Travis County Commssioners Court
January 27, 2004
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 14
Item 14-a is receive and take appropriate action on hospital and insurance fund annual report for fiscal year 2003 and 14-b, approve payroll stuffer for wellness fest valuing.
>> good morning, alicia perez , we're here to give our annual report for the close of f.y. 2003. The report covers the full year and provides data for the employee health care fund for f.y. '03. I would like to go ahead and start the report and I know you have another presentation coming up so we'll be brief. I would ask you to look at your backup and we'll start with page 1 in terms of indiduals we had participating as part of our health care program. And the total batch of employees was 3 -- gnawed. We had cobra 328 retirees, and we had 2,962 dependents for a total of 6,887. That compares with the f.y. '04, nell active about 22. And that is as of open enrollment and mostly we had less dependents that are on our health care plan, but we had almost 7,000 lives on our health care plan in f.y. '03. Travis County completed its second year of self-funding for health benefits. Individual claims up to 125,000 are paid by the health plan. Anything over 125,000 we have stop loss insurance. In f.y. '03 we had seven claims that hit the stop loss or claims that went over $125,000. This last year we did see our claims go over what was budgeted in that year so we saw a couple of transfers into the health care fund from the general fund and also from the risk management fund. The transfers from other funds into the health care fund totaled $2,765,944 in f.y. '03. If you remember, that was -- came in about April and we took steps not only in f.y. '03 to supplement the fund, but also in f.y. '04 in changes and plans to try to diminish the impact of the high cost of health care claims. The court and several of the court members asked for information on the -- those types of health care claims that hit the 50,000. You also asked for additional information, and cindy, do you want to pass those charts out? And we've got -- cindy is going to pass just one chart out right now and then we'll go to the ones that were distributed earlier. But we looked at the health care claims in f.y. '03. As I said, we had seven claims over 125,000. The types of illnesses were cancer, infections, heart disease, leukemia, diabetes-related I will innocence, and respiratory failure and pulmonary disease made up that group of claims. We had 10 claimants over $100,000 for a total of about 1.1 million. We had 32 claimants over 50,000, and that is of the 6600 or so people that we -- I'm sorry, 6,800 people. 32 of those individuals went over 50,000 in individual claims.
>> that number includes the seven and ten above it, right?
>> no.
>> no.
>> so over $50,000 would be 32 plus 10 plus 7?
>> yes. So the 32 represents between over 50,000 and less than 100,000.
>> yes. Less than 125.
>> the 7 and the 10 --
>> I see what you are saying. Yes, sir, that's correct.
>> okay.
>> you also asked us to take a look at the percentage or the claims that went over what you -- what the county and the individual would pay in premiums, or this is what the county pays. And we had 742 claimants over 6,204. The remainder and the majority of the claims were less than that. So what you have is a large percentage if we took the ones that are over 50,000, about 20% of the people on your health care plan, using the majority or -- of the funds. Or 20%, I guess.
>> taken significance of the 6204 is in terms of taking the amount that the Commissioners court kind of banks per employee in terms of what we think it ought to cover, we had 743 people just in that one chunk that the amount of claims that we had to pay exceeded what we were banking on their behalf.
>> that's correct.
>> and we add 7, 17 --
>> 792 all together.
>> and the remainder are -- they are way off the charts. Related to how much was banked on their pwafplt if people are asking why is it costing so much, well, the 36%, you are staying at or below what we're banking. But there's still a chunk of our workforce that has some pretty serious and pretty expensive things that are ailing them or their families.
>> yes. Correct.
>> if I wanted to know what my total insurance costs were for '03, would I be able to call you and get it?
>> you could call me and get it.
>> that's available to any employee?
>> yes.
>> so if you are wondering whether to join the county wellness program or whether there's a need, one way to make that determination would be to figure out whether you are benefit or liability in terms of [indiscernible].
>> I could also get on my u.h.c. And look it up.
>> that's on the internet.
>> or they could ask me to run a report.
>> and you have access to that information, as we said, over the internet. You can look at -- I mean detailed information in terms of your physical costs and also your pharmaceutical costs.
>> only for my information, not for yours.
>> that's correct. Absolutely.
>> okay.
>> there was a question that came up related to claims and I think I remember it related to retirees, but could you please refresh my memory related to plus one? And it had to do with the issue of whether the plus one or a retiree is over 65, and therefore has medicare benefits. Is our insurance primary insurance or is it secondary related to somebody, be it a retiree or plus one or family member who is over 65?
