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Public Employees' Benefit Board Meeting Minutes, March 18, 2008
Public Employees’ Benefit Board
Tuesday, March 18, 2008, 10:30 a.m. to 4:30 p.m. – Minutes
DAS General Services Building/PEBB-OEBB Board Room
1225 Ferry St SE, Salem OR
Approved April 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
Chelsea Hollingsworth
Isabel Joslen
Lydia Lissman
Mona McMullen
Ingrid Norberg
Brian Olson
Margaret Smith-Isa
Guests Present
Kristina Herron, Providence Health Plans
Gordon Hoberg, ODS
Diana Jones, Regence BCBSO
Renee McDonald, Regence BCBSO
Dr. Julie Marshall, Cascade EAP
Jane Moore, Oregon Dept. Human Services
Megan Myrick, Willamette Dental
Paul Pfnister, AFLAC
Dr. Ralph Prows, Regence BCBSO
Steve Schmick, Kaiser Permanente
Diane Skutack, BenefitHelp Solutions
Tamara Strauss, Samaritan Health Systems
Deborah Tremblay, Oregon Judicial Department
Don Wiggins, The Standard Insurance Co.
Consultants Present
Won Andersen, Mercer
James Foley, Mercer
Welcome and Approval of Minutes
Overview of Meeting
Board Priorities
Public Comment
Report Discussion
Health Survey Results
Regence Disease Management Programs
2009-2011 Policy Option Packages
Retiree Plan Options
Self-Insurance Infrastructure
Welcome and Approval of Minutes
Diane Lovell called the meeting to order.
Rocky King moved to approve the February 19 and February 28, 2008 meeting minutes.
Paul McKenna seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Overview of Meeting
Lydia Lissman provided an overview of the meeting agenda items.
Diane Lovell stated that the agenda includes a public comment period between 11:30 a.m. and 1 p.m. She explained that the Board prefers public comments to pertain to those items listed on the meeting agenda; however, as this is a new process for the Board and members it may take a few meetings to determine the best process for hearing comments. 
Board Priorities
Diane Lovell acknowledged the hard work of PEBB staff in the Board Priority Work Groups.
Wendy Edwards referred to Bdattach.3 and explained that staff implemented work groups for the four priorities identified by the Board for 2008-2011, including Evidence Based Plan Design, Medical Home, Communications and Wellness. The Board adopted the process, timing, guidelines and work group membership in January and February 2008.
She outlined the options for current funds available to PEBB through 2007-09 Policy Option Package (POP) 303, as well as POP recommendations for 2009-2011 that align with the Board priorities. She explained that staff and the work groups will continue to revise current funding options to ensure all Board actions move forward and all 07-09 funding is expended. Staff will provide quarterly updates as part of the PEBB budget overview. She reviewed the progress and next steps for each work group.
Margaret Smith-Isa outlined the highlights of the planning guide for the work groups, and the associated staff recommendations for 2009-2011 plan renewal and policy option packages.
The Board discussed the details surrounding implementation and outcomes for each recommendation, for final consideration during the POPs agenda item scheduled for later in the meeting.
Public Comment
Diane Lovell advised that testimony presented during the public comment period is considered public record.
Testimony #1
Dennis Sigrist testified that he is a full-time state employee with Oregon Emergency Management and a retired commissioned officer with the National Oceanic and Atmospheric Administration (NOAA). His NOAA career allows for military benefits, and in addition to his PEBB membership he is enrolled in TRICARE Prime, for which he pays for coverage on an annual basis. He also pays for supplemental insurance and as a result has chosen to opt out of PEBB medical benefits. He was dismayed to read in the March PEBB newsletter that new federal regulations mean that PEBB members with TRICARE coverage can no longer opt out of medical coverage. Further, he