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Public Employees' Benefit Board Meeting Minutes, Dec. 18, 2007
 
Public Employees’ Benefit Board
Tuesday, December 18, 2007, 10:30 a.m.-4:30 p.m. – Minutes
DAS/Basement Mt. Mazama Room
1225 Ferry St SE, Salem OR
 
Approved January 15, 2008

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
Isabel Joslen
Lydia Lissman
 
Mona McMullen
Ingrid Norberg
Brian Olson
Margaret Smith-Isa
Rebecca Sweatman
 
 
Guests Present
 
Seth Garber, M.D., Kaiser Permanente
Sally Hill, Providence Health Plans
Gordon Hoberg, ODS
Diana Jones, Regence BCBSO
Renee McDonald, Regence BCBSO
Megan Myrick, Willamette Dental
Jerry Olson, Regence BCBSO
Jean Poling, Kaiser Permanente
Ralph Prows, M.D., Regence BCBSO
Lynn Rosik, Oregon Department of Justice
Diane Skutack, BenefitHelp Solutions
David Scearce, The Standard Insurance Co.
Joseph Siemienczuk, M.D., Providence Health Plans
Tamara Strauss, Samaritan Health Plans
Deborah Tremblay, Oregon Justice Department
Don Wiggins, The Standard Insurance Co.
Rick Wopat, M.D., Samaritan Health Services
 
 
 
Consultants Present
 
Won Andersen, Mercer
Carrie Johnson, Mercer
James Foley, Mercer
 
Paige Sipes-Metzler, Aon Consulting
Sheree Swanson, Mercer
Dennis Tierney, Aon Consulting
 
 
Agenda
 
Welcome and Approval of Minutes
Overview of Meeting
Chronic Disease Management Report
Clinical Measures for Prevention, Screening, and Effectiveness of Care
ODS Refunding
Changes to Oregon Ethics Laws
Follow-up to Board Retreat
Optional Benefits
2009 Medical Plans
Reports Discussion
General Public Comment
Adjourn
 
Welcome and Approval of Minutes
 
Diane Lovell called the meeting to order and explained the changes to the agenda to allow for more Board discussion time during the meeting.
 
Rocky King moved to approve the September 18, October 9, October 16, and November 20, 2007 meeting minutes.
Sue Nelson seconded the motion.
 
  • Hearing no further discussion, the motion passed unanimously.
 
 
Overview of Meeting
Lydia Lissman outlined the agenda and provided an overview of today’s meeting.
 
Chronic Disease Management Report, and Clinical Measures for Prevention,
Screening, and Effectiveness of Care
Margaret Smith-Isa referred to Bdattach.5 and explained that the Board established the Chronic Disease Management (CDM) Report in 2001. This is an annual evaluation of aggregate claims costs and utilization for members with certain chronic diseases. Since 2001 the content of the evaluation has evolved and currently includes both the claims cost and utilization analyses as well as clinical measures, primarily HEDIS measures, that examine care provided to PEBB members with chronic disease by health plan. The methodology used in the cost and utilization analysis has been refined each year, generally improving the methodology but making it difficult to trend this analysis over time and develop definitive conclusions.
 
She further explained that PEBB staff recommends the Board sunset the CDM Report and focus chronic disease measurement efforts in the coming year on HEDIS measures related to chronic disease. Staff also recommends that the Board continue to encourage health plans to support community wide initiatives to collect and report performance data across health plans under the Aligning Forces for Quality initiative. The rationale behind the recommendations is that the CDM Report requires extensive resource investment and has not yielded significant conclusions to date. HEDIS measures are developed based on national standards, allowing for benchmarking, and require significantly fewer resources to collect and report annually. She continued by outlining the ten HEDIS measures related to chronic disease that staff recommends for continued monitoring next year.
 
Paige Sipes-Metzler referred to Bdattach.5 and Bdattach.5a and summarized the key findings from the 2006 CDM report.
 