>> cindy.
>> if our retiree, let's say our retiree is over 65, but they may have a spouse that's under 65, then medicare would be primary on them, and of course then since the spouse was not 65, we would also be primary. If you flip it and have maybe the spouse over 65, but the -- our employee under 65, it goes by what the employee's coverage is. So they would still be active. We also have some domestic partners that are parents, and if you are a dependent of an active employee, then you -- the county plan is primary.
>> we want to make sure that's clear, if the person is over 65 but an active employee, then the plan is primary. It's once they go into retirement and are no longer an employee that medicare becomes primary and we become secondary.
>> let me make sure that I'm asking the question properly. If you have a plus one, say my mother lived with me, she doesn't, but let's just say my mother who is over 65 lived with me. Is the county insurance going to be primary on her or secondary given medicare?
>> primary.
>> why would we be taking on expenses that the feds are willing to cover and that we wouldn't be filling in the gaps, which of course the biggie is --
>> that's according to primary rules actually -- I mean to medicare rules. It's all set out in the industry. There's an industry standard of who goes first and who goes second.
>> okay.
>> and we are in compliance with those standards. Medicare has stated that if you are a dependent of an active employee and covered under that insurance, then you are also considered as an active employee, you know.
>> so it's in accordance -- the feds are telling us --
>> they have one standard so our plan works well.
>> thank you. That helps tremendously.
>> refer to you page 6 of the report. If f.y. '03 original budget for claims was 18,855,000 plus. We ended up with claims, we added the 2.7 million to the budget, and that increased it to the 21.6, approximately. Total claims incurred through the end of September of last year was 22, a little bit over 22 million. We have stop loss, as we mentioned before, and we had high claims also. In terms of our incurred but not reported reserve, that is something that the actuary comes in and provides us information on each year. And he says you've paid so many claims, but we expect there are claims out there that you have not paid. They have been incurred but not reported. The actuary came in for f.y. '03 and said that the approximate amount of money that we needed was about 2.9 million in ibnr. We had booked almost 3.5 million, again being conservative with that particular number as we had some surprises in the past. We have the financials there also provided starting on page 8, and those give you detailed information on the state of the fund for f.y. '03. I'll go to the charts which provide the information on the use of theservices and either dan or cindy, do you want to start on page 21.
>>
>> [one moment, please, for change in captioners]
>>
>> next page, page 23, basically a comparison of active versus retirees and cobra. So it tells us who we are spending our money on. And again 69% is the active medical. 17% is the pharmacy, retirees are doing 13% of the cost. And then cobra is basically one percent. The cobra is what you go on when you leave the county, you have the option of continuing your insurance. If you pay the entire cost, usually for up to 18 months. On the next page, page 24, we are comparing the plans. We are comparing the epo to the ppo. Show you the breakout there. The epo medical expense was 69%, the epo pharmacy was 17%. The ppo then took up the other 15% of the cost. I think that we'll see a difference in this particular graph this upcoming year because we have more people on the ppo. And then the -- on page 25 you it's the type of service. What types of services are we spending our money on, how do they compare to each other. The one that we are spending the most money on, of course, is facility in-operator. It's showing to be about 20% of the overall cost, I guess position is also a large chunk, so the doctors in the hospitals, that's to be expected. Facility outpatient it's 15%, miscellaneous, allied health, includes your chiropractors, chemotherapy, the lab, other assorted sundry type of items. And then the next two pages are merely some of the data that shows how it goes from month to month. Then we did comparison charts, the fy '02 to the fy '03. On page 28 you will notice that the blue is the medical. And the red is the pharmacy. The top bar, the longer bar is fy '03 and the bottom bar is ty '02 -- fy '02. You can see the increase in two costs between the two plan years. The difference is $7 million.
>> was there much of a difference in terms of the number of participants in the plan this year versus the previous year? How much of that do we attribute to the --
>> we did have an increase, how much was it?
>> yes, we did.
>> let us get you that information, the '04 comparison, and the '02.
>> there was an increase and it -- it was significant but I don't think that it was overwhelming.
>> okay.
>> but we will come back with a number.
>> okay. Certainly if we have more people taking the coverage.
>> it makes sense.
