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PEBB Minutes, December 19, 2006
Public Employees’ Benefit Board
Tuesday, December 19, 2006 10:30 a.m.. to 4:30 p.m. - Minutes
PEBB Board Room
775 Court St NE, Salem OR
Approved February 13, 2007

Board MembersPresent
Diane Lovell, Chair
Peter Callero
Rocky King
Sue Nelson
Paul McKenna
Rich Peppers
Jeanene Smith
PEBB Staff Present
Bobbie Barott
Claire Kemmerer
Lisa Krois
Lydia Lissman
Ingrid Norberg
Scott Smyth
Rebecca Sweatman
Jean Thorne
Consultants Present
Barbara Wall, Aon
Dennis Tierney, Aon
Guests Present
Gary Allen, Willamette Dental
Thandi Clements, VSP
Gordon Hoberg, ODS
Salley Hill, Providence
Ron Klein, AFLAC
Renee McDonald, Regence
Megan Myrick, Willamette Dental
Paul Pfinster, AFLAC
Kim Waldroff, BenefitHelp Solutions
Ryan Webster, Providence
Welcome and Approval of Minutes
Overview of Agenda
2008 Renewal Requests
Review Committee for Dental RFP
2005 Chronic Disease Management
2007-2009 Governor’s Recommended Budget for PEBB
Summary of 3rd Quarter Health Plan Progress Reports
3rd Quarter Rx Exceptions and Bariatric Surgery
General Public Comment
Other Business
Welcome and Approval of Minutes
Diane Lovell called the meeting to order.  Sue Nelson moved to approve the minutes from the November 21, 2006 meeting (Bdattach.1 ) (doc). Rocky King seconded the motion.  The motion passed unanimously.
Jean Thorne:  Overview:  Since the Board decision-making timeline has been moved forward to May, there are additional items for review today:  a) the 2008 medical renewal request due to go out the beginning of January, and b) the Dental RFP Review Committee needs to be selected.  In addition, the Chronic Disease Management report findings for 2005 will be reviewed and each plan will be giving an overview of their plan management.  An update on the Governor’s Budget for PEBB will be presented. 
Jean Thorne reminded the group that starting in February and ending in May, on the second Tuesday of the month, an additional monthly Board session will be held from 10:30 a.m. – 2:00 p.m.  Portions of these sessions will be Executive Session.
2008 Renewal Requests
Jean Thorne outlined additional areas the Board had expressed interest in reviewing (i.e., asking for evidence-based plan design options and/or going out for an RFP).    Note:  Life & Disability was identified as a potential area to go out for an RFP.  The Board will be sending out a renewal request to Standard Insurance.  Based on the response to the renewal request, the Board can then decide if an RFP for Life & Disability is appropriate.   
Barbara Wall reviewed Bdattach.2: Renewal Timeline (doc) and outlined suggested evidence based care approaches the Board may request responses to for 2008.  These particular areas have been topics for discussion at the Council of Innovators..  Medical carriers will be asked to include a quote for vision, as well as VSP providing quotes on existing benefits. 
Response back from the medical plans for their current design (with and without vision) are due January 25th.  Additional time will be given for the plans to provide evidence-based care design and other options related to evidence-based care.     
Lisa Krois reviewed Bdattach.3, Recommendations for Promotion of Evidence Based Care (doc) regarding specific areas of inquiry related to back care and diabetes management.
Jean Thorne stated that the discussion around back pain/care has brought out the reality that PEBB has four plans with four very different systems.  Rather than trying to develop a single approach to addressing these issues, the renewal request will allow plans to outline how they can best address the issue given their particular system.   
Lydia Lissman reviewed Bdattach.4, Possible Plan Design and Administrative Changes (doc). 
Possible plan design changes, justifications, and administrative requirements as outlined in the recommendations were discussed by the group.   The issues included have arisen from member concerns.  If the Board might want to consider any of the changes outlined in the attachment, PEBB would ask the medical plans for rationale and evidence on the suggested changes and proceed from there. 
Review Committee for Dental RFP
Lydia Lissman reviewed Bdattach.5 and discussed the timelines and responsibilities of the Review Committee for the Dental RFP.    
After group discussion Rocky King, Diane Lovell, Peter Callero, and Sue Nelson agreed to participate in the review committee on the dental RFP. 
2005 Chronic Disease Management Report
Diane Lovell introduced Barbara Wall, Dennis Tierney, and Lisa Krois.  Lisa Krois outlined the report format from previous years and how the data was refined to capture information against national benchmarks and PETA.   
Barbara Wall and Dennis Tierney, Aon, reviewed Bdattach.6: 2005 Chronic Disease Management Report Executive Summary and highlighted the 2005 key findings. 
