Travis County Commissioners Court

May 22, 2012 - Item 16
Agenda

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16, consider and take appropriate action on the following employee healthcare items for fiscal year (fy) 2013 plan year, effective October 1, 2012: a, contribution levels for Travis County employee health plan for fy 2013; b, fy 2013 health benefit plan design changes; c, set employee public hearing on June 13, 2012 at 4:30 p.m. in Commissioners courtroom; d, request for printing and release of information to employees and retirees regarding benefit options, prior to employee public hearing; e, set fy 2013 open enrollment dates for July 16, 2012 through August 15, 2012; and f, designate default for employees that do not complete entire open enrollment process to employee only co-insured exclusive provider organization (co-insured epo) coverage and employee basic life.
if I look at this, cde seem to be so simple we should approve those, shouldn't we?

>> yes, sir.

>> I move approval.

>> second.

>> this is for 16c, d, and e.
discussion?
all those in favor.
that passes by unanimous vote.
what about a?

>> good morning, judge, my name is john with Travis County hrmd.

>> good morning.

>> my prior appearance before the court was in an elvis jump suit.
so I feel a little bit more comfortable today.
you are probably used to giving this presentation.
this is my first stab at it.
bear with me.
starting February is when we got the first inclination of our health insurance trend for the past year a couple of years from the united health care, and in March we got the actuary report and what we saw was a very high utilization mainly on epo plan of services, high utilization of across the board for several areas including in patient hospital, outpatient surgeries, urgent care visits which is reducing some of the er visits which a good thing and we saw a little bit of increase in er visits and health, compared to past few years, it's decreased.
areas we saw improvement were pharmacy.
we made a big change last year to our formulary.
we are starting to see improvements.
we don't have a whole lot of data yet, we have January until now.
we've seen really good -- costs have gone down for the plan and members in some areas.
generic utilization is up.
so we gathered data and present out it to benefits committee and several plans and variations we looked at and we brought before the court, two options, option one is basically outlined on page 2 of the back up, so option 1 is with no benefit plan design changes.
so leaving the plans -- the three plans exactly as they are today according to trend, and according to our actuary, what we would see is increase county contribution of a little over 6% from both the county and from employees and retirees.
what we didn't like about this option, it didn't address overutilization concerns, so next year we may see the next trend and then a plan design and so we cost it out with the second option, which is both plan design changes and county contribution and employee rate increases.
with the plan design changes that we outlined on page 8 -- sorry.
page 10, with certain increases to certain plan services, including deductibles, coinsurance maximums, changing some of the copays for outpatient surgery which is extremely high cost driver for us, we saw 19% increase in the cost per outpatient surgery, so we saw some areas of concern, and we immediate plan design -- and we made plan design changes with these plan design changes, the net result is 4% increase to the county contribution and a little over 4% increase to the employee rates.
and that's what we brought forward to the benefits committee.
the benefits committee recommended we proceed with option 2.

>> what are we asked to do on the option set forth in a today?

>> basically just -- my understanding is we typically review the options presented at that point and then we wait until the employee hearing and once that's completed, we would ask that we approve.

>> so you would take both options to the employee public hearing?

>> yes, sir.

>> that's what it appears like.

>> all right.
and do we need to discuss f?

>> yes.

>> how do we aggressively, I get, look towards making sure that the employee participation is to the level of where we would get the audience filled as far as that is concerned during the public hearing process and also our retirees.

>> speak into the mic there, Commissioner.

>> and also our retirees, because they are also a part of this process, so I guess my question again is how do we aggressively outreach these particular categories within the public hearing process?

>> and once we approve these two options as the go forward options we are going to start an aggressive meeting and campaign to educate our employees and our participants, including retirees as to what the changes we are proposing, including what is the status of our plan right now.
in fact, we have meetings scheduled.
how many?

>> about 15.

>> fifteen so far and they start this Friday and so again, and to be honest with you, it is one of those things we want to make sure people really understand what we are proposing and we think those meetings helped last year.
people understood and got their questions answered long before the employee hearing and so we think that's going to very much help.
we will also be sending out packets to our retirees detailing what we are proposing here and also when the hearing is so they can certainly come and have their voice heard if they have issues with either of the options or a preference between the options.
both options do involve increased costs to the participant, either in the form of contributions or in the form of contributions and/or copays, deductibles.
so forth.
it is less cost in contribution if we make those plan changes.
it is also less cost to the taxpayers and less to the could be think contributions if we make those plan changes.
plan changes are not getting the plan horrific, anything like that, and so we really encourage any member to come and learn what we are proposing so they can give us their feedback in person or at the hearing.

>> I don't know how to emphasize this as much as I think we need to, but I think we really need to ensure that we highlight as much as possible in the default situation, what triggers a default and of course I think employees need to be continuingly made aware of what default is in the way you penalize, whereby you won't have any insurance if you end up not doing certain things.

>> default, you are not not covered you just go to the --

>> right.

>> we are talking about f right now.

>> f, that's what I am referring to, sorry.

>> how a person finds themself defaulted if they don't complete all ten steps of the open enrollment process.
so if someone just ignores open enrollment, thinking they don't have to do anything and everything will stay the same, then they would get defaulted to coinsured only, employee only.

>> exactly.

>> if someone has problems, we don't default them.
we help them.
and we work with them and we can tell who has gone in and done it and who hasn't.
and in open enrollment we send ad nauseam emails to people.

>> my may not, let me get to that, the point is in the default situation is if it is only -- if I goat to the last tier, which is insured only situation, that person may have had family members involved in that insurance?

>> exactably.

>> that's what I am talking about.

>> and I didn't get a chance to include.

>> sorry.

>> that's all right.
that's all right.
the inclusion of the matter of what I said.
the default situation, you have gone through all of the tiers and the end result, you are just insures yourself and your family members will not be covered.

>> correct.

>> so that's what the point is I am trying to get and have a chance to complete my statement.
but anyway, that's what I am talking about.
thank you.

>> what other direction do you need from us today?

>> do you want to approve this?

>> not really.
I want you to take it to the public hearing, though.
with the employees.
that's what we have done historically, anyway, right, the last five or six years so it shouldn't be a surprise.
let's hold off on it and get employee input.
I guess employees would be interested in plan changes that are recommended as well as what the fiscal impact will be on them and retirees the same thing.

>> yes, sir, and we have almost ready to send out to them, as soon as the print shop prints it, we will be sending out information to both the retirees and the employees.

>> move you proceed as planned.

>> second.

>> discussion?
all those in favor.
that passes by unanimous vote.
commission Huber is off the dyas.
thank you very much.
good luck to you.

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