Travis County Commssioners Court
May 25, 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 11
11. Discuss and take appropriate action on second quarter report of the Travis County self-funded health program.
>> executive manager for administrative operations, we are here to present the -- the second quarterly report of the Travis County self funded health and hospital fund. We present this report in accordance with the requirements of chapter 17, this is a chapter that created the hospital and insurance fund. We presented the same report to the employee benefits committee and for you to the Commissioners court. The second quarterly report will provide a status of experience of the program. Including financial status of the fund and this will fulfill the requirement that -- that is set by Travis County code. This reporting period covers both the first and second quarter of the health care plan, covers the period from October the 1st, 2003, through March the 31st of 2004. We go to page 1 of the -- of the report, you see the -- the enrollment in the plan, and membership in the health benefits plan increased since open enrollment by 93 members. So from October to March owe to March 31st of '04, we increased the membership by 93. Dependents made up the largest portion of that increase in membership, with 64 dependents. We enrolled 23 additional retirees and then six were active employees. As of March 31st, the enrollment in the Travis County health care plan is 6,958. 6,958 members. Most of -- most of the members are enrolled in the e.p.o., That's our equivalent of h.m.o. And if you recall, last year we -- we had for the first time a premium in employee pay $40 a month to participate in that particular program. But we still have the highest amount of enrollees at 70% in the e.p.o., 23% of the population enrolled in the health care plan are in the e.p.o. And then are co-insured e.p.o., Which was a new plan last year, is at 7%. There have been high cost claims this year. 24 claims so far this year have resulted in payout of $50,000 or more in claims. 8 -- 8 of those claims penetrated our stop loss. We do have a stop loss of 125,000 and then [indiscernible] 2 million overall.
>> 2-point 2?
>> per month.
>> so we had eight individuals that due to medical conditions penetrated that 125,000 stop loss. At which time you would see our stop loss provider then begins to pay for those claims over 125.
>> how much does the stop loss insurance cost us?
>>
>> about 134,000 a year.
>> I take it in -- the premium for the next year, the insured looks at utilization to improve this year.
>> the history, the claim history is broader than just our experience. -- it's a nationwide comparison. It's compared to just ours, ours is not favorable, that's for sure. But it's not the increase that we expect to see won't be based just on our experience it will be based on national experience.
>> we expect to see some increase?
>> yes, sir.
>> let me make sure that I understand that. I mean, the -- our price on our stop loss will not be predicated on -- on what we exceed. I mean, it will be -- it will be predicated on a national average? If.
>> that's right. We are blended in with their national business and they base their rates on the national -- national volume of business and experience.
>> wow. We are fortunate in that regard.
>> we are fortunate.
>> I guess -- look at our experience, but then they look at the national experience.
>> well, they blend ours in with the national. So it's not looked at individually.
>> okay.
>> I wouldn't hold your breath.
>> I don't think it's going to be a reduction.
>> can you kind of walk me through, on page 4, it's not clicking with me related total changes in end -- related to the changes in enrollment between October 1st of 2003 March 31st of 2004. This is after the fiscal year has begun.
>> yes.
>> am I seeing here a reflection of people who have -- the cover makes sense because that's somebody who has quit and they decided to take on insurance. How are retirees being added, because they actually have retired.
>> yes.
>> I'm probably asking very proverbial silly question here.
>> each year we have a lot of retirees.
>> those truly are people who have retired, this is the first time they get to access, that's why the data is what it is.
>> that's correct.
>> then active employees that really would be people joining the workforce.
>> [indiscernible]
>> what I'm not understanding is where did the negative 27 come related to the co-e.p.o. I'm not getting what that is?
>> I haven't delved into the numbers that specifically to each individual one. My guess is that people who knew they were going to retire took a lower plan so they wouldn't have to pay, may not have had a lot of claims after retirement, then they could join the retirement plan.
>> okay. Just trying to figure out what that meant.
>> I'm still going to be wanting as we finish out this fiscal year to have a breakdown, since we now can get this data as to what are the claims and expendtures coming from our active employees, what are the claims and expenditures coming off of our retirees and what are the claims coming off of their plus one or children. I would like to break that out of kids versus adults.
>> we have that.
>> to really --
>> to really get down to what is driving this up. Is it our workforce is unhealthy or is it the dependents and partners, our workforce who are unhealthy.
