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Public Employees' Benefit Board Meeting Minutes, November 18, 2008
 
Public Employees' Benefit Board
Meeting Minutes, Nov. 18, 2008
Public Employees’ Benefit Board
Tuesday, Nov. 18, 2008
8:30 to 12:30 p.m.
Oregon Department of Forestry
Building D/Santiam Room
2600 State Street
Salem, Oregon
Approved December 16, 2008

Board Members Present
Sue Nelson, Chair
Rich Peppers, Vice-Chair
Peter Callero
Rocky King
Diane Lovell
Jeanene Smith
Paul McKenna
Bret West
PEBB Staff Present
Bobbie Barott 
Wendy Edwards
Ingrid Norberg
Lydia Lissman
Margaret Smith-Isa
Consultants Present
Mikel Gray, Mercer
 
Guests Present
Dallas Weyand,
Legislative Fiscal Office
 
Agenda
Introduction and Context for the Day
Planning Work
Closure/Next Steps
Public Comment
Introduction and Context for the Day
Chair Sue Nelson called the meeting to order. She introduced Kevin Boyle, the facilitator for the annual Board planning meeting; summarized the key priorities established at the previous year’s planning meeting (Bdattach1); recapped accomplishments to date; and discussed the goals for this meeting. Sue asked the Board members to focus today’s discussions on the "what", remembering the resources necessary for self-insurance and work beginning in early 2009.
 
Rich Pepper noted that the future RFP for medical self-insurance is a way to push forward priority goals and make further advances on the Board priorities.
 
Kevin Boyle commented that he first worked with the Board in 2001. He expressed that the maturity of the Board, dynamics and depth of issues is significant. Today the Board will continue to build on what they have done, including the Vision and strategic priorities from 2008. He emphasized the goal of focusing on the "what" while defining specific three year outcomes. How the outcomes will be achieved will be explored at a future date.
 
He distributed a one page diagram (Trends and Forces handout) and asked the Board members to discuss what each viewed as the trends and forces that could impact PEBB. Board members individually contributed the following:
 
Trends and Forces within PEBB Environment to 2011
 
 Trends
 
Forces
  • Educate members on necessary changes
  • Rising medical inflation
  • Use of electronic medical records
  • Cost shifting or sharing
  • Rising chronic diseases (obesity, diabetes etc.)
  • Affordability for health care
  • Provider capacity---# of doctors available
  • Employee contribution
  • Rising age of docs and nurses
  • Evidence based plan design
  • Focus of medical community on wellness and prevention
  • Fiscal crisis=fewer retirees
  • PEBB members are more aware of medical trends
  • Data based medicine and care
  • ODPD carve outs
  • As citizens are challenged on health care, the public are expected to contribute
  • Change in member demographics
  • Prescription purchasing power
  • Member push back on changes in plan

  • Local government health care purchasing pool
  • Severe budget constraints
  • Legislature in session
  • OEBB
  • Health care reform—nationally
  • State health care reform
  • Self funding for PEBB
  • ODPD—common language integration vs. segregation
  • Tier—holes in carrier coverage
  • "Leaky faucet" costs
  • Our impact on Evidence based plan design and medical home is a step out ahead
 
Planning Work
The Board reviewed the 2007 priorities, the trends and forces, and the 2nd and 3rd tiers of priorities to continue refining the priorities moving into 2009 through 2011. The Board reaffirmed commitment to PEBB’s four key priorities established in 2007:
  • Evidence-Based Plan Design
  • Medical Home
  • Wellness
  • Communications
The Board brainstormed a list of 2011 strategic priorities:
  • Chronic care prevention management
  • Alignment with Oregon Health Fund Board recommendations
    • Tie in with key Board priorities
  • Leverage of OEBB and PEBB power (negotiations)
  • Self-funding insurance
  • Payment reform (providers)
The Board then engaged in a facilitated discussion to identify key strategies PEBB will pursue to further the four key priorities (evidence based plan design, medical home, wellness and communications) over the next 3-year period. The self funding structure was identified as a major focus in the coming year.
The Board agreed that the overarching strategy for PEBB is based on evidence in the medical field and defined these as outcomes versus actions.
The Board brainstormed a list of potential strategies and possible outcomes:
 
