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Public Employees' Benefit Board Meeting Minutes, Nov. 20, 2007
Public Employees’ Benefit Board
Tuesday, November 20, 2007, 10:30 a.m. to 4:30 p.m. - Minutes
DAS General Services Building, Basement/Mt Mazama Room
1225 Ferry St SE, Salem
Approved 12/18/07

Board Members Present
Diane Lovell, Chair
Sue Nelson, Vice-Chair
Peter Callero
Rocky King
Paul McKenna
Rich Peppers
Jeanene Smith
Bret West
PEBB Staff Present
Bobbie Barott
Adrienne Binam
Dena Comer
Wendy Edwards
Joan Kapowich
Lydia Lissman
Mona McMullen
Ingrid Norberg
Brian Olson
Margaret Smith-Isa
Rebecca Sweatman
Jean Thorne
Guests Present
Diana Bianco, Artemis Consulting
Diane Skutack, BenefitHelp Solutions
Consultants Present
Won Anderson, Mercer
James Foley, Mercer
Paige Sipes-Metzler, Aon Consulting
Sheree Swanson, Mercer
Welcome and Introductions
Report and Discussion on Accomplishments to Date and Current/Planned Activities
Discussion of Future Priorities
Discuss Structure of Board Meetings
Wrap Up and Next Steps
Other Business
Welcome and Introductions
Diane Lovell called the meeting to order and roundtable introductions were made.
Jean Thorne reported that on November 13, 2007 PEBB was awarded the National Business Coalition on Health (NBCH) 2007 Employer Award for excellence in value-based purchasing. The honor recognized PEBB as an employer collaborating with partners towards healthcare reform.
Retreat Timing, Goals and Agenda Review
Diana Bianco of Artemis Consulting introduced herself as the facilitator of today’s strategic planning retreat. She reviewed the agenda and the discussion plan for today’s meeting, and explained that goals include assessing progress against PEBB’s Vision; determining focus areas for the next three to four years; and ensuring that Board meetings are structured efficiently.
The Board discussed what they would like as outcomes from today’s meeting, as follows:
Rocky King stated he would like a Board commitment to evidence-based health care, stepping forward with the difficult tasks, and taking risks to get to the Vision.
Rich Peppers would like to identify the Board’s role in a broad context, and to pursue dual roles of being innovative without upheaval and cost to members. He would also like a focus on evidence-based decisions while identifying what counts as evidence, and investigating how to ensure the responsibility for evidence-based decisions lies with carriers and providers, not just members.
Peter Callero stated that he would like to identify far-reaching ideas for consideration.
Paul McKenna would like to have a clear plan for both the long and short term.
Bret West stated that he would like a clear plan for the next year and to identify his role in accomplishing it. He would also like to address finding a balance between cost and excellence in healthcare.
Jeanene Smith stated that she would like to refine and promote one or two aspects of that work. She would also like to pursue partnerships in order to be truly innovative with the medical home, and to have better communication with agency heads and others so that PEBB’s efforts are well known.
Sue Nelson would like to have a clear understanding of the key areas where the Board can make the most difference and how it can be the most effective for members. She would like the structure of meetings to be action-focused, and would like a comprehensive communication plan.
Diane Lovell would like to reaffirm or modify the Vision to accomplish full Board ownership. She stated that the Board spends significant time on areas included in the Vision, but not always on those areas that could be most effective in moving the Vision forward. Not all components of the Vision should be treated equally. She would like to identify three to four strategies, including building wellness as a stronger component. Additionally, she would like to reevaluate how strategic partnerships could be used to advance the Vision.
Report and Discussion on Accomplishments to Date and Current/Planned Activities
Staff Presentation of Accomplishments
Margaret Smith-Isa referred to the Planning Matrix handout and explained it represents the Board’s accomplishments to date. She summarized those accomplishments and the current and planned activities according to each key component of the Vision.
Board Discussion and Analysis of Progress: Do we need to change or refine Vision elements?
The Board discussed possible modifications to the six Vision elements, as follows:
Jeanene Smith stated that coordinated, efficient, and integrated care (medical home) should be included in the Vision.
Peter Callero suggested that a clear depiction of evidence-based medicine and medical home be included.
Diane Lovell stated that the Vision should include a concrete description of an innovative delivery system.
Board discussion of what is meant by an “Innovative Delivery System” resulted in the following list:
  • Coordinated
  • Efficient and effective
  • Patient-Centered
  • Team of providers – based on relationship between patients and providers
  • Focus on Primary Care
  • Integrated Care – treats whole person
  • Affordable
  • Understandable
Diana Bianco explained that she will create a comprehensive and compelling over-arching statement to members, including all elements in the above list and submit it to the Board following today’s meeting.
The Board continued its discussion of possible Vision modifications, examining the six criteria individually.
Vision Criterion #1: An innovative delivery system in communities statewide that provides evidence-based medicine to maximize health and utilize dollars wisely.
Discussion to define Evidence-Based Care resulted in the following list:
  • Seek affirmative evidence
  • Weigh evidence
  • Where high-quality evidence is available
  • Right care at the right time for the patient
  • Clinical trials – scientific data and analysis, peer review
  • FACCT Report definition
  • Action – change to: An innovative delivery system in communities statewide that promotes evidence-based medicine to maximize health and utilize dollars wisely.
Vision Criterion #2: A focus on improving quality and outcomes, not just providing healthcare.
  • No action suggested.
Vision Criterion #3: The promotion of consumer education, healthy behaviors, and informed choices.
  • Action – change to: Promotion of health and wellness through consumer education, healthy behaviors, and informed choices.
