we accomplish the same thing without slaying a forest we will continue to follow the same principle i'm suggesting in the inter imperiod of time we make these decisions and open enrollment that these card will be posted on the website that will be the protocal moving forward >> aon hurt actuary correct me if i'm wrong i have presented the 10-county results in a prior meeting >> yes you have >> as a matter would you like me to repeat the results >> no. you will not repeat the results he turn to director dodd standby >> the resolution before you we present annually to the board of supervisors so they can approve the 10-county rate which is to

base many of our rates on and to base the retiree rates on if people have questions >> there any questions from the board members about the survey it's results how it's been utilized as we have done the calculations today? hearing no questions we will proceed to adopt this resolution is there a motion? >> i move to adopt. >> second >> it's been properly moved and seconded that we adopt this item is there discussion from the board? is there any public comment? hearing no public comment we're now ready to vote all those in favor, say, "aye." >> (multiple voices): aye. >> all those opposed? passed so ordered. thank you. item four. >> discussion item committee of the whole presentation of blue

shield medicare national ppo discussion options of funding blue shield retiree plans and side by side rate cards blue shield of california and aon hewitt. >> all right. i know that there are representatives from blue shield here in the audience i would like to have all of the members of the blue shield team that are here today to please stand. there are enough of them i don't think anybody could be at their offices at work. [laughter] but we're delighted you all came out ready to respond to our questions we appreciate your you effort in providing an alternative proposal to your submission to this board again it reinforces the point that competition is a powerful weapon in the market please thank you for coming introduce yourself >> i'm paul brown area vice president for account management

at blue shield and you all have the presentation material. i don't know if it's going to be shared with the audience but i will go through the presentation and note the page i'm on i will start with the introduction page as you noticed i brought a small army i won't introduce everybody else they are my back today we want to peak sure we bring all of the resources to answer whatever questions you may have about the alternative plan we put on the table there are pokes from our senior markets our medicare markets seam from pharmacy operation team as well as our claim operations. should you have questions in any of those areas we will be prepared to have those folks address you directly. i'm going to back in time a bit earlier this year as we presented what i'm going to call our status quo renewal the

renewal of your existing plans we put a proposal on the table and we were asked to consider another more cost effective option and we had discussions with aon hewitt in that regard what i'm going to present is that alternative option. note that it's apples and oranges with is what you have today it's completely different than several perspectives not only the way we administrator claims the way we get revenue but also what the member experience is with this alternative plan. and moving to the next page i want to state for the record what the existing -- >> just a moment here screen has gone black we are trying to get the presentation up for the public to see we're asking those joining us by television or

seeing this not to panic all of the information will be disclosed before we make this decision i can other sure you please if you continue >> i'm now on page three which say brief description of the status quo plans which are two plans one is shield 65 plus it's a group medicare advantage plan with a prescription drug plan those are available to those in the shield 65 service area then we also have for those living outside of the medicare advantage service area our access hmo which is administrator plan not a medicare advantage plan that is for those that reside outside of the shield 65 + service area i

would like to point out a few advantages and disadvantages on slide four to compare and contrast to the alternative plan on the table there are advantages sh and disadvantages to the existing plan number one should you stick with the existing set of plans there is no disruption stating the obvious retirees would maintain their existing coverages their pcp primary care physician and medical group selection an important thing here is they're medicare is delegated within the medicare advantage plan and well as the medicare cob plan we provide a competitive rate for the plan combination the one disadvantage is we're not anticipating as an organization

any of the plan 65 medicare advantage network so the zip codes in which that program is available will not change in 2016. so our alternative plan is one program instead of two. it's one program. it is a supplement to medicare pp o. or prepared provider organization with the prescription drug plan. just to be clear this is our full national net, work this is not limited to california and it's a coordination plan with medicare so medicare will pay primary and the supplement to medicare ppo plan will pay the portion that medicare does not pay up to the benefit level we

provided >> will you stop there for a moment and when you say full national network what does that mean? >> blue shield has a statewide ppo network with 70,000 physicians from san diego county to the far reaches of northern california and central valley that full network would be available to all members enrolled in this plan should you choose it. in addition it would be available nationally blue shield is part of the blue shield cross and blue shield association we have access to all of the blue shield blue cross network so it's a truly a pochlt network >> that is not the case with the current plan we have? >> it is not. >> thank you. >> how large is the national network? >> i don't have the number of providers but it is in excess of

