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Public Employee's Benefit Board Meeting Minutes, August 21, 2007
Public Employees’ Benefit Board
Tuesday, August 21, 2007 10:30 a.m. to 4 p.m. - Minutes
DAS General Services Building/Mt. Mazama Room
1225 Ferry St SE, Salem OR
Approved 9/18/07
Board MembersPresent
Diane Lovell, Chair
Rocky King
Senator Bill Morrisette
Sue Nelson
Jeanene Smith
Bret West

Staff Present
Bobbie Barott
Dena Comer
Lydia Lissman
Margaret Smith-Isa
Rebecca Sweatman
Jean Thorne
Consultants Present
Paige Sipes-Metzler, Aon Consulting
Barbara Wall, Aon Consulting
Guests Present
Jennifer Aberg, VSP
Sally Hill, Providence Health Plans
Gordon Hoberg, ODS
Diana Jones, Regence BCBSO
Bill Lindekugel, Kaiser Permanente
Renee McDonald, Regence BCBSO
Megan Myrick, Willamette Dental
Paul Pfnister, AFLAC
David Scearce, The Standard Insurance Co.
Diana Skutack, BenefitHelp Solutions
Tamara Strauss, Samaritan Health Systems
Deborah Tremblay, Oregon Judicial Department
Welcome and Approval of Minutes
Overview of Meeting
Update on Administrator Recruitment
Funding Proposals – Employee Survey, State HIT Leadership, Quality Corp
Update on Free and Clear® Tobacco Cessation Program
Statewide Safety and Wellness Leadership Initiative
Updates on Leapfrog and Patient Safety Commission
Update from Plans on Vision Implementation – 1st Half of 2007
Approve Revised Standard Rates
Summary of Evidence Used in Making Dental Plan Decisions
Reports Over Coming Months
Disease Burden Report
Refresher on Vision Elements
General Public Comment
Other Business

Welcome and Approval of Minutes
Diane Lovell called the meeting to order.

Rocky King moved to approve the July 17, 2007 meeting minutes (noting that on page 5 Bret West clarified that his decision to abstain from voting was based on a lack of information), and the August 15, 2007 meeting minutes.   
Sue Nelson seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Update on Administrator Recruitment
Diane Lovell outlined the status of the PEBB/OEBB administrator recruitment, and explained that the Board reviewed and approved the recruitment process at a public meeting held on August 15. Sue Nelson will chair the Selection/Screening Committee, assisted by the Department of Administrative Services (DAS) Human Resource Services Division (HRSD). The announcement can be found on the state jobs page and will close on September 7.
Overview of Meeting
Jean Thorne explained that the Board will hear three proposals for funding from the Stabilization Fund. It will also hear a number of updates on items requested in previous meetings, including the Free and Clear tobacco cessation program, the Statewide Safety and Wellness Leadership Initiative, Leapfrog, and the plans’ Vision implementation status for the first half of 2007. The Board will take action regarding the revised Standard Insurance rates, and will hear a summary of evidence used in making dental plan decisions. Finally, it will hear presentations intended to assist in the process for 2009 plan design, including new information regarding PEBB members’ disease burden, and a refresher on the Vision elements.
Funding Proposals – Employee Survey, State HIT Leadership, Quality Corp
Jean Thorne referred to Bdattach.3 and explained that included in the approved 2007-09 budget for PEBB is $1,257,343 of Other Funds limitation for possible expenditures from the PEBB Revolving Fund (aka Stabilization Fund). This amount was based on the Board’s requested budget which outlined several categories of potential expenditures:
  • Monitoring performance and outcomes (e.g. conducting the biennial employee health risk survey, additional support for data-gathering, reporting and analysis);
  • Assisting agencies’ efforts to support employee wellness; and
  • Developing evidence-based approaches to health coverage and supporting development of health information infrastructure and exchanges.
At its June meeting, the Board approved the expenditure of up to $250,000 to support the Wellness Grant Program, as outlined in the budget. Grant application materials have now gone out to all agencies.