Vision Criterion #4: Appropriate market and consumer incentives that encourage the right care at the right time.
  • Action - change to: Appropriate provider, health plan and consumer incentives that encourage the right care at the right time.
Vision Criterion #5: System-wide transparency through explicit, available, and understandable reports about costs, outcomes, and other useful data.
  • Action - change to: Accessible and understandable information about costs, outcomes and other health data is available for informed decision-making.
Vision Criterion #6: Benefits that are affordable to the state and employees.
  • No action suggested.
Discussion of Future Priorities
Determine Criteria for Choosing and Prioritizing Issues
Diana Bianco asked the Board to consider how PEBB decides to take on and prioritize issues. The questions in the resulting list were identified as involving R (Resources), P (Politics) or V (Vision) if applicable, and numbered according to priority, as follows:
Questions to Ask When Considering Priorities for PEBB
1 (V) Will it produce an outcome related to the Vision? Advance the Vision? How significant an outcome?
2 (V) Will it increase capacity to bring us closer to Vision?
3 (V) Can PEBB produce change on its own? If not, who are potential partners and are they going down this road?
4 (R) What level of resources from PEBB will it require?
5 (R) What level of effort will be required?
6 (R) Willing to review priorities? What will PEBB not work on as a result?
7 (P) What kind of member reaction might result?
8 (P) What will be reaction by plans and providers?
9 (P) What are the politics around the issue?
10 Can we communicate this to members?
11 Is it the right thing to do/Is there a greater good for the state?
Assess Potential Issues Against Criteria
Diana Bianco asked the Board to identify potential new issues and how they might prioritize them, given the criteria. The following list was the initial result:
Priorities: 3-4 years
  • Evidence-based plan design
  • Chronic care strategy
  • Member wellness
  • Medical home – (Demo project)
  • OEBB relationship
  • Oregon Prescription Drug Program (OPDP) model
  • Dialogue among Board members
  • Hospital contracting – Cost, Quality
            -Direct provider contracting
  • Tier rating system
  • Transitioning towards partnerships with others on quality data
  • Mining own utilization data
            -to inform decisions
  • Communications
The Board then took the first priority from the above list and discussed how it might be further refined:
Comprehensive Evidence Based Plan-Design – Development Work vs. Implementation(numbered by priority)
In Vision – outcome = better quality and more effective
  1. Right care at the right time
  2. Not on own – partnerships – major purchasers/payers, possibly through 329 process
  3. Very significant resources – Senate Bill 329 connection
  4. Huge effort
  5. Unknown
  6. If big outcome, big reaction
  7. If big outcome, big reaction
  8. Politics – big outcome, big reaction
  9. Communication challenging
Diana Bianco asked the Board to decide if any items could be removed from that list, and to determine the level of priority. The Board decided upon the following as tier 1 priorities:
  • Communications
  • Medical Home
  • Evidence-based plan design (one step at a time)
  • Member Wellness - partner
In addition, the Board did not want to eliminate other priorities without further information; however, the Board needed to identify tier 2 priorities:  
Tier 2 Priorities
  • OEBB Relationship
  • OPDP Model
  • Dialogue among Board members
  • Hospital contracting
Other Priorities
  • Chronic Care Strategy
  • Tier rating system
  • Transitioning towards partnerships with others on quality data
  • Mining own utilization data
            -to inform decisions
Identify Next Steps for Each Issue
Diana Bianco suggested that once the revised priority list is decided, staff draft answers for each question and suggest the type of actions that may be necessary (including relative resources of the Board, staff, consultants and plans). Final priority lists with concrete outcomes for three and four years could then be suggested for Board consideration.
Discuss Structure of Board Meetings
What Works About the Current Structure of Board Meetings?
Diane Lovell asked the Board to consider the structure of its meetings and to provide feedback regarding what’s working and what could be improved. Discussion included how to better utilize time, materials, and the length of full Board and Subcommittee meetings, resulting in the following list:
Board Meeting Feedback
  • Consider, “We are sharing this information so that…”
  • Materials ahead of time – not print Board materials twice
  • Fewer subcommittees
  • More time for policy-level dialogue on priorities (keep same structure but have more time for sharing/discussion)
  • Reporting Back
  • Less time on RFP scoring
            -define clear criteria and let consultants and staff do more
Wrap Up and Next Steps
Diana Bianco summarized today’s work, as follows:
  • Refined the Vision – Diana Bianco will do first draft of overall Vision statement and criteria changes for Board consideration.
  • Set Priorities – Staff will look at the top four and answer the set of questions for each one. Staff will also determine the timeframe to complete the questions for the tier 2 priorities so the Board can further refine as needed.
  • Impose Discipline – Board will determine how to focus limited staff resources and energy.
  • Board Meetings – Board and staff will make meetings as efficient and effective as possible.
Next Steps
Staff will work on the first and second tier priorities and come back with information so the Board can do more refining of priorities, for part if not all of the December Board meeting. Staff will also research the FACCT report for more information on evidence-based care for future Board review.
Other Business
Jean Thorne reported that Board leadership met last week with Regence leadership, primarily to discuss future direction with respect to medical home. Regence presented a draft agreement with Peacehealth to conduct medical home pilots in the Eugene area, as well as a Legacy pilot. Additionally, Regence has worked diligently to get lab data into the Disease Management Report but they have only been able to capture 20%; therefore, this information will not be included in the December Disease Management Report.
Leadership meetings with PEBB and Samaritan, Providence and Kaiser are in the process of being scheduled.
Meeting Adjourned