Health Plan Reports on Chronic Disease Management
Regence:  Dr. Ralph Prows provided comments on performance of Regence providers, as well as the Regence approach on disease management.  Since HEDIS is a set of measurements for managed care plans, he believes that having a PPO plan be able to hit the 75th percentile of HEDIS nationally is a high standard.  For most clinical measures, Regence’s performance was close to the 75th percentile.  HEDIS also provides a good barometer of plan performance year-to-year.  He noted that emergency room and inpatient utilization appear to be improving for patients with asthma.  For some measures, there are issues because of small numbers.  Regence initiated Advicare for PEBB members in 2006 and is now in the process of implementing its Clinical Performance Measurement Program as well as Clinical Performance Improvement pilots.  This should affect the results over time.  Regence is actively pursuing being able to gather lab data on a significant portion of PEBB members.
Kaiser:  Dr. Tom Hickey outlined Kaiser’s approach and goals in disease management.  Kaiser strives to achieve the 90th percentile on all HEDIS effectiveness of care measures by 2010.  Populations are prioritized based on significant gaps with the 90th percentile and the illness burden of the populations.  He outlined Kaiser’s high priority actions.  Kaiser also has problems with some measures for PEBB members because of small numbers, meaning that the rate can fluctuate dramatically based on only a few PEBB patients.
Providence:  Dr. Joe Siemienczuk outlined the Providence approach to disease management, including population identification, interventions and the ways in which electronic medical records (EMR) can support better management of patients with chronic diseases.  The implementation of the care management software has significantly improved Providence performance overall on clinical measures.
Samaritan:  Dr. Rick Wopat discussed Samaritan’s progress in implementing disease management.  Samaritan is in the process of implementing its EMR, which should assist in the management of patients with chronic diseases.  Samaritan is also sponsoring pilot programs that include group visits for persons with certain diseases and is part of implementing disease management for their 3-county area in concert with their local health departments under a grant from the Department of Human Services.
In a discussion among the representatives from the four plans, the following points were made:
  • The greatest success is in managing an entire population of patients with a certain chronic disease, not just those patients from a certain payor;
  • The focus should be on management of the patient, not just management of the disease;
  • Disease management should be integrated with the patient’s primary care provider so that care is not segmented;
  • A key is in finding ways to activate members to better manage their disease – disease management programs can serve as a bridge to members.
2007-2009 Governor’s Recommended Budget for PEBB
Jean Thorne shared program option package information and spoke to the nature of the packages and the required limitation to spend.
  1. This package includes the funding necessary to develop and implement the upgrades identified as essential by the advisory group and PEBB’s technical staff.   Funding supports one permanent, full-time program analyst position and enhancements to pebb.benefits website. 
  2. Program Option Package 302 - Support to quality and prevention initiatives.   The purpose of this package is to support the Board’s Vision of focusing on improved health care outcomes through more effective management of health plan performance and emphasis on member wellness; two factors that ensure effective management of PEBB benefit programs.    This package links the department’s goals of efficient and effective government infrastructure and adaptive government for future generations.  Funding supports one permanent, full-time position program analyst and one physician consultant contract.
  3. Program Option Package 303 Implementation of the PEBB Vision.  The purpose of this package is to continue implementation of the PEBB strategic Vision adopted by the Board in December 2002 via use of stabilization funds towards identified key components.  There is no staffing impact.
  4. Program Option Package 304:  Oregon Educators’ Benefit Board (OEBB).  The purpose of this package is to support an Oregon Educators’ Benefit Board (OEBB) within the Department of Administrative Services (DAS) as proposed by the Governor.  Proposed staffing is for a combined 17 positions.
Board members expressed concerns regarding the possible impact on PEBB of having PEBB staff needing to help support implementation of OEBB.
Summary of 3rd Quarter Health Plan Progress Reports
Lisa Krois reviewed Bdattach.8: 2006 3rd Quarter Progress Report Summary (doc) reporting that all plans are moving at a good pace.  Third quarter progress reports provide further improvements and advancements by each carrier toward the PEBB vision.  As discussed over the year’s progression, the different insurance models have required innovative and varied approaches to meet or work toward vision goals.  All health plans have provided thoughtful implementation plans and approaches which indicate positive movement toward the stated goal for each vision element that was not in place at the start of 2006.  Slight modifications have been noted again on various deliverables dates in the third quarter work plans but none indicate a lack of planning or progress. It is anticipated that implementation plans will include continual dialogue and refinement throughout the remainder of the year.
3rd Quarter Rx Exceptions and Bariatric Surgery Reports
Jean Thorne reviewed Bdattach.9 on 3rd quarter Rx exceptions and Bdattach.10 on 3rd quarter activity for bariatric surgery.
General Public Comment
Other Business
Jean Thorne  reviewed the Board schedule for the beginning of 2007 noting additional sessions and March 20th as the joint Council of Innovators/Board meeting. 
PEBB staff changes:  Lisa Krois will be leaving in February to move to Israel; Rick Schoonover is retiring this month and will return to a temporary position to fulfill contract negotiations while PEBB works to fill his position; and Scott Smyth will be leaving PEBB and going to the State Controller’s Division February 1.   
Diane Lovell shared with the group the details of the Oregon Health Forum leadership dinner at which Jean Thorne was honored as Visionary of the Year.