The Board discussed details in consideration of the following additional requested expenditures:
  1. Employee Survey - $36,581 (estimated);
  2. Support for State Leadership in Health Information Technology (HIT) - $86,000; and
  3. Support to Community Efforts for Reporting of Ambulatory Care Performance - $5,000.
Jean Thorne explained that item 1 supports the costs of conducting the employee health risk survey. Plans call for fielding the survey beginning in mid-September, and PEBB is being asked to fund about 39% of the costs (this is an estimate; the costs may change following a test of the survey questions by the contractor). She referred to Bdattach.3a, which outlines the process and expected costs.
Bret West moved to approve covering 39% of the employee survey costs in the estimated amount of $36,581.
Jeanene Smith seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Jean Thorne explained that item 2 supports state-level leadership on health information technology (HIT).  The Oregon Health Policy Commission specifically recommended that purchasers, including PEBB, encourage and financially support these efforts, since purchasers and payers are the primary beneficiaries of such systems, which should lead to enhanced quality, less duplication of services and ultimately a reduction in the cost of care. Although a key element of PEBB’s RFP was the establishment of Electronic Medical Records (EMRs) within health care systems, state-level support is needed to address issues, such as privacy, security and interoperability. The Office of Health Policy and Research currently supports a state health information technology coordinator. The Board agreed that it would help provide financial support to that position in the 2007-09 biennium if limitation approval was received. The Board committed to $86,000 in support. She referred to Bdattach.3b, the statement of work drafted by OHPR for the state coordinator.
Rocky King moved to approve support for state leadership in health information technology (HIT) in the amount of $86,000.
Bret West seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Jean Thorne explained that item 3 speaks to PEBB’s leadership role in efforts by the Oregon Health Care Quality Corporation (Q-Corp) to develop a set of “common measures” for ambulatory care performance. The measures have been defined, but the next step involves funding the data aggregation and reporting at the physician clinic level. Most health plans in the state have agreed to contribute data and financial support to this effort, so that more robust and valid reporting can occur (beyond what may be available from a single health plan). The Oregon Coalition of Health Care Purchasers, of which PEBB is a member, has contributed $26,000 to this effort; however, because of PEBB’s key role in supporting performance reporting, a separate contribution by PEBB would demonstrate to other major employers the importance of having a community-based effort to provide such reporting. 
Diane Lovell stated that this is an opportunity to collaborate with other organizations toward the achievement of the Vision, and will send the message that PEBB considers itself a stakeholder.
Jeanene Smith commented that this would provide feedback to providers and support quality improvement.
Jeanene Smith moved to approve supporting community efforts for reporting of ambulatory care in the amount of $5,000.
Bret West seconded the motion.                                                                
  • Hearing no further discussion, the motion passed unanimously.
Update on Free and Clear® Tobacco Cessation Program
Rebecca Sweatman referred to Bdattach.4 and provided an overview of the elements included in the Free and Clear® tobacco cessation program. She explained that while PEBB members continue to take advantage of the Free & Clear® Quit For Life ™ Program benefit, there appears to be a trend of declining enrollment that may indicate the need for enhanced program promotion by PEBB and its health plans. On August 9, 2007, PEBB hosted a teleconference with Free & Clear® and its health plans to discuss strategies for implementing program improvements, including:
  • More collaboration with the plans around communicating with members about the Free & Clear® Quit For Life™ Program;
  • Increase online enrollment;
  • Continue to partner with DHS and the plans in preparation for the DHS Tobacco Free Campus Policy roll out in 2008; and
  • Discuss benefit variations with plans and identify specific benefit changes for the plans to consider.
She continued by outlining quarterly program enrollment from 2005 though 2007, as well as program satisfaction and quit rates.
Senator Morrisette would like to see a demographic breakdown of program enrollees, specifically of family members and teens.
Jeanene Smith would like to see longitudinal data on reoccurrence beyond 6-12 months, to determine if those who quit stayed quit.
Bret West asked what percentage of state employees smoke.
Rebecca Sweatman replied about 10%, based on the 2005 employee survey.
