JHCC Members met with Premera and Health Care Vendors In Review of Plan Performance

The annual Knowledge Management and Vendor Summit meetings between members of the Joint Health Care Committee and UA health plan partners Premera Blue Cross Blue Shield, Best Doctors, VSP, ComPsych, PatientCare and Healthyroads Nov. 11-12 provided insight into factors driving health care cost increases, and intensive discussion on what can be done to improve consumer awareness and utilization of services, smooth integration between vendors, lower overall plan costs and improve wellness.

Premera processed nearly 200,000 claims for the university last fiscal year. Their annual report evaluates claims history, pharmacy scripts and demographic data to create a storybook highlighting trends and insights into UA Choice plan usage as compared to Alaska norms. The information is utilized by the Joint Health Care Committee and UA management to highlight areas where they can improve communications, promote better consumer activity, improve wellness and target preventive efforts.

It is also an opportunity for Premera to highlight how changes in their programs, including increased contracted network providers, enhanced utilization management programs for pharmacy, prior authorization program, medical travel support, member health support and their NurseLine service have benefitted the university and members on the plan.

Joint degeneration and cancer are the top two conditions affecting the largest portion of our population and accounted for 19 percent of the total spend last fiscal year. Wellness efforts focused on weight loss, increased physical activity, proper bending, lifting and stretching techniques, cancer screenings and smoking cessation can positively affect the plan by reducing these kinds of claims. High claims costs, those more than $50,000, are responsible for the greatest increase in plan costs. Last fiscal year 44.6 percent of plan costs were generated by just 2.4 percent of the population.

One area that could benefit from increased utilization is the NurseLine. UA Choice Plan members called 250 times last year, mostly to determine if an ER visit was necessary. In 81 percent of those calls members were re-directed to a lower level of care. Savings to the plan due to the NurseLine calls last year is projected at $171,170. Increased utilization could lead to increased savings. The number for the NurseLine, 1-800-841-8343, is printed on every member’s Premera card.

Virtual Care, a new service that provides virtual medical care services on behalf of Premera, giving members immediate and convenient access to care whenever and wherever they need it, has huge potential for reducing both plan and member costs. Under this service, members receive care virtually from their own doctor or from a doctor at the national provider service Teladoc. Virtual care is not meant to replace a member’s relationship with their primary care provider, but provides expanded service delivery options and helps contain costs. For example a member can call for a prescription renewal for $40 instead of the cost of a full office visit. Registration for the service is available on the Premera.com website and makes it possible for members to receive care via phone, online video or other online media as easily as walking into an office for face-to-face care but at a substantially reduced price.

One area where UA performed fairly well is in preventive care. Preventive exams were above the norm, whereas preventive screenings were just under it. Well baby exams and immunizations were also above Alaska norms. Considering the high levels of cancer claims, increased communication on the importance of preventive care and screenings could have a positive affect on overall member health and plan cost. All three plan options on the UA Choice health plan cover preventive exams and screenings at 100 percent of allowable charges with no deductible or coinsurance expense.

One tool that plan members can better utilize is the Premera website and mobile phone app. Personal health management tools and coaching, access to personal health data, management of accounts, and online health tools help members manage their own health. Treatment cost estimators and detailed information on in-network providers can help members manage their health care costs and avoid expensive out-of-network providers. The more members that register on the Premera.com website and elect to receive electronic instead of paper explanations of benefits (EOB), the greater the discount to the university. Premera’s pharmacy benefit also has a mobile tool to assist in tracking prescriptions, locating pharmacies and ordering refills.

The next Statewide Voice issue will focus on the Vendor Summit and additional health plan partners and their services.

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