Health Insurance Committee

Health Insurance Committee

Kalispell Public Schools

Date: Thursday, September 24th

4:00pmGlacier High School Library

Members: Barb Zavodny, Burt Inabnit, Dawn Ann Anderson, Deb Hunt,Bette Albright, , Greg Letourneau, Lisa Lykins - Chair, Mike Lincoln, Mike Thiel, Niki Dykstra, Sylvia Heselwood, Warren Lane, Alex Schaeffer, Karen Mainolfi

Advisors:Gwyn Andersen, Tracy Scott, Mark Flatau, Braumlee Boyce, Dave Schultz

Consultant:Michael Young, Consilium

(Names marked through we not in attendance at this meeting)

AGENDA

Financial ReportGwyn Andersen

-Gwyn did not have a report for the committee

-Gwyn reported that she was told by OPI she couldn’t continue to move monies among accounts as

she had been. Kim Downey and OPI are at odds about how accounts/monies should be

handled. Gwyn is working with them to reach a consensus

-She had to transfer $20,000 from county to cover claims for last month.

-Committee members question that all claims were legitimate medical claims.

-Committee needs financial reports monthly to know where we stand financially and to confirm

that all expenditures were legitimate.

Board Representative for ConsortiumLisa Lykins

Postponed

First Choice Year in ReviewMike Young

-First Choice Health reps Randy Smith, Sara Kasper, Rob Hunter and Ruth Baker provided the

Committee a lengthy summary regarding KPS claims/usage/cost.

Highlight:

The 2014-15 membership =1,525 ppl (employees/spouses/dependents)

Medical costs are 34% below the comparable Milliman Benchmark.

Plan has an older population as 8% of our members are retirees (over 65 years of age)

FCH claims accuracy was 99.3%

FCH claims turn around within 15 business days was 99.6

FCH service of coordination of benefits saved the KPS plan money

Pharmacy costs driven by cancer drug costs

KPS medical costs increased by 13.9%, but remain well below Milliman benchmarks; KPS Med and

RX costs $224.39 PMPM vs $385.11 for Milliman

Top 15 of members are typically 30% of total medical costs for book of business; top 1% consists

of 15 members

91% of urgent care visits were at MedNorth Urgent Care in 2014

Outpatient surgery/services increased 17% due to multiple procedures for individuals with

cancer or pregnancies

KPS plan members are utilizing the ER appropriately

7 major cases were referred for diagnostic case management – Kidney/Urinary tract (29%);

Mental Disease & Disorders (29%); Infectious diseases & Disorders (14%)

Highest Claims from 5 cardio conditions; 5 oncology conditions; 2 gastro conditions; 1 back

condition; 1 immune conditions; 1 neurological condition; 2 mixed conditions;

Highest RX utilization were from 2 cases with oncology conditions on maintenance chemo; 1

neurological condition

Chronic conditions of plan members include (in order of cost to plan) cancer; musculoskeletal

conditions, neurological conditions; hypertension; diabetes’ asthma; mental

health/substance abuse; gastrointestinal disorders; thyroid disorders

POTENTIAL STRATEGIES:

1. educate members on urgent care resources vs ER
2. encourage members to establish a relationship with a local primary care provider
3. encourage primary care use over urgent care
4. increase education and engagement with case managers when appropriate
5. educate members on importance of preventative care screenings
6. promote Choosing Wisely Initiative to help eliminate waste in healthcare
7. continue to pursue provider network contractual advancements
8. ask KRMC for a list of elective service costs; what is their charge master for costs?

Discuss Mammogram Billing IssueLisa Lykins

-Asked if all mammogram billing issues had been resolved. Braumlee and Mike feel that this has

been resolved with KRMC.

Amendment for WigsLisa Lykins

-Lisa proposed an plan amendment to cover the cost of real hair wigs. She read a letter from Sylvia

Hesselwood that shared a her thoughts from a personal perspective

-Mike Young will bring potential language for this amendment to the next meeting

Enrollment Numbers ?Braumlee Boyce

Wellness Program Screening UpdateBraumlee Boyce

-Per Braumlee there has been a good turnout for wellness screenings so far. Will also be offering 4

Saturdays at the Summit

-RFP for flu shot has close. KPS will be going with Costco. Shot clinics will take place at

GHS/KMS/FHS with extended hours. Members at site other than those designated can go to one of the three designated sitesOR can use a flu shot card to be used at Costco at their convenience.

FSA Maximum Deferral AmendmentMike Young

There has been a new governmental increase in allowable flexible spending account contributions.

Members may contribute no more than $2550 per plan year to their flex plan. This change

requires an amendment to the plan documents.

MOTION

Dawn Ann Anderson moves to accept the new amendments to the plan documents to reflex the new governmental increase.

2nd - Warren Lane

Committee unanimously accepts amendment

Summer Claims AnalysisMike Young

-The plan ended the year with claims far exceeded funding. Claims for March, April and June were

extremely high.

-Finished with a 115% loss ratio; luckily we has $2 million in reserves to cover claims

-Had 14 cases that exceeded $60,000.00

-Plan was over budget by approx. $500,000 due to large claims

-Received $186,000 back from stop loss carrier due to large claims cases

-Hope this is a one year event

-Dental & Vision for 2015-16 is starting off high; will most likely come down, but need to watch

closely

Consortium UpdateMike Young

FLATHEAD GROUP

-Bigfork joined the Flathead group this year making 10 schools with approx. 260 ppl this year

-Flathead group finished year with 97% loss ratio

-claims were at just 76 of funding resulting in approx. $375,000 in reserves, more than enough to

pay claims run outs

-Flathead group has started this year off at approx. 80% funding which puts them in good position

WHITEFISH SCHOOL DISTRICT

-had a 93% loss ration at end of 2014-15 year putting them in a good position and indicating they

are charging correctly

UPCOMING MEETING DATES:

October 22, 2015

November 19, 2015

December 17, 2015

January 21, 2016