Evidence-Based Plan Design:
Implement a set number of evidence based plan design components based on mining utilization data with emphasis on chronic care and prevention and maintenance.
  • Possible outcomes: Improvement in health of PEBB members around top chronic diseases and cost-savings for funding initiatives of plan design changes.
Patient Centered Coordinated Care (Medical Home)
The Board had an in depth discussion about whether the term "medical home" described this priority or if "patient centered coordinated care" better defined the Board priority. There was agreement that regardless of the term used, the PEBB communication needs to assist members in understanding what patient centered coordinated care includes. The Board agreed to use the term patient centered coordinated care for this priority.
 
Develop a set number of tools for promotion of patient centered coordinated care and electronic medical records.
  • Possible outcomes: Number of patient centered coordinated care sites serving PEBB members that have electronic medical records.
Initiate and partner to further learning collaboratives among provider groups.
  • Possible outcomes: More care coordination across the PEBB population and improved health outcomes for members.
Member Wellness
Continue to advance and expand current member wellness initiatives and align with the Governor’s health initiative.
  • Possible outcomes: Connect the BRFFS survey to have a focus area on wellness and chronic disease.
Communications
Use every available vehicle to communicate the programs of PEBB.
  • Research future electronic methods to communicate PEBB programs and information. The Board asked that PEBB staff look into getting university level student interns to assist PEBB communications in the creation of video clips.
    • Possible outcomes: Effective videos for greater member awareness.
Payment Reform
The Board discussed payment reform and potential opportunities with self funding to pay differently to encourage medical home pilots, electronic medical records and wellness.
Identify opportunities for payment reform.
  • Possible outcomes: Pilots with plans’ existing providers on payment reform. Leverage self funding for payment reform.
Self Insurance
The Board discussed self insurance as the systemic process change to PEBB and recognized this requires enormous energy in 2009 to establish for plan year 2011. The following are the key questions the Board identified that need to be answered as PEBB moves forward to expand self insuring medical.
  • How do we communicate well on why we are moving to self funding? Fear of misunderstanding or of seizing PEBB funds.
  • Do we have appropriate level of expertise in house and in the consultants? The right knowledge and the right number of staff?
  • Are we clear on where we are going?
  • How do we get there?
  • Is there risk of losing PEBB Vision?
  • What are our contingencies and risks down the road?
  • What are the benefits of self funding?
  • Articulate the benefits.
  • How will the Board create quality time to manage transition?
  • How do we use Board time in an optimum manner?
  • How does the Board control the PEBB member expectations? (lower cost)
  • Do we have the support of the Legislature?
  • What are the members/others expectations for self-funding?
Closure/Next steps
The following actions were identified as next steps:
  • Staff to explore an alternative to the word "patient" in the Vision statement and provide this for the Board’s consideration at the December or January Board meeting.
  • Staff to include the self funding questions with draft responses for Board discussion at a future Board meeting.
  • Staff to send the summary of the 2008 accomplishments to the Board
  • Staff and Board to develop communication information about self funding.
Public Comment
Dallas Weyand, Legislative Fiscal Office, provided the following comment:
"The Board is far more cohesive than it used to be, but I think it is kind of one sided. It is not representative of both sides of the equation and that is why things are cohesive. I think you’re heavily oriented towards taking care of the members and not as concerned, if you will, with the payer of the freight, the employer. And, that will probably change, if and when, at least within the State, it becomes a shared cost arrangement. It will get right to your point, Rocky. And, I agree with you 100% on the tier rating system. I think it is, where as a single person pays far less than any other. And, I think that would change the dynamics, if that were to happen, because all of a sudden the contributions would change where the constituencies lie and that created a little bit of the tension. That is why I alluded to the fit of the PERS Board and the change in composition, particularly if you go to the self-funding. They are to take sole responsibility for all the dollars and stays on the hook for the deficit. And that to me may require a different skill set for the Board."
Meeting Adjourn