The Health Care Committee’s modification of co-payments enjoyed considerable success last year with a 4.66% increase compared to double digit increases throughout California. This year’s increase of 26.9% is almost entirely based on ten catastrophic claims that represent atypical utilization. Six of these individuals had medical expenses above $150,000. Four of the individuals had medical expenses between $100,000 and $150,000. Overall, high dollar claims represented 35.9% of total annual cost.
Blue Shield is actively managing these cases to minimize their ongoing impact on future plan increases. In addition, the Blue Shield Plan will be providing its final report on the pilot Healthy Rewards Program the County and Blue Shield implemented earlier this year. Based on outcomes for high-risk / high-cost participants, the County and Blue Shield will be considering next steps to focus on lower costs for the small percentage of participants that represent significant annual expenditures.
Blue Shield is being recommended for continuation without a formal Request for Proposal process because:
• They were initially selected n a Labor-Management-Retiree Request for Proposal process that specifically conformed to the County’s previous self-funded plan,
• No new options have arisen which would represent comparable design, less costs or less disruption of patient-physician relationships and
• Blue Shield represents the only option for retirees who re-locate out of the coverage areas of Aetna and Kaiser as it provides coverage to retirees throughout the world.
|