Margaret Smith-Isa referred to Bdattach.6 and 6a and explained that the Prevention, Screening, and Effectiveness of Care Report was developed to capture and report baseline data on eight HEDIS measures largely related to preventive services provided to PEBB members by each of the contracted health plans. The specific measures were generally selected to align with the Common Measures Set established by the Oregon Health Care Quality Corporation. Two measures were added to capture information about back care services provided to PEBB members. This initial report reflects data on care provided to PEBB members during calendar year 2006. Information reported by the health plans are generally compared to the HEDIS 75th percentile as a benchmark and the HEDIS 90th percentile as a stretch goal. She continued by outlining the specific HEDIS measures captured in the report.
 
Jeanene Smith suggested examining the work resulting from the Aligning Forces for Quality (AF4Q) grant. The grant was awarded to the Oregon Health Care Quality Corporation for the purpose of collecting outpatient, ambulatory, primary care measures and involves a collaborative effort by various health plans.
 
Diane Lovell reminded the Board that it must consider the benefit of the staff recommendations, which would allow PEBB to collaborate with its partners in measuring common areas through common means. Sunsetting the CDM report would release PEBB staff, consultants, and the Council of Innovators to focus on improving the CDM numbers for the PEBB population.
 
Peter Callero moved to sunset the Chronic Disease Management Report and focus chronic disease measurement efforts in the coming year on HEDIS measures related to chronic disease. The Board will continue to encourage health plans to support community wide initiatives to collect and report performance data across health plans under the Aligning Forces for Quality initiative.
Sue Nelson seconded the motion.
 
Rich Peppers asked what the Board would be giving up in sunsetting the report.
Paige Sipes-Metzler explained that the Board would be giving up level I and level II analyses/discussion. Claims data will be available if in the future the Board wishes to review CDM data. Further, HEDIS measures are actionable.
 
  • Hearing no further discussion, the motion passed unanimously.
 
PEBB consultants and staff will work to develop recommendations for actions that will ultimately improve the health of PEBB members, for future Board consideration.
 
ODS Refunding
Lydia Lissman referred to Bdattach.7 and explained that the Board must determine the amount of PEBB funds currently held by ODS to be transferred to the PEBB Stabilization Fund and when the transfer(s) shall occur.
 
Rich Peppers moved to request that ODS transfer $4,758,781.73 plus any additional interest earned on or before the close of business on January 4, 2008, and to retain $3,274,568.70 at ODS for payment of claims submitted by providers until the end of the filing period. Additionally, that PEBB transfer the remaining balance with interest earned to the PEBB Stabilization on or before July 31, 2008.
Jeanene Smith seconded the motion.
 
  • Hearing no further discussion, the motion passed unanimously.
 
Changes to Oregon Ethics Laws
Assistant Attorney General Lynn Rosik explained that new ethics laws will be go into effect on January 1, 2008. The laws are the result of Senate Bill 10 and House Bill 2595 and affect any public official (anyone who works for the state regardless of classification or volunteer status, including boards and commissions). She explained that the Board should be particularly mindful of the new laws in that it has direct responsibility for spending state funds and that it works with stakeholders who offer services to the state.
 
Section 23a of Senate Bill 10 is a new revolving door statute that applies to anyone acting in the capacity of a public official who authorizes contracts, and states that they cannot go to work for anyone they authorized as a contractor for two years from the time the contract process began. The term authorized by refers to more than simply the last person who signed the contract. It involves anyone who prepares the request for proposal, staffs the selection committee, or takes part in other aspects of the contract process. However, the public official may work for the entity provided there is no direct financial benefit as a result of the awarded contract. The statute has a civil penalty of $25,000 per violation.
 