>> let's take a -- take a look at the high cost claims for a minute. I did a little bit of an analysis on those.
>> [indiscernible] what page?
>> what page are you on.
>> there were 24 claims -- sir? We talked about high -- the claim that there's not a particular page that I'm referring to. But I can give you the -- the data. This was just some research that I took from the information. There were 24 claims that were -- so far this year, from October to the end of March that were over $50,000. There were 8 that were over 125,000. If we took a look the at average tenure, average tenure of the individuals with high cost claims, the 24 over 50,000, their average tenure was 13.4 years of service to Travis County. The high of that was a retiree that had 31 years of service. And low was someone that had 18 months, a year and a half at Travis County. In terms of the -- of the particular category, employees, retirees, we had 11 employees, four spouse, four retirees, two domestic partners, two children, and one adult parent. So employees were 11 and then the four, so about 15 of the 20 were employees and retirees, the rest were either spouse, domestic partners or children. So ...
>> the night -- the nine of them.
>> nine of them. Uh-huh.
>> huh.
>> nine represents what now?
>> nine of the 24 were other than retirees and employees.
>> okay.
>> [indiscernible]
>> and what you have to remember is that on the extra adult, they are not paying what the -- what the adult employee is paying in terms of what is being set aside there. So --
>> you'll see some recommendations from the benefits committee that will adjust that issue.
>> take a closer look at this stuff.
>> I will ask you to go to page 6 of the report.
>> when you make recommendations to us, will you also let us know what other major employers are -- [indiscernible]
>> here --
>> can I go back one more time.
>> yes, sir.
>> give me an idea comparison-wise on the 24 from October to date for what we had last year. I mean, what has been the increase? Is that something that you --
>> I don't have it right with me. We are analyzing all three claim years actually. We ended up with seven stop loss claims or seven or eight stop loss claims the first year, looks like that's going to be about our average. From claims that penetrate 125,000 are stop loss claims.
>> to date.
>> there's 8 to daylight.
>> so I mean -- 8 to date [multiple voices]
>> what we are seeing is those 8, at least five of those hit the stop loss because they were a continuous -- the illness doesn't start and stop as of 10-1, those people end up hitting again very quickly each year. What we are look knowledge at our large claimants, the majority of them have chronic ongoing conditions. They are for the going to have a miraculous recovery. It's not something that goes away.
>> right.
>> so we have analyzed diagnoses and you know their projections what was going to be. Uhc staff, the medical director came down and went over our data with us. They are in concurrence that we have chronically ill people going forward as well.
>> we talked about this a little bit this weekend, kind of a backwards question to get into. There are going to be questions related to who is going to be on this plan this year, cscd, not of our making, but the state of Texas is requiring all of those folks go off local plans --
>> that's about 253 employees.
>> that's 253 employees, changes in doctors, in ceanch, coverage, a lot of stuff. I want to make sure there is a lot of information, education, heads up, warnings, let's, -- warnings, et cetera, but it's no easy thing to change plans, doctors, whatever. I a lot of that stuff disproportionately falls on the females in the family to make those kind of decisions. We need to make sure cscd works with their employees and makes sure they understand what is fixing to happen and understand that the state of Texas is forcing them to change coverage.
>> I spoke with rosy last week and sent jim rust an e-mail, there is a meeting scheduled to try to ease that transition of those employees. Also, we gave the new numbers to the actuaries, so the numbers that you had before have gone down because of the 253 employees and we have a better count of the employees that are in fact on the plan as of March the 31st.
>> okay.
>> the courtesy of the state, the cost of the --
>> I think we were reimbursed for the county's portion.
>> I'm not sure how that worked.
>> that's a state program. So they would have of course paid for it, they were on our plan as part of, as county employees under our health insurance plan. Now they won't be on the county's health insurance plan. Starting September they will be on the state's health insurance plan.
>> I think what they did judge was reimburse our portion, I will double check on that.
>> the question is whether they reimbursed us 100%. The second question is whether we expect a positive or negative impact of losing 253.
>> the other part of that is if they are going to be going on, because there is a radical change in the kind of coverage, whether we are going to see a rush to get certain things done under our plan while it is still covered before it switches over to the state plan which may not be as -- as rich.
>> yes.
