06-07-07 Chapter 172 Employee Retiree Insurance and Benefits Board Meeting

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Disease IMedical Management: Essentially what we are talking about here is how good of a job can this firm do in helping our folks with chronic and serious illness management of their care? We can't do that as plan sponsors; we can know about an individual's circumstance and try to be an advocate from an HR standpoint. But we certainly depend upon the folks who administer these plans to be our advocate in these kinds of situations. Certainly there are some subjective issues related to Disease Management and Medical Management because we are talking about human beings talking to human beings. It is kind of the opposite of auto adjudicating a claim. Here we are really talking about reaching out to the employee or retiree and saying, "hey I understand you are dealing with this particular medical issue, what can we do to help?" So, there is a little bit more subjective component to Disease and Medical Management but that is how we help not only manage the cost of the plan but also provide the benefit that has some meaning to the plan participants. Preferred Provider Networks: The Doctors that participate in their particular networks. In our plan 98% of claims paid are paid in network Therefore, we are very interested in providing as many good providers of service in all specific disciplines. We want to make sure that not only do we have the best Doctors, but Doctors that are convenient to our plan participants. You will see information including zip codes that are where our active and retiree participants live. Pharmacy Benefit Management: This is the PBM. What we are looking for there is the right pricing on Drugs. We are also looking to see what tier some of those drugs are in so we can compare with our co-pays. We look at their capabilities for mail order, administration, special programs, step therapy, and high cost of injected drugs. There are all sorts of pieces of that economic pie that we want to preview and select accordingly. Question Karen Beerman: Do you have the capability of going in and extracting our employees and plan participants to see what prescriptions and medications that are most often prescribed? Answer Neal Welch: In a group your size almost everything that is in an RFP will be unique to your group. This includes your zip code, your drugs, your healthcare expenses, your chronic illnesses. Wellness Programs: We spend a lot of time concentrating on the 20% of the people that constitutes 80% of the expense. But we also want to do something for the 80% of the people that constitute 20% of the cost. So, we want to know what kind of programs and I will not call them just Wellness, there are health awareness programs.