Skip to main content

tv   [untitled]    April 28, 2015 2:30am-3:01am PDT

2:30 am
and it will probably put that in as one of the comments in the management when we start working with the auditors this was different we changed over but we have been preparing for it i think last july we started to talk about it. >> as long as we know the month to month amount and it's noted for the record i recognize we spent $2 million and we're talking about $100 million it may not material mean but $2 million is $2 million at least it's noted. >> and also the forfeiture performance they go back into the trust fund; right? >> the forfeitures are go to
2:31 am
the trust fund and used to fund the allowable uses to fund the administration of the f s a that produce the administration that's like our contract for could be bra and health care and did not care sf a. >> used for administrative purposes for the other health plans. >> no, it is so - >> you're the forfeitures come because - and i know how they got there they're used for what. >> to offer the benefit of the expenses in the first time. >> what about the guarantees you have goes and forfeitures here. >> the guarantees are used -
2:32 am
are accrued into the fund balanced they're not used to cover any specific expenses in operating. >> they go into a separate pool? know what they are >> we can give you the s. >> any other questions if not we'll move on to any public comment? hearing no public comment we'll move on to action item 12 >> item 12 action cancelation of revenue 11. >> chief financial officer on february 25th the vision benefits services request for proposals the request for a quality contractors to provide the qualified plans the selected
2:33 am
contractor is responsible for negotiating and negotiation and establishment of vision provider network and the disbursement within the legal requirements all the services fall under protection and the hippo protection excluding the terminal benefit it is only offered to select unions and it is $4.8 million and the vision display terminal are cost approximately $160,000 per year person seek price proposals that reduce the amount by 2 percent and we are working with the initial contract terms of 3 years with two year renewable
2:34 am
options with the total not to exceed contract of $14.7 million and in 5 years we also required a two year two percent annual increase for the two years the rfp responses were due on march 16, 2016, however, due to various requests to extend the deadline to march 26 a total of 05 proposals were submitted to h s f although a panel of fully qualified participants to evaluate the proposals was approved it wasn't in the evaluation and explicit occur due to the extremely aggressive timeline which was deemed unrevelation for are you aware of the responses and seeking approval
2:35 am
to award the contract timeline that was sent would stith negotiate and receive approval of all city departments that execute a city contract that serves the members in addition assuming a 2 to 5 reduction rates for 2016 without an executed contract is a risk to the health services system based on those risks h f may reissue the benefits request for proposals in late summer with the rfp being similar or the same we have taken the proposals and we have improperly schuler
2:36 am
disbursed them in the event that the public would have asked for a copy of the proposals they would not have been provided because proposals are disclosed after a contracted award and we didn't have a contract award we were there was a request to release the proposals and we stated that it with compromise the integrity of the process in the next rfp and it may also place the proposals in a excessive disengage that is an even not in the best interests the city. >> if i may you say we it was under the advice of council. >> yes. >> i wanted to get that intond. >> we didn't take any actions
2:37 am
without working closely with our council. >> thank you. i want to make sure we made that pubically. >> we'll advise you before we the next time and the recommendation we approve the appeal of the rfp; is that correct. >> at this time. >> this is think an ax. >> it's the cancelation. >> cancelation okay as the an action i think. >> all right. that's the recommendation of the chairs ruling to entertain a motion to that effect. >> i move we approve the cancelation. >> cancelation. >> of the rfp. >> of the rfp. >> provision. >> provision. >> all right. it's points
2:38 am
improperly moved and seconded for the rfp benefits be cancelled at this time is there comments or questions from the board. >> so for 2016 the rfp there is a one year extension? seems like >> we received yes - we received a quote for a one year extension but with the rfp so we'll continue to have coverage. >> conform. >> all right. other questions from the board questions from the public hearing none we're presented to vote all opposed by the same sign $0.19 we now down to item
2:39 am
14. >> item 14 action item follow-up on the national ppo i'm neil an actuary at the last meeting to bring the rates the u a to nicole but in the presentation as part of my responsibility i need to share that, and, secondly, it is very exciting that was presented last time the value of the promise by the health care the gadsby number has been reduced that's the actions taken by the board that was presented last week and as a point of contact as you listen to the presentation what are the rates for the full replacement and the slice we talked about we'll add the plan okay. as a point of context how
2:40 am
much do the other plans cost in 2015 blue shield costs $378 right now city plan with the stabilization is $315 and kaiser is 3 hundred and thirty there's and $0.52 etc. what we're asking once you hear the prediction to come back in june with a rate card i'll clear the decks with the slides it is too late in the game to do a full replacement but it's your decision to proceed with the slice or future determine whether we want to do the ppo at the future time >> i want to be clear on the terminology slice it is offered along with the all cotter plans it's interpreted by the person