>> if -- there's always a possibility. If you look on page 6, what you have there is the contributions, the actual contributions from the county at -- that first table, shows the county portion of employees, the county portion of retirees, employee portion, retiree portion, which are the premiums, cobra portion and then the total that has been collected through March the 31st. Under claims, you also have the -- the category of claims and in this year we have claims, total claims incurred as of March the 31st of 10,927,893. That's a difference of about 3.8 million from contributions to claims. We also have on page 7, if you remember, we had much discussion last year about the id and r occurred but not reported claims. One of the big hits was the ib and r of over 1.6 million in the one year time period. This year, we have $3,474,306 in ib and r. That is kept all -- off the books. It is a reserve that is not -- it is like an unaloe indicated reserve. We can't really go into it. That stays there until the end of the program to cover any claims that may come in at the end of the program. And this amount is a -- an amount that we believe will not increase very much for next year. So that's good news because if you remember last year that was part of the big increase. And we have talked to the actuary and I think he projected between 3.2 and 3.6 million that was needed. So we are not talking about a large increase for next year.
>> alicia, how do -- how does it work? I guess what I'm trying to figure out here, that says at the end of the fiscal year. October 30. And of course claims of course aren't just going to stop at the end of the fiscal year. They have started prior to the end of the fiscal year and then lapsed over into the new fiscal year. Where is that money coming from to address those claims that was in the previous fiscal year?
>> if --
>> not capped in this reserve right here.
>> no, sir.
>> where is that money coming from?
>> this particular reserve is for claims that go through all fiscal years, from year 1, 1, 3, 4, 5 -- 1, 2, 3, 4, 5, there are a certain amount of claims that are actuarially assessed that are out there, but not reported. They have been incurred but the doctor hasn't sent them in, the hospital hasn't sent them in, you have a certain percentage every year. This is your unallocated reserve. Runs through the very end of the program, you keep it until you make sure that all claims are paid.
>> [indiscernible]
>> right.
>> pays for your runout. On claims that we have, say that the person goes to the doctor in September, but we don't get the -- the bill until October.
>> right.
>> we pay for the bill in October. It's incurred in September, but paid for in October. So it's part of our budget as it is incurred. That's why there's a difference between incurred claim --
>> the ib around r is set aside -- aib and r is set aside, we decide we are going to become fully insured again, that money is set as a reserve to pay out claims that come in after the program ends when there are no premiums coming in to pay runoff claims.
>> okay. That makes it clearer [multiple voices]
>> exactly.
>> it's just an estimate.
>> exactly.
>> from again national standards and the actuarial will give you, say that you need to put that aside for claims coming in. The detailed financials are included. Let me just give you some highlights from those. The detailed financial statement as of March 31st reflects a reserve of 2.675 million, so that 2.7 million from fy '04 contributions over planned costs. So we have reserve now --
>> so there's one other follow-up information. Dan, we had a great deal of discussion when we switched to united about the availability of doctors. How big was the network, how many of them were taking new patients, blah blah blah. We made some very good effort to try to get more people within the network. Since that time, the city of Austin and I think Williamson county have also joined united health care. I would like to know how many more doctors have been added to the network to take care of what are a whole lot of other live bodies that are also competing for doctor time. Because my concern is that we were already concerned when it was just us. That the network would be wide enough to take care of all of our employees. And I would like to get a report from united as to what changes have now occurred with them adding on some very large governmental contracts that create a whole lot more competition. That really, it's getting into how many more doctors, how many of them are adding new patients. Because we still need to keep a very close watch on that. Especially on the geographic mix because if you are adding a whole lot of new doctors and -- and -- in the 183 corridor, that doesn't do a whole lot for somebody living down in oak hill. Really just doesn't. Vice versa, putting doctors down in oak hill when everybody is living out in Pflugerville. So if you could get some follow-up information from united about where are their doctors, where are they located, where are they adding more doctors and whether we are satisfied with the answers that we are getting.
>> alicia asked us to run a study similar to that, we expect to get the information back on June 3rd. We will be glad to share it with the court.
>> that's super, thanks, dan.
>> if we look at where we are right now, compared to last year, last year at this very same time we had spent 54% of the budget. This year we have spent 41% of the budget. Which -- which we anticipate is very good news. We have asked the actuary as was directed by the court on a monthly basis to look at our trend and the claims to see if there's anything that we could expect. That would be -- that would change that dramatically for the rest of the year. The answer has come back no. We expect to stay -- excuse me, within budget this year and in fact have a reserve. In -- if we return to page 11 --
>> in that comparison, does that include the pipeline or just the payout?
