/BAM might also be included. The opportunity to provide input is important, but not necessarily as a work group.
Diane Lovell suggested a survey of the other unions.
Rocky King expressed support for a survey. He suggested that PEBB also talk with DAS, get input from Aon on the impact of moving the timeline up 4-6 weeks, and provide a recommendation to the Board.
Diane Lovell would like to present both models in the survey so that everyone is aware of both sides.
Jean Thorne will bring a recommendation to the Board in either September or October.
Flexible Spending Account Administrative Costs
Lydia Lissman explained that last year, the Operations Subcommittee approved the transfer of $200,000 from the Stabilization Fund to cover the administrative costs of the FSA. At the time, that amount was projected to be sufficient to cover administrative costs through 2007, which previously has been fully covered through forfeitures. The Board did ask, however, for staff to bring this issue back for reconsideration prior to the 2007 plan year. Since data are not yet available and decisions to change would be needed prior to the Board’s August meeting, Board leadership asked that staff bring the policy options to the July meeting. Bd attach.3 outlines the options and the pros and cons of each. She explained that the staff recommendation is for a transition plan of charging a small administrative fee for 2007, using the Stabilization Fund to offset, to allow the opportunity to determine whether charging a small fee would have any impact on the uptake for the FSA.
Rocky King moved to continue to cover the FSA administrative fee with the Stabilization Fund.
Paul McKenna seconded the motion, and suggested the Board revisit the issue when planning for 2008.
Sue Nelson asked how frequently the members elect to have only $10 a month directed to their account (under option 2). This information will be provided at the August meeting.
David Hartwig asked staff to also explore what other entities are doing and if they have a floor or a cap on contributions.
Rocky King suggested that the FSA is one of the most underutilized benefits and the Board needs to figure out a way to communicate the details of the benefit to its members.
Hearing no further discussion, the motion passed unanimously.
Process for Review of Rural Subsidies
Jean Thorne referred to Bd attach.4 and explained that the Board indicated it wished to analyze the issue of rural subsidies in more depth prior to making decisions on the 2008 plans. She outlined the proposed questions, suggested stakeholders, and proposed timelines for such analysis.
Diane Lovell asked the Board to provide feedback on the proposed questions, and if a future policy discussion is needed.
Rich Peppers stated that the Board needs to have a broader perspective and to make sure it gets input from those employees who would be effected by a change.
David Hartwig said the data is needed in order to put the policy into the appropriate context; the Board needs to determine the value of the decision before a policy can be decided.
Rocky King commented that employees should not be disadvantaged because they work in rural areas.
David Hartwig suggested that this might be considered for urban areas, as well.
Diane Lovell stated that the process would be to gather the data and then solicit input from stakeholders prior to making a decision.
PEBB staff will provide information to the Board at its November meeting so that the Board can then decide from whom they would like to solicit input.
Report on Smoking Cessation
Lisa Krois referred to Bd attach.5 and provided a report on the Free & Clear Quit for Life program offered by PEBB, including the 1-year evaluation results for members first enrolling in the 1st quarter of 2005 and a six-month summary for 2006.
Possible August-December Agendas
Jean Thorne referred to Bd attach.6 and outlined the proposed Board meeting agendas through the remainder of 2006. The Board is scheduled for a work session with Kevin Boyle from 8:30-11:30 on August 15, followed by the regular Board meeting beginning at noon.
Rich Peppers suggested that the Board have a longer-range discussion of the Vision, possibly in an extra meeting in the fall.
Diane Lovell suggested adding a discussion on how the Disease Management report data is presented.
General Public Comment
Other Business
Jean Thorne explained that Board approval is requested for worksite wellness screenings to be an allowable add-on administrative cost for the two self-insured plans.
Rocky King moved to allow the ASO plans (Providence, Samaritan) to pass the health screening costs on as administrative costs, and to allow PEBB staff the authority to make any necessary contract changes.
Rich Peppers seconded the motion.
Hearing no further discussion, the motion passed unanimously.
Jean Thorne reported that new agencies have been selected for the Healthy Worksites initiative, and that training and orientation is planned for August.  
Staff Updates
Jean Thorne introduced Scott Smyth, who began July 7 as PEBB’s new Fiscal Coordinator. Cheryle Lawrence returned to PEBB on July 17 as the Contracts Coordinator, and Rick Schoonover will continue with PEBB to work on contract-related issues. Dena Comer has accepted a position with Parks and Recreation, and her last day as the Executive Assistant will be July 28. The announcement for this position vacancy has been posted and closes July 28. Temporary employee Tera Cushman will be leaving as well. Tera has been working part-time with Lisa Krois on program development related to the Vision, and her last day will be July 26. PEBB has received approval to hire a limited duration program analyst to work with Lisa Krois, and Rebecca Sweatman has accepted the position and will begin August 1.