The law specific to gifts refers to items of economic value provided to public officials that are not provided to others, and where the source has a financial interest in the agency that others do not have. In the new law, there are no longer exceptions for food and beverage experienced in the presence of the provider, or for travel and lodging associated with an event. The gift limit has been reduced to $50 total from a source per calendar year, and no entertainment is allowed. It will be important to identify the source, as the public official must track everything by source and amount to ensure the limit isn’t exceeded. She pointed out that if there is no administrative interest in the agency, there is no financial limit from the provider. She added that the Legislature carved out 14 exceptions to the gifts rule, including some travel, receptions and meals. Some of these exceptions are:
 
  • Cost of admission or the cost of a meal at a conference or scheduled event if the public official is included on the agenda or is actually participating in the event.
  • Reasonable expenses paid by the federal, state or local government, a tribal government, a membership organization, or certain not-for-profit organizations for conventions, fact-finding or other events to which the public official is invited.
  • Reasonable food, lodging and travel expenses when the public official is representing the state at an officially sanctioned event.
  • Food or beverage at a reception where the food is incidental and there is no dollar value placed on the food (the food cannot be a meal).
  • Entertainment if it is incidental to the main purpose of the event.
 
An honorarium is a gift given because the official has served on a panel, or served as a speaker at an event. The new law limits the honorarium to $50 per occasion. If it is worth more than $50, the official should do something with it that doesn’t personally benefit them (examples could include hanging a piece of art on the agency wall or giving a food basket to the Governor’s Food Drive).
 
She explained that the same limits apply to those who live in the same household as, or who are relatives of the public official (this can include an extensive group). The violation would apply to both the public official and the provider. Oversight of the laws is complaint-driven. There are no reporting requirements for standard public officials, but there are requirements for some, including elected officials.
 
She suggested that those interested in the specifics of the laws can find them posted on the Ethics Commission Web site, or questions could be taken directly to the Commission.
 
Follow-up to Board Retreat
Overview of Follow-up
Lydia Lissman explained that this portion of the agenda addresses recommendations made by the Board at their November 20 retreat.
 
PEBB Goal Statement
Lydia Lissman explained that during the November 20, 2007 Board retreat the Board decided to adopt an overall Vision statement. Facilitator Diana Bianco agreed to develop a statement of behalf of the Board, based on input and comments provided during the retreat. She developed the following two options for Board consideration:
OPTION 1: PEBB envisions for its members a health system that is patient-centered, coordinated, efficient, effective, accessible and affordable. The system is built around the relationship between patient and provider, is focused on primary care, and takes an integrated approach by treating the whole person.
 
OPTION 2:
PEBB seeks optimal health for its members through a system of care that is patient-centered, coordinated, efficient, effective, accessible and affordable. The system emphasizes the relationship between patient and provider, is focused on primary care, and takes an integrated approach to health by treating the whole person.
 
Rich Peppers moved to adopt option 2 as its overall Vision statement.
Peter Callero seconded the motion.
 
Rich Peppers agreed to accept an amendment to the motion, to include a reference to community/public health.
Peter Callero concurred.
 
Rich Peppers agreed to accept a second amendment to the motion, to include a reference to wellness.
Peter Callero concurred.
 
  • Hearing no further discussion, the original motion and two amendments passed unanimously.
 
Bret West and Jeanene Smith agreed to further wordsmith the statement for future Board consideration.
 
Rewording of Vision Statement
Margaret Smith-Isa referred to Bdattach.9 and explained that during the November 20, 2007 Board retreat the Board reviewed and discussed the six criteria that comprise the PEBB Vision. The Board determined that aspects of these criteria required revision to better reflect the specific changes in the health care system the Board expects to achieve through the Vision.
 
The Board reviewed the following revised Vision criteria for adoption or further modification:
  1. An innovative delivery system in communities statewide that promotes evidence-based medicine to maximize health and utilize dollars wisely.
  2. A focus on improving quality and outcomes, not just providing healthcare.
  3. Promotion of health and wellness through consumer education, healthy behaviors, and informed choices.
  4. Appropriate provider, health plan, and consumer incentives that encourage the right care at the right time.
  5. Accessible and understandable information about costs, outcomes, and other health data is available for informed decision-making.
  6. Benefits that are affordable to the state and employees.
 