was surprised that no Attorney General opinion accompanied the Administrative Rule. He believes that the determination made by PEBB may not have been correct. He stated that this decision has created a significant hardship, and has left him unprepared to address the results within the 60-day timeframe. Among other concerns, the requirement is not considered a Qualified Status Change, which would have allowed him to review his PEBB Flexible Spending Account. In the interest of protecting his state and military benefits, he would like the Board to request an opinion from the Attorney General or Department of Justice regarding the matter. If the requirement is determined to be valid, he stated that it should be implemented during Open Enrollment to allow for review and change to benefits as appropriate.
Bobbie Barott explained that agency payroll staff was notified about the upcoming changes during the summer of 2007 so that they could inform employees enrolled in TRICARE.
Rich Peppers thanked Mr. Sigrist for bringing the issue to the Board. He added that this could be an opportunity to learn how best to identify “triggers” for communication with members on future issues.
PEBB staff will research the issue of TRICARE and medical opt-out, and provide information and recommendations to the Board. Mr. Sigrist will be notified of the outcome. Additionally, staff will provide a communication strategy for any similar issues in the future.
Diane Lovell asked the Board if they would like to have a special meeting to address the issue in time to meet the May 1 deadline.
Rich Peppers moved to add this issue to the agenda for the April Operations Subcommittee meeting, with an invitation to the full Board to attend. The Subcommittee shall have authorization to make a decision without returning to the full Board for approval.
Peter Callero seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Testimony #2
Ley Garnett testified that he is an employee with the State Treasurer’s Office and expressed his concern regarding a medical bill that he believes should have been covered by the Providence Choice plan. He asked his provider if he was preferred on the Providence Choice list and the provider responded “yes”. Upon billing, Providence determined that the provider was not on the Providence Choice preferred provider list, and Providence will not pay more than 70 percent of the cost.
Diane Lovell asked if this has gone through the appeal process with Providence, and if he has worked with PEBB staff.
Ley Garnett replied that he has gone through the 2nd level of appeals and will continue to the next level with Providence. He has also spoken with PEBB staff.
Diane Lovell thanked the member for his comments and asked that he leave his contact information so the Board and staff may address this issue.
Staff will research this issue, to include a review of the process for determining a preferred provider within the Providence Choice plan, either directly or through a referral. Staff will provide a report to the Board, including a recommendation for improved communication regarding preferred providers on Providence panels.
Testimony #3
Lydia Lissman explained that a PEBB member e-mailed a letter to PEBB staff and requested that it be read into the public record. The letter contains personal medical information; however, the member requested that the letter be read as written. 
On behalf of member Nicole Petty, Bobbie Barott read the letter as written by Nicole to her employer, the Oregon Department of Transportation and forwarded to PEBB via e-mail on March 7, 2008. The letter outlines her request for PEBB assistance to make infertility services a requirement in Oregon. The letter explains her understanding that Endometriosis can be put into remission by way of pregnancy, specifically through the process of In Vitro Fertilization.
Bobbie Barott reported that she contacted the member’s medical carrier regarding this issue. The carrier response is as follows:

“Our Medical Policy Department advises there is no scientific evidence supporting the fact that In Vitro Fertilization puts Endometriosis into remission. We do cover some infertility services; however, In Vitro Fertilization is not covered under the PEBB benefits due to the fact that it is considered experimental and investigational.”
PEBB staff will continue to communicate with the member and share the medical carrier’s response. The request will be reviewed when the Board considers new or revised benefits for the upcoming plan year. 
Report Discussion
OregonHealth Fund Board
Jeanene Smith reported that the Oregon Health Fund Board’s six committees are continuing work with the goal to complete their reports to the full Board in time for its May meeting. She outlined the work in progress by the Finance, Benefit, Delivery, Health Equity, Eligibility and Enrollment, and Quality committees. The Board plans to have a draft product available for public comment in September. Additionally, the Board will invite public input at meetings scheduled for April and May.
Diane Lovell encouraged Board members to attend the Health Fund Board committee meetings.
Health Resources Commission
Diane Lovell reported that work is in progress and a report is forthcoming at a future meeting.
Future Agenda Items
Lydia Lissman referred to Bdattach.4 and outlined the schedule of 2008 Board meeting agenda items.  
EAP Return on Investment
Lydia Lissman referred to Bdattach.5 and explained it is provided as information only.
Rich Peppers suggested that the Board consider a POP for alcohol and substance abuse, in addition to tobacco cessation.
Diane Lovell stated that Board leadership will discuss how this suggestion can be incorporated into future Board work.
Wellness Conference
Lydia Lissman referred to Bdattach and explained that for the past three years, the Department of Human Services’ (DHS) Public Health Division has sponsored the annual Healthy Worksite Initiative conference to provide worksite coordinators with additional training. This year’s conference, held in February, was co-sponsored by PEBB and DHS and was attended by approximately 80 coordinators and managers representing 35 different agencies, as well as Board member Paul McKenna.
Health Survey Results
Lydia Lissman introduced Jane Moore, Manager of the Health Promotion and Chronic Disease Prevention Program in the Department of Human Services Health Division. She expressed her gratitude to Jane and her staff for their time and effort in preparing today’s presentation. This preliminary report was prepared for PEBB in advance of the document for public distribution, so that the Board could review the data in time for preparation of its POPs and renewal considerations.
Jane Moore referred to Bdattach.7 and presented highlights of a comparison of Oregon state government employee respondents surveyed in 2005 and 2007 with full-time employees who responded to the 2005 and 2007 Oregon Statewide Behavioral Risk Factor Surveillance System (BRFSS). She explained that today’s presentation represents two sets of data from three different groups, and includes a small sample of the overall results. She provided a brief outline of the data on demographics, prevention, chronic disease, confidence in self-management activities, absenteeism and presenteeism.
Regence Disease Management Programs
Dr. Ralph Prows, Senior Medical Director for Regence BlueCross BlueShield of Oregon distributed a handout, which outlined Regence’s Disease Management Programs. He provided an overview of the internal Regence Chronic Disease Management Program as well as the AdviCare Disease Management Program currently purchased by PEBB.
Within a sample population of 50,000 surveyed by telephone, PEBB’s AdviCare Disease Management Program rated 81 percent good-excellent for the overall program. Dr. Prows reviewed the outcomes of AdviCare from 2006 and the second quarter of 2007 utilization measures. Both years indicate a decrease in utilization. He continued with a side-by-side comparison of Regence’s Disease Management and the AdviCare Programs, including the philosophies, outcome measures, member identification and risk scoring of gap analysis, conditions, and returns on investment.
Diane Lovell expressed her appreciation to Dr. Prows for his presentation.
2009-2011 Policy Option Packages (POPs)
Lydia Lissman referred to Bdattach.8 and outlined PEBB’s two draft POPs for the 2009-2011 agency request budget. PEBB is requesting limitation only. She explained that POP #1 relates to PEBB Infrastructure, and POP #2 relates to Board Vision Priorities. 
POP 2: Board Vision Priorities for 2009-2011
  • Medical Home Work Group
Rocky King moved to approve $90,000 for primary care Health Information Technology (HIT) expansion.
Peter Callero seconded the motion.
Diane Lovell expressed her concern that the Board isn’t funding more toward the implementation. She is hopeful that this POP will not be the end of the collaborative work toward this end.
  • Hearing no further discussion, the motion passed unanimously.
Rocky King moved to approve $200,000 to support statewide primary care reform efforts.
Sue Nelson seconded the motion.
Peter Callero suggested that the Board use caution when considering an amount. It’s difficult to know how much funding to apply to this effort, as the results of pilots (such as Regence’s) are not yet available.
Diane Lovell commented that PEBB cannot do this alone and strongly suggested putting funds into collaboration with others.
Rich Peppers commented that he would support requesting a later timeline for a decision if the Board so wishes.
Bret West explained the process involved with doing so.
Rocky King amended his motion to approve up to $5.2 million to combine supporting statewide primary care reform efforts and the planning and implementation of medical home.
Bret West seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
  • Wellness Work Group
Rich Peppers moved to approve $9,000,000 for PEBB member incentives.
Rocky King seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Rocky King moved to approve $500,000 for a Wellness Infrastructure improvement project.
Peter Callero seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Current PEBB 2007-09 POP 303 Funds
Rocky King moved to accept the following stabilization fund expenditures from POP 303 for the 2007-09 biennium:
(Estimated current budget authority $126,000)

  •  Pilot program for healthy cafeteria choices
  •  Display cases for wellness messaging/PEBB communications      
  •  Pedometers and walking program for PEBB members                  
  •  DAS tobacco free work force funding for signage    
  •  Wellness grant funding    

Evidence Based Plan Design
Estimated current
Evidence Based Plan Design
Estimated current budget authority $400,000)

  •  Wellness incentive infrastructure 
  •  Employee engagement communications 

**does not include staff to administer communications
Employee Survey
(Estimated current budget authority $80,000)
Possibilities include: Garnering member input on health issues related to the 2007 Public Health survey; and develop ways to increase member response rate for survey.     
Bret West seconded the motion.
  • Hearing no further discussion, the motion passed unanimously.
Retiree Plan Options
Wendy Edwards referred to Bdattach.9 and explained that the Board requested information on benefit plan design and pricing for a high deductible health plan option for pre-65 retirees. She outlined the findings of Mercer’s analysis.
Lydia Lissman stated that if the Board decided to approve this as the retiree plan for 2009, PEBB would require additional rate information from the plans.
The Board decided to postpone consideration of this until the fall of 2008.
Self-Insurance Infrastructure
This agenda item postponed until the April meeting.