95-94% of all providers in the united states. it is the largest network by far of all of our competitors. the pharmacy piece of this alternative option is the existing plan. so nothing would change respect to the egg wip prescription drug plan should you elect this alternative. there are supporting programs moving onto slide six members will continue to have access to the nurse help line and life referral plan for personal financial and legal advise. there are other programs that they have today that would not be a part of this program programs like disease management and case management are not part of the supplement to medicare

plan. similar to the status quo i would like to point out advantages and disadvantages to the supplement to medicare ppo first i will go through the advantages as i mentioned retirees would have access to not only our full california network but access to our national ppo through the blue shield and blue cross association. this may be an advantage or disadvantage but there is no medical group. it is not a delegated model nor would members be required to select a primary care physician. as a result of that they will be allowed to self refer to specialists it is truly a fee for service program again medicare pays first we're paying the claim supplement to medicare so they have free access to any specialist within our network.

we were asked to craft a plan that was similar in design to the existing medicare advantage plan. so we have flexibility when we design this type of coordination plan. and we have in your packet prepared a full plan design the first two columns are the existing plans the status quo plans the third and 4th column respect the in and out of network components of the medicare cob plan. it's worth mentioning most of the providers in the shield 65 + plan are also in the ppo. in a moment i will also talk about those exact numbers. on slide nine there are disadvantages that i want to call to your attention. there is no clinical management by blue shield or the medical groups as i mentioned in the

existing plan we do disease and case management. the medical groups have their own intervention it's a delegated model so they're responsible for care delivery within their capitated contract arrangements all of that will go away should you move to a medicare cob clan. and that lack of clinical management could in the future impact utilization we want to be really clear about this. i mentioned at the beginning this is a little bit of apples and oranges medicare advantage is different from medicare cov plan should the utilization increase that could impact future rates we want to make that very clear. other components such as gym discount silver sneakers is not available. under the supplement to medicare ppo in the process of actually

presenting your id cards at the point of care is different. so today you got medicare advantage card with blue shield and you have a pharmacy card with us. with the cob plan very similar to the access plus plan that is in existence today the member would present both their medicare card and blue shield supplement to medicare ppo card. at that point the provider would submit the claim to medicare first and blue shield would pay supplementary to that. much in a way i believe as the city plan works for retirees. moving to the next slide we got a slide on which you don't appear to have in the deck it's in the hard copy which is

network overlap. we wanted to take a look at the exist existing primary care physicians that are used by retirees so we took the existing inventory of all the primary care physicians that each of your retirees are assigned to today and matched that against our ppo network it's in the hard copy the summary is 1.9% of the retirees would be impacted by a change to the supplement to medicare ppo program because their primary care physician is not in our ppo. so 98.1 are in one are out. it's important to note when we do this type of disruption that you not only look at the

disruption but you also look at the benefit to those today who may not have access to provider they want to see that they now will have access to. we do hear noise throughout the year for some providers who are not in our medicare advantage hmo or medicare advantage cob plan that members might like to have access to too so this is actually somewhat of an advantage and disadvantage. >> i understand that. if there a request by this board you would try to contract with those providers do you have a process in place to do that. providers come in and out of networks all the time that is the nature of the business i understand that. when we know we're going to have to type of impact will you have a plan in place or could you have a plan in place to narrow? >> yes.

so we do have the ability to attempt to recruit physicians not in the network. and we have a process for that. there is obviously no guarantee we can get a provider to join it's also worth noting with this plan the member is going to 88y % coverage with medicare with and out of network provider and there is an out of network benefit that does exist today but yes to your direct question we can in fact recruit providers >> all right so you will have a reimbursement option for outof network care if that physician is not part of this network ultimately after approached or if they are you would have access to that physician under this umbrella? >> yes.

so in the design if you look at the attachment the outof network benefit has a $500 deductible for most care then 90% coverage following that. after retiree has reached $500 out of pocket maximum virtually everything at that point is covered at 90%. again medicare is paying primary this is a very large network it's rather difficult actually to find providers who are not in the ppo network should somebody have a direct need to see a provider we will try to recruit them number two as a fall back, they will have coverageage they don't have today. >> questions? >> there are a lot of things not covered under network. specifically preventive care there say whole list of them

>> yes that say a good point >> what do you do all of that out of network none of those would be covered >> correct to the degree they will could covered by medicare they would have coverage there we as a blue shield policy ppo plans do not cover preventive care with nonparticipating providers >> that is no different than today is that correct? >> well today we don't cover anything for non-- >> just for a point of education i'm trying cocompare and contract >> that care would not covered. >> it would not be covered at all >> correct. >> is the mills peninsula group in paloalto a part of this group. >> yes they are >> mills peninsula.