Rich Peppers moved to adopt the modified Vision criteria as listed above, changing the word “promotes” in criteria 1 to “uses”.
Peter Callero seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
 
Jeanene moved to adopt the modified Vision criteria, adding the words “right place” at the end of criteria 4.
Rich Peppers seconded the motion.
 
  • Hearing no further discussion, the motion passed unanimously.
 
Rocky King moved to adopt the modified Vision criteria, changing the words “right place” to “and place” at the end of criteria 4.
Paul McKenna seconded the motion.
 
  • Hearing no further discussion, the motion passed unanimously.
 
Evidence-based Definition and Guidelines for Evidence Evaluation
Margaret Smith-Isa referred to Bdattach.10 and explained that during the November 20, 2007 Board retreat the Board discussed the need to adopt a definition of “evidence-based medicine” to guide future discussions regarding evidence-based benefit design. She referred to Bdattach.11 and explained that at the same retreat the Board also stated a desire to adopt a set of guidelines clarifying how the Board will evaluate and use evidence to inform future decisions regarding benefit design. The Board discussed their initial reactions to the two documents.
 
Diane Lovell stated that she doesn’t like the word “convincing” on Bdattach.11, bullet 1.
Paul McKenna suggested using the word “conclusive” in its place.
Sue Nelson concurred.
Rich Peppers spoke in support of leaving the word “convincing.”
Diane Lovell expressed her concerned that two groups could be convinced of different evidence. It is important to know which group used the best evidence available.
Rocky King stated his disagreement with the 3rd bullet of bdattach.11 in that the Board should weigh scientific evidence.
Diane Lovell explained that she only wants to consider reliable information from entities that hold high standards. If those entities are convinced and the Board accepts this, then the word “convinced” is acceptable.
Lydia Lissman stated that it is important that the Board make the distinction around the level of evidence review the Board would like to carry out.
Jeanene Smith suggested that bullet 1 of Bdattach.11 be changed to “The Board will require best available evidence-based medicine to make evidence-based changes to existing benefits”.
Diane Lovell concurred.
Peter Callero suggested that bullet 3 of Bdattach.11 include the words “impartial experts”.
 
The Board agreed that staff would take the suggestions from this discussion, make the changes to the recommendations in Bdattach.10 & 11 and bring them to the January meeting for Board decision.
 
Priorities for 2008-2011
Lydia Lissman explained that during the November 20, 2007 Board retreat the Board identified tier one and tier two priorities for 2008-2011. At the Board’s request, staff have worked through each of the top four (tier one) priorities as well as the one of the tier two priorities for Board consideration.
Wendy Edwards referred to Bdattach.12 and explained that each priority includes a timing/rollout, which could change based on the Board decision on how it would like to carry out the priorities. She referred to Bdattach.12a and outlined the allocation of staff resources across PEBB.
 
Peter Callero asked if there are cash resources available for use in completing the work.
Wendy Edwards replied that there is cash, but no limitation.
Lydia Lissman explained that prior to the 2005 Legislative session there was no limit on the use of the Stabilization Fund. In 2005, the Legislature placed restrictions on the use of those funds. Historically, the Stabilization Fund has not been used for staffing.
Rocky King expressed his concern that the Board must move on the priorities now or it could be looking at 2012 before they could be completed. He suggested engaging the consultants to provide a detailed implementation plan identifying staffing and other resource needs, and taking it to DAS and the Governor’s Office for approval.
Sue Nelson suggested getting started now with the existing resources, then plan for the remaining work and seeking approval if needed.
Lydia Lissman explained that staff could outline a structure for doing as much as possible with existing resources, and preparing policy option packages for approval to complete the remaining work.
Diane Lovell stated that she would like the Board to fully pursue both evidence-based plan design and wellness, and fight for resources to keep them going or scale back as needed.
Wendy Edwards explained that staff would be happy to prepare proposals for the remainder of the biennium and then two years beyond that.
Lydia Lissman suggested that staff come back with a strategic plan for moving the priorities forward now, as well as identify those areas where additional resources would be needed. Staff could then create concrete proposals to complete all the work.
Rocky King suggested that staff work with Board members to discuss the work prior to Board meetings, in order to complete the work more efficiently.
Diane Lovell concurred, adding that she likes the idea of staff, consultants and Board members working in teams to complete the work. She asked if members of the Board would like to volunteer for work groups.
Rich Peppers agreed to work on evidence-based plan design.
Bret West agreed to work on medical home.
Peter Callero agreed to work on medical home.
Rocky King agreed to work on evidence-based plan design.
 