2:41 am
in this case u h w they'll be getting a portion of the population not all the population a portion means a slice so we keep our metaphors clear. >> in the portion it didn't mean a take all medical people. >> anybody that wants to enroll in this project bans their observations of the benefits will be able do that. >> as a retiree with medicare. >> with medicare i have another question. >> for me or you. >> you. >> the second one is united health care opposed this plan to be offered alongside so the two 16 rates without any clanks as it is today would be $306; is
2:42 am
that correct. >> i thought you said it was doing well, last year was 2 hundred and 71. >> the rates last year for our program the u program is $271 with the clean stable shin claims factored in the true rate is $215. >> i'm looking at it from what the members pay. >> right now 2 hundred yes $271 the claim stabilization that's absolutely correct to compare that you'll compare that to the full replacement rate $278 if we took two numbers. >> i know i know if we dismiss that new proposal and we go ahead with what we have what's it going to be next year.
2:43 am
>> the number i've presented i don't have the exact number is $280. >> in march. >> yeah. she's going to look it up. >> as opposed to 271. >> we have a number do you have that katherine director dodd's. >> no, i think we did it in january maybe the county though; right? and i remember you saying that was going down i recall but. >> you don't have the figures. >> i don't have a rate card. >> okay. it is approximately
2:44 am
$280 are existing programs based on us taking the risk for the $171 premium for 2016 is it sufficient for the board. >> yes. that's on here. >> we take the risk that can impact us with that those are my comments i'm going to turn it over to my colleague. >> good afternoon good afternoon. >> nicole with the united health care thank you for your time. >> are you our account executive. >> i work closely with heather and manage the medicare. >> i wanted to remember you
2:45 am
were. >> do you have the presentation madam clerk is pulling it up we've been asked to present the rates for the 2014 to the scenario that was mentioned and also talk about the plan design we've quoted as well. >> and i want to as we begin this. >> yes. >> in the appendix i'm reading changed i have distance glasses and computer glasses and reading glasses those microscopic numbers in the appendix are an absolute challenge to read and understand. >> i apologize we'll get you a much larger version in our effort to get everything i understand that's a challenge.
2:46 am
>> when we went only sfgovtv there was a font required this will not make it. >> we broadcasting our city. >> you know the public there's no way to read this this is the whole idea of the meetings so the public - and absolutely i know there was a larger document it was hard to read we'll make it much larger so everyone what read it. >> i'll put that on a duo to do as a followup to the discussion regardless of our action today. >> happy to. >> excellent if you look at slide 3 we provided information on the wooeths rates for 2016 and the two different scenarios the first scenario assumes all medicare ab members move off the city plan into the medicare ppo
2:47 am
plan the 2016 rate is 2 hundred$278 plus and then the slice option this rate is $305.12 with that scenario anyone that has medicare parts ab can enroll in the plan if they want to be interested in enrolling in. >> they could but not have to on our second option. >> i'm sorry. >> yes. >> it's an option. >> the first one is not an option. >> right so the first one everyone moves over this has ab and the section option ab can enroll in the second option. >> what's the commercial r x plan. >> the commercial r x plan for
2:48 am
the early retirees not a cms regulated plan in place today i believe we have a little bit under one hundred people as the plan that does not have ab so those folks will not be able to enroll in a medicare advantaged plan because cms required ab city enrolled. >> if you look at the plans first, i want to talk about the medical the medical benefits quoted under the ppo it current to the network plan on average the members as a whole pay a similar amount under the proposed arrangement some costs are more and some less i'll get the chart. >> i'm saying as i read through
2:49 am
the proposal i participated on the call with director dodd and it seems like everything was we can do it all and whether that carries through is understanding the level of detail so when i see a sweeping statement matt haney members of a whole paying a average i get nervous i want to see a memoranda price because averages range from god awful million dollars dollars to a few cents in change it would be helpful when you're making those references to have the data to support it but talk about something everyone averages that is very misleading as a whole. >> thank you for that feedback
2:50 am
i want to mention with the design there is an annual out of pocket 3 hundred tell you you're out of pocket moment is under the city plan today with regards to the prescription benefits drug it is the same as the part d plan 9 seem co-pay structure with the expectation for diabetes testing those are covered at zero the formula is the same as the formula under part d filings are the cms every year with the expectation of the treatment of high-risk medications we've spent a lot of time talking about that at the last meeting based on current utilization where that will impact 5 hundred plus people we'll have to see with the new
2:51 am