>> incurred and paid and then the trend. What we are incurring and paying for the first half of the year.
>> okay.
>> so both.
>> something just occurred to me, the state's budget is September 1, not October 1, correct? Did we figure into our projections the loss of those 253 folks and their claims, et cetera, that that would be happening a month before our fiscal year ends?
>> I don't think that would --
>> both on the revenue side in terms what was contributions and on the expenditure side in terms of what those folks might be expending, because there's an awful lot of stuff that happens in the end of the year, getting their flexible spending accounts -- we can do that, answer that, barbara.
>> [indiscernible] I do not know that e.r.s. Will be honoring that part of the law, because I would be told by their general counsel --
>> ers.
>> employees retirement system, the people who administer the state plan.
>> thank you.
>> but -- but there is a possibility that they may not leave us until October 1st. I don't know how that's going to fall out.
>> the question also is to make sure if they don't leave until October 1 their money continues to flow during that last 30 days, not that the state of Texas would ever try to shift anything on to county government.
>> might be confused about things occasionally.
>> yeah.
>> on page 11, you'll see in detail what the contributions were for active retirees and cobra. The total and then what the claims were, also, for -- for the epo, the co-insured epo and the ppo, all of the detail is there. I will ask you to look at the very bottom of the page, where you have the reserve that we talked about, the -- the 2,675,542. That is anticipated reserve at this -- at this time. Also, I would like for you to look at this chart that's up here. And one of the things that -- [indiscernible] we want to be cautious about, part of that is experience that we had last year. This is -- this is an -- in '02 you see the claims and this is -- this is per employee, per member per month, and the claims we are going steady, then we had this big upshot right here. Them in August and September, then it went down. We are still trying to figure out what that was. Whether it was people that knew the premiums were going to change, scheduled surgeries at that time, maybe all the claims came in, but -- but this kind of tells us to be cautious with that, with that reserve, we don't anticipate, I think this is an an no lee, don't answer -- anomaly, don't anticipate that again, this is what the chart looked like last year when you had a big upshot, all the way down. Remember we had the reports about we were a sick -- we were sicker than the -- than the -- than the other groups or then the peer groups, well, what you saw this, what you saw was part of -- part of that. So we'll have to again take a look at that and -- this year and see is that really the case or was that something that was happening there. We'll be straight then to -- to the charts for you and cindy, dan --
>> cindy.
>> [indiscernible]
>> these basically reflect paid claims through March, so the -- so the -- pharmacy is 19% of our overall cost, medical 81%, we are kind of excited about the 19% because the national average is running anywhere from 22 to 24%. And if you remember when we first started, we were at like 26 or 28%. So our our pharmacy, the things that we implemented last year, as far as the higher pharmacy co-pays, I think that you are seeing as a result of that, I think that's something that we would see immediately is the pharmacy co-mais. I think that we are headed definitely in the right direction with the 19% pharmacy. This pie in the pie chart, this is a way to show how we are doing on pharmacy. So the -- so the --
>> [indiscernible] pharmacy, have they had an increase in mail order prescriptions.
>> that's what we are going to look at right now Commissioner is the little pie, the blue and yellow pie, that tells you, we broke out the form mass by retail -- the pharmacy by retail and mail order. Mail order the little yellow wedge is the mail order expense at 19%. The retail is 81%. We also feel like that we can do better on mail order, but mail order at 19% is not bad at all. We are doing some -- some employee education in the upcoming months, we are bringing in the medical people to talk to our people in the departments about mail order. How it can benefit them and what it can mean, and how they also still get one month free on their mail order. So it's a money saving tool for the plan. As well as the employees. But we feel like 19% usage of mail order is good. This next one contrasts the paid claims active to retiree. And it just basically lays out who is spending what. The big blue wedge, of course, is the active medical. You would expect that. And the larger wedge next to it is the active pharmacy. So our active employees are still spending, of course, the majority of the money on the plan. But the retiree medical is 80% and the retiree pharmacy is 3%. So -- so basically 11% of the cost is attributable to retirees.
>> tell us about what to expect.