>> even if we are just doing the normal stuff, that number is going to be bigger simply because the population has grown.
>> right.
>> page 29 is comparison of fy '03 - -- fy 2003-2003 of active claim costs broken out by pharmacy and medical. Again, red is fy '03 and blue is 2003 '02. -- blue is '02. You will see there wasn't much difference on the pharmacy, the pharmacy increased a little bit. So it was -- you know, holding a little bit more steady. But there was an increase in the medical costs. The next page is one of the most interesting graphs that we did on page 30. This is the retiree claims cost. We broke it out like this because you know we are looking at the whole retiree issue right now. When we saw that large spike, we drilled down into our data to determine what that was. Our first thought was that it might be stop loss claims. But it was not stop loss claims. That large spike has -- is accounted for in almost its entirety by seven retirees. It counted for $528,000 worth of the claims, yet none of them actually reached the $125,000 stop loss threshold. So they were underneath the -- the stop loss threshold. But we thought it was very interesting to see how that spiked out like that. And that was on the epo retiree age less than 65. On the next page, 30 -- we are to the budget page then.
>> on 31 you have the budget that provides the information on fy '03 actual. And the comparison to fy '04. If you look at the bottom of the page, first call them an actual, ending fund balance for fy '03 is $929,000 plus. More than -- a little bit more than what we had anticipated and at this point in time, our projection for next year would be about a 755,000 as an ending fund balance. But that's given that the claims come in as they were projected and also the revenues and the premiums come in. I do want to mention to the court that we audit all claims for eligibility, each and every claim. We audit to make sure that the individuals are eligible to receive the benefits. We also have been auditing the claims over $8,000. We received information from uhc that they would send us information only on those claims over $25,000. I believe that we are in agreement with that because it has not been significant number of claims between the 8 and the 20 -- the 25. We have more experience now and we are okay with them increasing that amount from 8,000 to 25,000 for audits. Answer any information, any questions that you may have?
>> I guess my question would be -- I guess I understand [papers shuffling - audio interference] over 25,000. What information did we contract to receive?
>> actually, actually, the $8,000 threshold was on notification before a check is released to pay claims that reaches $8,000. We still receive information to audit on every claim. So what it -- what we are asking the court to do is to approve the increasing the threshold for notification. In other words, uhc would call us on every chamber of commerce that they are going to pay until the $25,000 before that check is released. That puts us on notice so we can do some things in the background, but they do go ahead and release that check. We would continue to audit claims. It's not -- it's not a fact that we are not -- that we are though the going to audit claims under $25,000. It's just that the notification from uhc would be at the 25,000 [indiscernible] instead of the 8,000.
>> I assume when we audit we audit for accuracy. What do we look at?
>> we look at the -- beginning with the eligibility. We look at the type of claim, the amount paid, paid according to plan -- the plan summary information, and in other words is it something that should be cover order something that should be denied. Is it paid at the correct rate? Or is it deductibles and co-payments apply, things of that nature. Actually, the two people that do the audit on a day to day basis are norman and cindy and they can give you more detail on how they approach that.
>> currently, all claims are audited for eligibility. In other words, they are a member of our plan and they are eligible to have their claims paid. It's when we get to the higher threshold that we go into a deeper audit of the actual claim itself and what it was for and all of the details and cindy is the one who conducts those types of audits.
>> what we do currently is every claim over 125 is automatically on my audit list. We do -- right now all claims, 8,000 and above, which includes tonsilectomies, includes everything, you can't hardly be admitted to the hospital for under $8,000 now. We also do a 15% random audit every week. We base these on the banking information that they send us every Friday letting us know what the check run was that week. So that is limited information we have to work with. But then we also can do a deeper audit, we pick out various different one that's I want to look at deeper, we do a deeper audit as we go along. So in the two years that I have been auditing this, I have not found any pattern of missed payment or any pattern of thinking that would really give me cause for concern. You have some that maybe they need to go back and do adjustments on or when we look at it, just like maybe the cob with the medicare dependent issue, that they have to go back and manually intervene and make sure. Because a lot of our claims go through, our -- our -- are paid through electronic claims submission. So a real person doesn't necessarily look at them, if it comes through and goes through with all of the appropriate points hitting. So sometimes on those we go back, they are very good about doing any adjustments. Sometimes they contact us and tell us that they found things they adjust to, but I haven't seen a pattern of anything that would give me concern.