Diane Lovell asked that staff and the health plans discuss the possibility of aligning benefits across the health plans sooner than 2009. Staff will follow-up.
Statewide Safety and Wellness Leadership Initiative
Deb Bogart of the Department of Administrative Services, Risk Management division, explained that the Safety and Wellness Leadership Initiative (SWLI) is an effort that actually has its roots in a Governor’s safety initiative in the late 1980’s, which was an endeavor to reduce workers’ compensation rates. In 2005 there was a 55 percent spike in risk assessment for worker’s compensation rates, and in addition to other efforts to reduce costs, it was determined that the best course of action would be to avoid having injuries in the first place, and/or to promote faster healing.
She referred to Bdattach.5 and explained that the SWLI Steering Committee is comprised of agency leaders and technical advisors. One of the major focuses of the initiative is to develop the agencies’ culture to one that is consistent with increasing wellness awareness and decreasing the number of injuries. She outlined the key management strategies and processes involved in the initiative, as well as next steps.
Senator Morrisette suggested that performance measures to demonstrate program success would be helpful for future funding requests.
Deb Bogart explained that two groups are examining available data within state government, including use of sick leave, family medical leave (FMLA), and workers’ compensation (SAIF).
Senator Morrisette suggested pursuing adequate wellness funding in the 2009-2011 budget.
Diane Lovell commented that wellness is a significant component of the Vision and identifying strategies to advance this will be included in the budget discussion. Additionally, PEBB has received approval to hire another program staff person toward this issue.
Rebecca Sweatman explained that information is available resulting from regular assessments on pilot agencies conducted through the Healthy Worksites Initiative.
Diane Lovell spoke in support of the initiative, but expressed concern that some employees might perceive this as the state prying into personal affairs. Union involvement would be helpful. She thanked Deb for her presentation, commenting that the Board will look forward to future presentations.
Updates on Leapfrog and Patient Safety Commission
Leapfrog Update
Margaret Smith-Isa referred to Bdattach.6 and provided background information regarding Leapfrog reporting. She highlighted Leapfrog’s efforts to improve quality and safety, specifically through the hospital quality and safety survey. She explained that the Oregon Coalition of Health Care Purchasers (OCHCP) requested 30 general acute-care hospitals in the state to participate in the survey, and explained that to date, survey results for 13 hospitals are publicly available on Leapfrog’s website.
Jeanene Smith explained that the Department of Consumer and Business Services partnered with the Office of Health Policy and Research (OHPR) to create a report on hospital cost transparency. This information has been intertwined with OHPR’s quality indicators and is available on their Web site.
Bret West asked if Leapfrog presents a large administrative burden to hospitals.
Jean Thorne replied that while some hospitals have claimed this, hospitals who are actually involved have reported that it doesn’t take an inordinate amount of time.
Patient Safety Commission Update
Margaret Smith-Isa referred to Bdattach.6a and explained that the Oregon Patient Safety Commission was established by the Legislature in July 2003 and was charged with developing a voluntary, confidential serious adverse event reporting program for hospitals and other health care facilities. Hospitals began reporting to the Commission in May 2006, with retail pharmacies, nursing homes, ambulatory surgery centers, outpatient renal dialysis facilities, and freestanding birthing centers to be added to the reporting program in the coming years. She provided an update on the Commission’s work to date, and outlined the highlights of the Patient Safety Commission’s 2006-2007 Hospital Report, including pattern, types, and seriousness of reported events as well as areas of ongoing work.
Further, she provided a summary of key findings from the Public Health Officer’s first annual Certification Report for the Patient Safety Reporting Program for Hospitals (July 2007). The findings were that the overall quality of reporting is good and the program is demonstrating good overall integrity, although the volume of reporting is low.
Update from Plans on Vision Implementation – 1st Half of 2007
Margaret Smith-Isa referred to Bdattach.7 and explained that PEBB’s Request for Proposals (RFP) 7210 outlined requirements for comprehensive, integrated plans for the delivery of medical and pharmacy benefits to PEBB members based on the Board’s Vision for 2007. She outlined key highlights from the Vision updates that plans provided to describe their progress through the first half of 2007.