>> I think so. Considering that we don't have a human number of retirees yet. But that number is only going to get larger as we have more and more people retire, we can expect to see those wedges to increase as time goes on. This is a comparison of the plans, of the -- of the epo, the [indiscernible] epo and the ppo. How is the cost, the paid claims attributable by plan. And you'll still see that the large blue wedge again is the epo, we will our plan as alicia told you in the epo, we still expect that wedge to be high. Again the pharmacy is right next to it. The ppo is the next highest expenditures and then of course the co-insured epo, since we have so few people participating, compared to the others, their wedges will be smaller. This one is the types of service, what are we spending our money on? What type of service? Facility in patient is still a -- still the largest at 26%. Facility outpatient is 23%. The physician component is 20%, the managed pharmacy is 17%. Allied health encompasses all of the other types of services. Chemotherapy, radiology, physical therapy, those types of things, chiropractic are all lumped in together under allied health. So this is kind of an even distribution. I think in the past we've seen our facility in patient is a little bit larger piece of the pie. But now the -- the facility outpatient is growing. To kind of -- to kind of alleviate that, I guess. In most cases as alicia talked to you before, having high facility outpatient is not necessarily bad because you are doing things on an outpatient basis versus doing them on an in patient basis. It's always cheaper to have someone in the hospital and send them home versus having them spend the night and having all of the in patient charges that are associated with that. This is a new slide in direct response to Commissioner Sonleitner's request. We just showed the actives on your information today, we do have it broken out for retirees, too, Commissioner that we will be glad to share. This easy -- this is paid claims by tier. You can see that the first column is the pharmacy, active epo. The second column is medical active epo. What that shows you on the second column with the high blue bar is that your employees only are the one that's are spend being the money. Spending the money. It's very interesting when we did this. You'll see that in all of the cases except for the ppo, the medical ppo, the spouse is the one spending more money in the medical ppo.
>> uh-huh.
>> if -- on the retiree ones, it's not included in this chart, but one of the retiree ones, the spouse is the higher. But under --
>> very interested.
>> under the epo, the employees are definitely spending the bulk of the funds. You have seen this before, we figured putting it in a graph was easier than trying to manage the numbers and figure out the picture in your mind.
>> we would like to share some good news on our -- more good news I should say on our health plan. We have spoken to dr. Almeda, who has spoken on diabetes, he's interested in a study for Travis County employees on diabetes, under written by a pharmaceutical company. We will be bringing back information to the court as we get further along in the discussion. Recently a resource provider is being credentialized right now to provide services for our cardio pulmonary disease patients and asthma patients on improving quality of life, disease management, pardon me, in prevention techniques. So they will be referred to -- referred to clients who will work with their doctors to provide education and training and disease management. As well, they are interested in conducting an asthma study for Travis County employees on -- on medication regimes, they are moving more from a day or a 12 hour period to a weekly period that inhalers, things of that nature can be used. So there's some exciting things coming back, bringing back to court for approval, we can get additional details for you.
>> dan, you mentioned that wellness program. Have there been any increase, in the participation of Travis County employees into the wellness program, the -- [indiscernible] all of the others.
>> yes, there has. There was an increase, a leveling off, slight decrease, now we are seeing a slight increase in the number of groups that are walking and it's really becoming more consistent. I look out my window and see alicia and her group walking Mondays and Wednesdays, different groups, it's staying fairly consistent. The interest is exceptionally well received by employees. We are -- we are constantly asked don't discontinue the programs, please keep the programs going, we have especially seen interest in the money management and the smoking cessation programs. So there's -- there's movement in that area. We want to definitely keep the momentum going. That is part of the education that -- that we -- that we undertook at the direction of the court back in I believe it was November when the -- with the instruction to develop a wellness program. We have kind of taken that and moved the initiative forward to -- to educating employees, how to become wise health care consumers, how to get healthy, stay healthy and use their benefits wisely because as everyone knows, as time progresses, employees are going to pick up not just in Travis County, but everywhere, employees are going to pick up more of the cost of health care. That cost has to be translate into consumer purchasing practices, just like you do with any other commodity. We are working to educate employees, giving them the resources they need. We are doing this through the wellness initiative. So I think it was a major step in the right direction for the court to direct that to be done. We are excited about it. There's -- there's -- if there's any inconsistency, it's in our ability to have time to track and gather the information to be able to report back strong statistics on these, but we are doing this on a -- on an ad hoc basis. Hopefully through some of the initiatives that you just saw with the e enrollment, we will be able to track some participation a little better.