formula to understand the situation but based on the fact you're looking at slice rather than full replacement whoever wants to enroll in the plan i said but first, let's talk about drugs retirees nephews and again if so it the same formula it is going to do xyz a person needs to know what the formula is to make a determined choice so we've got to do translation to what kinds of how risk is there a way to chargries this if i took this i might be impacted.
2:52 am
>> those are good points we talked about that in the last meets there are typical drugs that effect the cognitive ability to provide of that nature when a member is looking at to enroll in one of the plans they can call and ask if the drugs are on the formula so they know ahead times it is not as to they enroll in the plan and not have the coverage. >> i can appreciate we're in the policy side of that i haven't gone into who's endorsing to make an informed policy decision i need to have an understanding of the broad categories i recognize that after we approve it if we do someone about pick up the phone and know that i'm saying from
2:53 am
standpoint of making the information or the types of disease categories risk of falling into a variety of things you know and drug whether or not drugs are influencing that one way or another is another issue i'm asking you to step back and look at it from a policy standpoint that's what we're trying to consider. >> we'll get more information on that as well. >> if you look at slide 5 we've spent a lot of times last month talking about the way the ppo acts the only requirement is that the provider is medicare participating so members can see any medicare participating
2:54 am
providers from the standpoint we have a long history of those that are outside of our network treating our national ppo members we'll have a good amount of success in making sure that members can continue to see their seem doctors you know as an example ceda are a is no the in the national ppo network but many doctors treat their members having said that, interests not a guarantee when out of network they'll treat the members but we've had great success in those members bob being treated as the geography east of the mississippi river. >> we've offered this plan but in california less so our right. >> again, i caution i forgot
2:55 am
the young man's name he was here last month how mathematics operate we happen to be in a market that is heavily hmo.com natdz people are used to certain things their neighbors have certain because to get their services and such and such a way for another health plan patterns of behavior that is not typical because they have a presence of this type of marketing so i'll urge some caution again about whether the in and out of network treatment is acceptable and using our past practices for what might happen we may find this market slightly different.
2:56 am
>> that makes sense thank you for sharing that we have clients in northern california as well as and the plan does seem to be working well, one - >> is that county of sacramento. >> how many people. >> county of skoment has an hmo and ppo i believe the n p p-4 to 5 hundred. >> 4 to 5 hundred. >> i'll be happy to share their contract information. >> we recently had people last year that had they were a group which the sutter group blue shield they left that and went into the city plan will they be part of the network and i'm going what was the name of the group. >> peninsula. >> i'll have to check i know a palo alto and it's like a
2:57 am
medical group. >> uh-huh. but i'd to check on the peninsula. >> now the city plan may have to do the same thing this is a problem there's a sarcoma clinic in language that came up a number of times people had to shift plans. >> what's the name. >> it's ucla's sarcoma clinic. >> i can certainly check on those. >> okay nicole can you clarify if mills peninsula network was not in the network people can go to miles peninsula hospital thank you. >> what we do is if we were fully replacing the city plan we'll look at the doctors that
2:58 am
have been seen by the members over the last year and any we haven't had a record of ref claims we do is a very degree of acceptance. >> dr. my point is you can go to any physician who takes medicare period and absolutely any willing medicare provider we found that most doctors outside of our members we have to call to educate them we don't have a guarantee. >> what rate are they grurtdz. >> they'll grutd as medicare original medicare will pay. >> but if you don't have a contract how do you know they'll be reimbursed. >> they'll be educate and it's
2:59 am
done by phone. >> uh-huh sometimes phone and sometimes mail. >> interesting. >> all right. please precede i know the next slide was pharmacy reduction. >> to minimize disruption so. >> that feels what i was saying it is all of the medicare ab city people they can move over to the national p p plan and we'll look at the claims and reach out to the doctors we don't have a history of ref claims. >> i'd like to see what the network disruption had a are members having now and what they'll have now even without the full replacement. >> we ran the exclaims there and analyzed them 62 percent of claims that run through the
3:00 am
system last year would be submitted by the doctors in the network. >> so 38 percent. >> uh-huh having said that we've received the claims from doctors out of network i can get more information for that. >> okay. please precede. >> so if you look at slide 6 pharmacy disruption this feels what i was talking about today in terms of how how risk medications are treated different under the national ppo plan again, we would get more information for you on exactly what that looked like in terms of clinic terms and as i said if you move everyone from the current plan into this national ppo plan it would

18 Views

info Stream Only

Uploaded by TV Archive on