Jeanene Smith asked if Providence’s prescription drug comparison tool will be linked to the evidence-based drug review that the Oregon Health Resources Commission (OHRC) has been conducting.
Margaret Smith-Isa replied that while this wasn’t specifically noted she will look into it.
Approve Revised Standard Rates
Paige Sipes-Metzler of Aon Consulting referred to Bdatttach.8 and presented information based on the Board’s July 17, 2007 approval of the additional funding for the Claims Fluctuation Reserve (CFR). The July actions in turn change the 2008-2009 rates previously approved by the Board in June.
Rocky King moved to approve the new rates for optional voluntary active life insurance that were lowered as a result of the additional funding for the CFR as follows:
Optional Voluntary Active Life Insurance for the 2008 and 2009 Plan Year
Coverage from
$20,000 to $400,000
($20,000 increments)
increasing to $600,000 in 2009
Rate per $1,000
June 19, 2007
Rate per $1,000
as a result of the
July 17th additional
funding of the CFR
Under 25
25 – 29
30 – 34
35 – 39
40 – 44
45 – 49
Optional Voluntary Active Life Insurance for the 2008 and 2009 Plan Year (continued from previous page)
50 – 54
55 – 59
60 – 64
65 – 69
70 + over
Sue Nelson seconded the motion.
Bret West asked if a rate spike is likely to happen in the future.
David Scearce of The Standard Insurance Company replied that there is a two-year rate guarantee and rates are based on claims experience.
  • Hearing no further discussion, the motion passed unanimously.
Summary of Evidence Used in Making Dental Plan Decisions
Diane Lovell explained that the Board will schedule a planning session during the month of November and will include a refresher on how it will use evidence.
Margaret Smith-Isa referred to Bdattach.9 and explained that during the 2008 Dental Plan selection process, the Board requested that plans propose options for consideration regarding specific areas where evidence-based plan design changes could be adopted. The Board relied upon information presented by each of the dental plan proposers as well as analysis conducted by Aon Consulting in making decisions about changes to the dental benefit for the 2008 plan year. She summarized the evidence each dental plan provided, including frequency of routine cleanings, crown replacement, recall radiographs, and root planning.
Rocky King asked what process ODS would put in place to ensure that providers and patients will know whether or not more than one cleaning per year would be covered.
Gordon Hoberg of ODS replied that the provider will have to submit paperwork to explain the risk of not having more than one cleaning per year.
Jeanene Smith asked if a member requiring several cleanings per year would be flagged, or if paperwork would need to be submitted for each incident.
Gordon Hoberg replied that it depends upon the risk criteria; Diabetes would be flagged, for example.
Rocky King expressed concern that members will receive unexpected bills for cleanings.
Lydia Lissman explained that communication efforts are essential, as this is a big change. PEBB is working with plans, providers, and members to communicate the changes.
Diane Lovell stated her concern about member reactions, but emphasized that this plan design is based on evidence and is consistent with the Board’s Vision. 
Reports Over Coming Months
Jean Thorne explained that over the next few months the Board will begin to examine what it needs in order to determine a course of action related to 2009 medical plans. This will take two tracks - the first being the identification of PEBB member conditions (Disease Burden Report) and the second being an assessment of plan progress in relation to the original RFP criteria.
Diane Lovell explained that the Board’s strategic planning session later this year will include consideration of the Vision to determine if any changes are necessary. She added that this will be a facilitated session.
Disease Burden Report
Paige Sipes-Metzler referred to Bdattach.10 and explained that the Disease Burden Report was prepared with the utilization of the Diagnostic Clinical Groupings (DxCG) tool, which has been used by numerous organizations including the federal government. The tool is an actuarial and clinically-based statistical application that evaluates claims transaction data in the past to define the risk profile of participants and to forecast claims arising in the next year. She outlined the demographics and findings for PEBB members.