>> are we tracking any possibility of -- of the spouses or dependents of Travis County employees?
>> no, sir. It's --
>> premium as far as actually getting involved in -- in any type of walking or anything else, exercising, anything like that?
>> we haven't been on a consistent basis. I would answer that as saying no, we may have one or two or three, not a consistent basis. We are sure spouses are involved but we are not able to track as well as we would like to. I think with some additional programming that's being done by i.t.s., When we get our tracker system online, it will be easier to accumulate the information and be able to report back to the court.
>> thank you.
>> one of the aspects that we are hoping to bring back to court is a wellness and health clinic, onsite clinic that would serve as a wellness center as well as an acute health care provider of sorts manned by or staffed by a physician assistant, a nurse and administrative assistant. That would become the focal point of the wellness program where the education, wellness prevention, disease management and acute care would be offered. We hope to bring that back to you in the next few weeks.
>> do we have somebody putting together a cost benefit analysis on that project.
>> it looks like it will come back close to cost neutral if not just a little closer for next year because of start-up fees, but we are doing that.
>> of course.
>> as sandy said, in June we will be continuing our wellness program in education by offering classes to the specific departments over a three-day period where we educate employees on how to access my uhc and the health risk assessment as well as understanding the difference between generic and name brand drugs and why you should ask your doctor for -- if a generic drug will do as well as a fame brand and not -- a name brand and not be tied to the advertisements that you see on tv or in the newspapers. Finally, we received some very good news from our partner, uhc. I use that very strongly because uhc is offering us a value added service, no additional costs to the county and no costs to employees or retirees, two benefit that's they are adding. One is the 24 hour nurse line that employees will be able to access any time, 24 hours, if there's an emergency and they need help or if they have questions about medications, questions about diagnoses. Treatment that they will be able to access and nurse and receive that assistance and that will be a terrific resource. The other benefit they are offering and we will be bringing back to court on I believe June 10th at our work session is a vision benefit that -- that will be -- again, at no charge to the county or employees for -- it's a very good vision benefit, but they're offering this as a part in recognizing Travis County has been a good partner, working with them to develop some services and this is one way that they are willing to show their appreciation. They have been an excellent partner in our program. There are two benefits, the 24 hour nurse line, which normally would run about 95 cents an employee per month. The vision benefit which normally would run probably about $6 for employee and retiree. Those are two benefit that's they are adding to their service. At no cost again to the county or employees. So that's -- that's some additional good news. I think the program is moving forward. Moving forward on two or three fronts. We are also -- we also will be bringing back some information from you, our life and disability carrier, huma, our safeguard and dental carrier on programs.
>> I would just like to end the report bypassing out a benefits calendar. I had sent an e-mail to christian on a work session and got some comments from each of the Commissioners, so as it stands now, the -- we have recommendations on rates and plan changes from the benefits committee, along with the retirement benefits committee also coming to a work session on June 10th, follow-up with the court to that June 10th work session on June the 15th. We do have a planned employee hearing for June the 23rd. That was part of the budget schedule. So we would hope to send information to employees in preparation for the hearing on June 16th and 17th, about a week before the hearing. Then vote from the court the 29th and then open enrollment starts July the 21st through August the 20th. So at this time this is a calendar that we would like to introduce to you. There will an be a lot of information, we will get you the information as soon as we receive it. This -- this report was just the beginning of putting together the whole package for next year's employee health plan and benefits.
>> one question. How will this information be related to the employees of Travis County, especially those low cost benefits that -- that dan just mentioned, along with a lot of other things, how will -- how will they actually know about that 24 hour service example of a nurse? For example, is that something that's going to be happening immediately? In the near future or when?
>> well, once we are able to bring back details to the court in these -- and these are approved, we will move forward with notifying employees through newsletter, e-mails -- payroll stuffers, as well as onsite education sessions.
>> okay.
>> we will have to bring exact -- exact information, also contract amendments for -- with additional services.
>> okay.
>> then we would get it out to the employees after that.
>> I just -- [indiscernible]
>> yes.
>> all right.
>> this has been very helpful.
>> thank you.
>> thank you all very much.
>> thank you.
Last Modified: Friday, May 26, 2004 7:00 PM