Optional Benefits
Wendy Edwards referred to Bdattach.14 and explained that PEBB frequently receives information from vendors on products available in the marketplace with requests for the Public Employees’ Benefit Board to include the product(s) in the optional benefits offered to members through payroll deductions. The Board considers these products on an annual basis and determines if any should be considered for the next plan year. A Request for Proposal (RFP) process would need to be conducted if the Board wishes to provide additional optional benefits for plan year 2009. She summarized the various products presented by vendors to the PEBB Director of Operations throughout 2007, and outlined the following recommendations for Board consideration as they determine if additional optional benefits will be included in the 2009 plan year:
 
  1. At this time, no additions be made to the optional benefit offerings for 2009;
  2. Staff work with OUS to identify options to meet the need for OUS liability insurance outside of the PEBB benefit system; and
  3. Further information is gathered on specific products the Board would like to consider for plan year 2010. Staff will present detailed options during an Operations Subcommittee in Quarter 3 of 2008, with recommendations being presented to the full Board in December 2008.
 
Diane Lovell stated that recommendation #2 should be delegated back to OUS.
 
Peter Callero moved to accept staff recommendation #1.
Bret West seconded the motion.
 
  • Hearing no further discussion, the motion passed unanimously.
 
Rich Pepper moved to accept staff recommendation #3.
Bret West seconded the motion.
 
  • Hearing no further discussion, the motion passed unanimously.
 
2009 Medical Plans
Wendy Edwards referred to Bdattach.15 and outlined the current Oregon Administrative Rule 101-005-0070, and explained that the Board must take action to formally interpret the OAR as applicable to the four medical plans selected as vendors under RFP 7210.
 
Rich Peppers moved to formally interpret OAR 101-005-0070 as “Provided there is continued performance in accordance with the existing four medical benefit plans between PEBB and its contractors, the Board may elect to renew the existing benefit plans pursuant to OAR 101-005-0070. This rule authorizes the Board to increase the existing contracts, prices and lengths of time without entering into a formal procurement process. The Board interprets OAR 101-005-0070 to mean that PEBB, by specifically mentioning the power to establish the contract amendment “that increases the original contract length of time,” intended that a mere extension of the duration of a contract would not amount to an amendment that ‘materially alter(s) such a contract.’”
Peter Callero seconded the motion.
 
  • Hearing no further discussion, the motion passed unanimously.
 
Reports Discussion
Lydia Lissman referred to Bdattach.16, 17, and 18 and asked the Board if they had any questions about the Open Enrollment, READI Program, or Regence Back on Track Program reports. Hearing none, the Board progressed to the SB329 presentation.
 
SB 329 – Oregon Health Fund
Jeanene Smith provided a report on the work being done within the Health Fund Board’s seven subcommittees.
 
Rich Peppers asked if there should be a formalized mechanism through which PEBB might comment on the Health Fund Board’s work.
Diane Lovell explained that all of the Board’s subcommittees will be providing reports in April 2008. Once those reports are released PEBB could give formal testimony or some type of organized input.
 
Health Resource Commission plan for developing the report on evidence based benefits for autism
Diane Lovell reported that she will participate in a subcommittee to address autism that is kicking off in January. She will provide regular reports to the Board as soon as they are developed.
 
General Public Comment
None.
 
Adjourned