Travis County Commissioners Court
April 5, 2005
Item 28
28, receive and take appropriate action on reports from f.y. '05 first quarter hospital and insurance fund and employee five '04 health care.
>> yes, sir, alicia perez, executive manager for executive administrations. We are here to provide the court with a report as we usually do every quarter concerning our hospital and insurance fund for Travis County employees. Several years ago we went -- to a self-insured fund meaning that we manage our own health care fund. We contract with united health care to make the payments and get the network of doctors, but we fund the claims ourselves through premiums from the employees. Really in the last year or so this particular fund has really improved in terms of its stability and its reserve. We now have about 6,640 total participants in the health care fund. 3,800 -- about 3800 members, employees, cobra and retirees, and about 2800 dependents, spouses and children.
>>
>> [one moment, please, for change in captioners]
>> ...page 8 of the report. This page is significant because it has the three months of fy 2005 budget, fy '05 budget. And it tells you why we're supposed to be in terms of the budget. We're supposed to be at about 5%, which -- 25%, which is what the revenue is of the total budget. If you look on your operating expenses, it's 20%, which is the health claims and then you have third party administration fees, the stop loss premiums. So overall we are running at about 20% in expenses, compared to 25% in -- in operating revenues.
>> it the wellness clinic, isn't it?
>> [laughter]
>> well, it's -- I think that we have had lower claims. We still have a significant number of high cost claims. But overall, the -- the claims have been significantly lower. In terms of the -- your ending fund balance for this -- this fund, it is at 8 million -- approximately $8 million. Which is a lot better than what we have seen before. In the first quarter, if you go to page 10, in the first quarter of the 2005 fiscal year, your year to date change in assets has grown to about $975,801. You add that to your ending fund balance for last year and you have currently an ending fund balance much about $8 million. Of about $8 million. How are we spending that money? I’m going to turn it over to cindy and dan to go over the charts with you. We usually put together some pie charts and some graphics for you that tells you how the money is being spent. And the claims.
>> good morning, cindy [indiscernible] in human resources. On page 12, the parts that I’m going to talk about start, this is our overview graph of the plan in its entirety. All plans together. And it shows that -- that the medical portion of the expenditures is 86%, while the pharmacy portion is 14%. I’m pleased to say that pharmacy portion is decreasing, but the blue portion is an ever increasing number. It's kind of misleading to show that the pharmacy is decreasing because we are always comparing it against a larger medical number. On the next page, 13 is our pie chart that shows hoe we're doing on our -- how we're doing on our pharmacy, kind of pulls out the detail of the mail order versus the retail. Full notice the retail portion of our pharmacy expendture, 79% ass on opposed to the -- as opposed to the mail order, [indiscernible] we are doing better ever quarter in increasing mail order numbers, that's an ongoing mission to me to get more mail order usage because it's cost effective. If you want to go to the next page 14 is the comparison of paid claim to active retirees. Again the majority of our dollar is spent on active medical, 76% of the spend with active pharmacy being 10%. So altogether, we are spending 86% of our dollar on the active employees. With 11% on retirees, 3% on cobra. Those cobra numbers are higher than we have ever seen them in the past because we had one of our active employees transition to cobra and he was one of our very high claimants. So we kind of saw his costs follow him over to that cobra column. However that will not be an ongoing expense.
>> 18 months, is it 18 months.
>> yes, but he's off of cobra now, that expense will kind of maintain steady I would think on the cobra. On page 15, we are doing a man to plan comparison plan to plan comparison. This is how our three different plans compare to each other, with the epo, [indiscernible] ep and at the ppo, again the majority of our spend is on the epo million, that's our 100 -- epo million, our 100% plan, ppo being 15 percent, co-insured epo medical being 4%. As people transition between the plans, you will see these percentages change a little bit. On page 16, this is what are we spending the money on, what types of services are we spending the money on? Again, the highest percentage is facility in patient with 34% and facility outpatient which is 14%. Those numbers have remained kind of steady for the last few quarters. Managed pharmacy again is 14% and physician care is 23% with ally health, which is the combination of everything else like chemotherapy, physical therapy, some of your -- of your affiliated types of services are all captured under allied health. On page 18, is a -- is a paid claims by tier. We are always interested in -- in who we are paying the claims on. This is a -- kind of a picture of the -- of the actives. And you will notice that we have kind of an anomaly on this particular chart. If you will notice the -- the first active medical under epo that really high red bar. That is a family category, normally we don't see our family costs being that high. But if you will notice the note I put on there for you, that four of our large claimants fell into this category this time. So we had some sick children and family members not just employees. So it caused this kind of anomaly to show here. This kind of tells you who we are spending the money on in our tier structure. That's always important when we go to set our rates for the next plan year. Okay? Then 18 is just what the payments by month have been by medical and pharmacy. And then i'll turn it over to dan, dan did you want to make any comments on the first quarter?
>> I would only mention something -- follow something Commissioner Sonleitner said, that is that I think we need to applaud our employees who have stepped up to the plate in the wellness program that offered education, consumer education, how to be a good medical health care consumer. We stepped up to the plate and they understand that basically it's coming out of their pocket one way or the other. So they have used discretion on how the plan is -- health benefits are used. We did have -- we did have a meeting with united health care, I think last week or the week before, where we discussed what -- what chronic illnesses we are paying this money out on. Cindy mentioned who is getting the money, the reason they are getting it. The top fund urinary tract problems which we have identified primarily as being those patients that are on dialysis. Circulatory, which is any form of heart disease, cardio pulmonary disease, neoplasam, which is cancer, musculoskeletal, anything from the knee, hip, back, next injuries or problems and then digestive. Actually the last two, the musculoskeletal and digestive had a reduction over last year, but they are still in the top five category. The highest category that we see is the reapnal failure. A direct -- renal failure a direct cause of diabetes if it's not managed correctly that it end up in dialysis and we were paying an exorbitant amount for dialysis in some instances, that has been corrected. Those fees have been renegotiated. They are now more reasonable. How we add these five, top five cost drivers through our wellness program is to ed -- through education and screening. Dr. Turner was going to be here, but I think he had a roomful of patients. Hopefully he's screaming ly he's screening today. The way to really address that first cost driver, the renal failure is to prevent it. To get in early detection, identify those that are at risk and work with them to manage that disease or in many cases to prevent diabetes, which can be done if it's detected early enough. Circulatory, that's where the cholesterol counts come in. That's another reason why screening is so important because if you can get on a diet, you can prevent developing that disease. If you can increase your exercise, watch your diet and use caution, you prevent going into this high category of cost. Again, screening can help on that. Neoplasam, we've had a very high incidence of breast cancer and that's something that can be detected early with screening. Again, and tests. We have -- we have the clinic will be putting on a -- a -- a training program on self check and it will be addressing this particular issue as well as early detection through physicals and other exams because if you can identify and detect the cancer early enough, most cancers can be treated successfully. Musculoskeletal, those are joints and muscles, that can be addressed through nutrition, can be addressed through exercise. And so again through a wellness program we hope to be able to -- to reduce the incidence of these diseases. Digestive, that's a -- that's a gastroproblem and again through diet, early detection, treatment and management that can be prevented and controlled. The reason it's so important to control these five because the top five accounted for 5 the .6% of the total cost of claims. 59.6% of the total cost of claims in plan year 2004. That's what the wellness program and the clinic will be concentrating on to manage these and prevent these diseases.
>> okay. Nothing else expected today, right, just to receive the report.
>> yes, sir.
>> anything else required of the report.
>> no, sir. Just accept the report.
>> thank you very much.
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.
Last Modified:
Tuesday, April 5, 2005 3:19 PM