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CalPERS Health Benefits Program

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					CalPERS Health Benefits Program
         2007 Rates
Public Employees’ Medical and
Hospital Care Act (PEMHCA)

CalPERS Objective
• To provide you, our employers, with a
  comprehensive, cost-effective health benefits
  package

Why?
• To help agencies attract and retain qualified
  employees
• To foster a healthier and happier workforce


                                                  2
What’s Happening in the
Public Employer Insurance Market?

• Local governments are under pressure to
  reduce costs due to budget constraints

• Public agencies are looking for cost saving
  alternatives

• Commercial rates may change significantly
  after the first year




                                                3
CalPERS Understands


Health Care Cost Drivers

• Aging population            • Escalating hospital costs

• Provider reimbursements     • Member health decisions

• Escalating pharmacy costs   • Medical technology

• Chronic diseases            • Uninsured population

• Provider disruptions        • Federal and state mandates


                                                            4
CalPERS Basic HMO Increase
Lower than the California and national averages for 10 years




                                                               5
CA Legislative Analyst’s Office
(LAO)

In 2006, LAO said CalPERS saved more than $168
million since 2002 by implementing the following initiatives:
• Did not renew contract with Health Net and Pacific Care -
  $77M
• Narrowed Blue Shield’s hospital provider network - $45M
• Moved Medicare eligible members from basic to Medicare
  plans - $19M
• Provided member incentives to use over the counter and
  mail order prescriptions - $27M

Other Contracting Agency-specific initiatives:
• Adopted Regional Pricing - $40M
                                                              6
Approved Regions for Contracting
Agencies

2007 CalPERS Regions
• Bay Area/Sacramento
• Los Angeles Area
• Other Southern
• Other Northern
• Out-of-State




                                   7
CalPERS 2007 Health Premiums
Medicare Rates



                                  2006                           2007
    Medicare                                                                            Percent
                                                                                      Change (+/-)
                        Single    2-Party   Family     Single    2-Party   Family


                        Medicare Premium Rates - All Regions

  Blue Shield CA        $286.49   $572.98   $859.47    $318.95   $637.90   $956.85        11.33%


  Kaiser CA              218.59    437.18    655.77     289.68    579.36    869.04        32.52%


  Kaiser/Out of State    209.99    419.98    629.97     271.78    543.56    815.34        29.43%


  PERS Choice            322.03    644.06    966.09     341.75    683.50   1025.25         6.12%


  PERSCare               347.20    694.40   1,041.60    371.68    743.36   1,115.04        7.05%


  WHA                    277.44    554.88    832.32     296.86    593.72    890.58         7.00%



                                                                                                     12
CalPERS “More Than The Premium”


• Experienced

• Proven Leaders

• Committed

• Innovative

• Educators


                                  13
CalPERS Quality Care and Coverage
Disease Management Programs


Programs to improve outcomes and cost-effectiveness
• Identify and educate high risk individuals
• Case management
• Five chronic disease care programs
         Asthma
         Diabetes
         Cardiovascular risk reduction
         Chronic Obtrusive Pulmonary
         Heart Failure


 CalPERS health plans provide these programs
       at no additional premium cost.
                                                 14
CalPERS Quality Care and Coverage
Strategic Initiatives


Member Engagement
• CalPERS Web-based Health Plan Chooser Tool
• CalPERS Health Wallet

Member Incentives
• Pilot programs such as Blue Shield’s Healthy Lifestyle
  Rewards program

Telemedicine
• Blue Cross telemedicine pilot program implemented for
  select PERSCare and PERS Choice Basic plan members
  in 2006
                                                           15
CalPERS Quality Care and Coverage
Strategic Initiatives (cont’d)


High-Intensity Case Management (HICM)
• Blue Shield pilot program indicates preliminary estimated
  savings of over $7,000 per case
• Staff continues to review results of existing HICM
  programs

Centers of Expertise (COE)
• CalPERS works with health plan partners to identify
  certain procedures and facilities as Centers of Expertise
• Planning to implement bariatric COEs in 2006
• Reviewing joint replacement surgery COEs for 2007

                                                              16
Addressing Public Agency Needs
Ease of Program Administration


Administrative Support
• Established negotiating power with health plans and
  providers

• Online enrollment system (ACES)

• Continuous educational and program support

• Timely grievance resolution of both provider and plan issues

• CalPERS Health Benefits Officer for retirees


                                                            17
CalPERS Administrative Costs
Lowest in the State


Our low administrative costs cover all of the following:
• Online enrollment costs
• Dedicated member services
• Open Enrollment support
• Annual Open Enrollment notification process
• Health Benefits Officer for retirees

Also, participating agencies pay no commissions
 and there are no commission fees built into the
             health plan partner rates.
                                                      18
CalPERS Board of Administration


Priya Mathur – Elected Member for Public Agency Membership
Tony Oliveira – Governor Appointee for Local Government Representative

Board Member                        Constituency
Rob Feckner, President              School Members - Elected
Marjorie Berte                      Insurance Industry Representative
George Diehr                        State Employees - Elected
Charles P. Valdes                   Total Membership - Elected
Steve Westly                        State Controller
Philip Angelides                    State Treasurer
David Gilb                          Department of Personnel Administration
Mike Quevedo Jr.                    Public Representative
Maeley Tom                          State Personnel Board
Kurato Shimada                      Total Membership - Elected
Robert F. Carlson, Vice President   Retired Members - Elected


                                                                             19
Employer Engagement
Your Voice


Health Benefits Constituent Workgroup
• Stay informed and provide input
• Meets monthly (second Thursday) from 10:00 -11:30 a.m.
• Attend in person or via teleconference
       Contact: Jennifer Rae at (916) 795-2807 or via email at:
                   Jennifer_Rae@calpers.ca.gov

                         Meetings held at:
      CalPERS, Lincoln Plaza North at 400 Q Street, Room 1140
                      Sacramento, California

  Dial-in number for teleconference is (877) 771-5833, Code 784356#
                                                                      20
Employer Engagement
Your Voice (cont’d)


Health Benefits Committee and Board Meetings

• Generally held the third Tuesday and Wednesday
  of each month

• Agendas available at www.calpers.ca.gov




                                                   21
Contact CalPERS


The highest level of customer service

• Contact us through CalPERS On-Line or our toll-free
  Employer Contact Center:

      www.calpers.ca.gov
      888 CalPERS (or 888-225-7377)




                                                        22
CalPERS Health Plan Partners
Contacts


The following contacts are available to you when you need
additional assistance with a specific health plan question:
  Ann DeRose, Account Manager for Blue Shield HMO N. CA

    Call 916-329-4567 or email @ Ann.Derose@blueshieldca.com

  Terri Raymond, Account Manager for Blue Shield S. CA

     Call 310-568-2813 or email @ Terri.Raymond@blueshieldca.com
  Mark Johnson, Account Manager for Blue Cross PPO PERS Choice or PERSCare
     Call 916-636-2181 or email @ Mark.Johnson@wellpoint.com
  Gladys Stone, Account Manager for Western Health Advantage
     Call 916-563-2283 or email @ G.Stone@westernhealth.com
  Josh Costa, Account Manager for Kaiser Permanente
     Call 916-614-4557 or email @ Josh.S.Costa@kp.org
                                                                             23
CalPERS Health Care for Today
and Tomorrow

CalPERS

• Fully committed to our partnership with you

• Delivering quality and affordable health
  coverage




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