As next steps, PEBB’s Council of Innovators will be reviewing the following items over the coming months:
  • Behavioral health issues (including substance abuse) and its relationship to other co-morbid conditions such as ill defined symptoms or injuries;
  • Diabetes and what cardio-vascular co-morbid conditions are found with what frequency;
  • Morbid Obesity and what co-morbid conditions are associated with this condition; and
  • Examination of the burden of disease from birth to 17 years of age.
Jeanene Smith commented that compared to the benchmark population, the likelihood of fewer chronic heart, lung and hypertension illnesses for PEBB members is not surprising due to the low number of smokers in the PEBB population.
Rocky King suggested that this tool could help with the early identification of members in need of case management. Regence is working on a predictive model to address this; it would be helpful to know what they are using. 
Diane Lovell explained that recommendations from the Council of Innovators will be brought to the Board  periodically.
Other Business
Diane Lovell explained that the order of items on the agenda has changed in order accommodate Board member schedules.
Jean Thorne reported on new business in a number of areas.
Next Board Meeting
PEBB recently met with CareOregon, who has agreed to attend the September Board meeting to provide information on pilot clinics which incorporate a redesign of primary care. They have also been invited to meet with PEBB’s plans and other purchasers in early October to discuss the redesign, and improving performance measurements to ultimately improve results.
Diane Lovell would like to invite the Oregon Health Sciences University to the September meeting for inclusion in the discussion with CareOregon.
Barney Speight, director of the Oregon Health Trust Fund Board, will also attend the September Board meeting to discuss the potential impact of Senate Bill 329 on PEBB.
Award Nomination
The Oregon Coalition of Health Care Purchasers has nominated PEBB for the National Employer of the Year award from the National Business Coalition on Health.
Staff Update
Lude Domi has accepted the position of Member Services Coordinator effective August 27. Lude has worked as a temporary in this position since March. Additionally, Darla Bell will begin as PEBB’s new Benefits Analyst on September 4.
Recruitment is underway for the Program Analyst and Administrative Specialist positions, which will close in late August. 
The PEBB/OEBB move to the General Services Building (1225 Ferry Street) is now scheduled for early February 2008.
Diane Lovell reported that OEBB’s Board Chair was present at the last PEBB Leadership meeting, and Diane will attend a future OEBB meeting to discuss PEBB’s work and lessons learned.
General Public Comment
Refresher on Vision Elements
In preparation for future reports on the health plans’ progress in implementing the Board’s Vision, Jean Thorne presented a refresher on the Vision elements.
She referred to Bdattach.11-11a and explained the background behind the principles used to guide the scoring given to plans who responded to the 2005 medical RFP, as well as the process for developing the criteria (utilizing the assistance of the Foundation for Accountability, or “FACCT”) and selection of finalists. The initial medical contracts were for 2006-2008, although the Board has the authority to enter into renewals for beyond that time. The Board will soon begin identifying issues it wishes to have all plans, or individual plans, address as it determines whether to renew medical plans for 2009.
She referred to Bdattach.11b and outlined the recommendations of the FACCT report. The report defines the technical performance criteria, essential “domains” that present themselves in most care settings, and the weighing and evaluation criteria for those domains as a basis for the quality scoring in the 2005 medical RFP.
Rocky King commented that members don’t see the information in the FACCT report, in terms of their benefits or how they interact with their providers.
Jean Thorne replied that the determination of how best to communicate evidence-based care to members is a process. Engaging them and successfully communicating the concept of the employee’s role in their own care is crucial.
Rocky King suggested that the challenge is how to stick to evidence-based care and to track how we’re doing.
Diane Lovell stated that the Board needs to have a discussion about not only where PEBB wants to go, but where purchasers and other partners are going, as well. Bringing partners together will result in a stronger movement.
Jeanene Smith asked if the FACCT report has been considered side-by-side with the eValue8™ Request for Information (RFI).
Jean Thorne replied that without having actually compared them side-by-side, an important item is medical home measurements related to infrastructure, which could be addressed more in the eValue8™ RFI. She estimated that 75 percent of the FACCT Report is captured in the RFI.
Jeanene Smith suggested that PEBB stay in alignment with eValue8™ as it moves forward.