>> one of the audit -- as an example, what we look for is -- we are dependence eligible, and the court may recall that we determine that there was a claim paid on the individual who was not an eligible dependent. That's the type of audit that we do to catch those and be able to cover funds wherever we can do so.
>> okay.
>> any questions regarding 14 a? Annual report?
>> so on the tech piece, do we need to physically make a motion related to the threshold or is that something that will come up, barbara, in our annual contract renewal with uhc? When is the appropriate time to do that?
>> if I remember correctly, that was -- [indiscernible] [inaudible - no mic]
>> okay. So we have already done that.
>> yes, I can go back and check on it.
>> okay.
>> increasing it, it's increased. Past tense. Okay.
>> b?
>> yes, sir. You have a flier that we put together to send to all Travis County employees. And this is concerning the Travis County employee health care festival. This will be our kickoff for our wellness program. It will be one of several that we will be taking on the road to various locations. This particular health care will be on Thursday, February the 12th, in the granger building and will start at 10:00 to 4:00 p.m. We encourage all employees to come out and join us. We will have lions club screening n that will provide a screening on glaucoma, diabetes, blood pressure, and visual acuity and that's a mobile van and we will have employees from Travis County, also, volunteering. But you have medical professionals that will be administering the test. We want them to sign up for enrollment in the pilot projects. Walking challenges, weight training and to also provide information on things that the individual employees are doing to improve their wellness.
>> alicia, a quick question on the lions club. Is that free screening or are those low cost screenings?
>> no. Those are free.
>> they are free.
>> I would put some kind of little thing, free, because people might be confused and be hesitant and not ask.
>> they get immediate feedback. The results of their tests, too. As they leave the van snield play up free.
>> we will do that. We also have speakers and a lot of tiflts at the -- of activities at the festival, we will have massage, also speakers on diabetes, cardiovascular disease, all being free. The speakers are free, in fact we have a couple of individuals coming in just to do next massage, also, free of charge. If you look at the back we have the wellness program, pilot programs, walking program. Several volunteers, employees, including myself and a couple of others have volunteered to do walking programs at different times with -- with employees. I have done it kind of motivated for me also to meet a group of people and -- we will walk about two miles. But they will be different distances. We are also looking for additional volunteers that would like to lead walking groups and make that commitment for about a two to three month period. They can call lee mccormick at 854-9586 to volunteer. We have a pilot program, also, for the prevention and management of cardiovascular disease and diabetes, that has a six week curriculum. We will also have lee mccormick who was our safety engineer, a professional certified trainer, providing classes and support for individuals who want to work out and be physically fit, plus attending the classes on different topics that have to do with cardiovascular and diabetes. And we have prevention and control of -- as lung disease and smoking cessation and again a six weeks curriculum of classes and the services of a -- of a certified professional trainer. And we encourage employees to come out and sign up for these programs. Our last pilot program is on weight loss. This particular program is with Austin diagnostic clinic. And it is -- has a clinical approach for individuals who need to lose 30 pounds or more due to a chronic health care condition. Our health care plan does pay for weight loss program, this particular weight loss program if it is tied to a particular disease, chronic disease, such as diabetes or high blood pressure, cardiovascular disease. It does not pay for the but it e of many programs that we have -- that we will have and sponsor for individuals who want to lose weight. Including classes by nutritionists and a physical activity program. So we -- we invite all employees to come out and that's February the 12th, that's on a Thursday, to the granger building, 10:00 to 4:00 p.m. We understand this is in the downtown campus but we will also be taking these sorts of activities to the individual sites throughout Travis County.
>> I move approval.
>> second.
>> discussion?
>> sorry. Under pilot project number 3, we use the word "loose" "lose" spelled loose. Spell check won't pick it up.
>> I have to highlight that. [laughter]
>> proof of employment. What is proof of employment of Travis County?
>> what did we have in mind for proof employment?
>> any form of employee i.d. Or pay stub, anything to show that you are a Travis County employee. We are --
>> you are your health care -- your health care card, medical card, that would be one of the proof of employment.
>> [indiscernible] health insurance card or --
>> checks.
>> employee i.d. Employee i.d. Or check stub.
>> uh-huh.
>> good idea. Any more discussion? All in favor? That passes by unanimous vote. Thank you all very much.
>> thank you.
Last Modified: TUesday, January 28, 2004 6:44 AM