>> pal low alto >> yes they're in our ppo >> those are the two not covered before for the seniors >> correct >> they will be now >> yes >> how many are there? do you have any idea >> providers? >> members down there? >> boy i don't know. i don't know if i know that. >> we will refer to director sh dodd to do research on that we can continue. >> part of the disruption we should be able to part of that information, and we also did geo access by county you can see how many people by each county >> these people turn 65 now and they're not being able to go to their doctors as of now >> correct >> if they went into this doctor they would be able to stay there >> that has been another point of noise within our plan an existing member active member

early retiree goes into their medicare advantage network they don't have the same access network they have today. >> so i don't have the exact blue shield numbers but i will tell you that san francisco has in terms of the retiree memberses has 12,221 san ma matao has 689 members -- >> i was inqueering about that group the mills pen anyone la and paloalto group there are ones coming in all the time -- >> it's 2012 >> people are turning 65 it's a constant problem. that's okay -- >> if you listen to our chief operating officer that sun one of the chief complaints that blue shield members make >> i know. it's been a problem. >> and this would be a

corrective to that. >> might be one of the positives. >> yeah santa clara we don't have it completely rolled up >> but they would all be covered >> they're all in the network yes. this is of course our population 95 people in sanmateo county and it looks like about the same in santa clara county. which is where palo alto -- >> we have another 135 right now that will not be in the network a new 135 that will not be -- >> right. >> where are these people? they're obviously in california probably right? >> yeah. pltalo alto --

>> they're virtually in the bay area they're further out today. >> you are pretty sure you can accommodate all of these people in some way? >> to the medicare pp o.? yes. again it's ape ls and oranges it's one large ppo network. >> please continue. that was the highlight of the advantages and disadvantages of both plans, in the appendix we provided a sample of the id cards making the point that general medicare is primary they would have to show their medicare id card as well as blue shield card and they would following that particular slide

have a separate prescription drug card so it is different from a service experience level today different id cards it's not a delegated model the payment isn't today like it is today the $25 koe payment at the point of service they will get a pill this is not a bill from blue shield so that is different today. >> also on page one of this here in-network services under out-of-pocket maximum the new in network would be 6005 and the new one is 2,000.

that is quite a jump. >> yes it is the jump. >> i thought it would be the opposite for blue shield 65 +. that's a huge jump. >> yes. >> >> $4,000 >> with work with our product people why there is such a high maximum. >> please identify yourself >> chris parerrez blue shield account manager i think your question is you are asking about the annual out-of-pocket maximum >> yeah, the access now is only 2,000 for an individual 4,000 for a family and new ppo it would be $6,350 for an individual and 12,700 for a family.

>> that is correct. so the majority of your folks today are covered under the gmapd which is the 65 + plan out of about the 7,000 people that we cover currently about 5300 aren't in this plan so we modelled the national ppo plan we wanted to model it out of the current hmo plan that is offered to the majority of your people. if you notice that that third column where it says shield 65 + annual out-of-pocket maximum is 6,000 per individual >> i was looking at the access i don't know how many people are in the access >> 15 to 1700 >> out of area >> they're out of the gopd 65 +

service area so in actuality the new national ppo plan we're offering has a lower annual out-of-pocket maximum than the current 65 + plan. >> i see that one. >> all right is there more clarification on this point? i think i see someone to wrour right paul >> my name is charles lee with the medicare product organization to piggy back on what chris is mentioning about might be roring the 6700 for the gmpd program for 65 + the reason it's set at that level is initially when we modelled the benefits was the fact that the benefits overall for ccsf is so rich that getting to that 6700 number oftentimes you know actually would be beneficial if we left it at that figure it

would help actuarily to lower those the rates so the folks due to the generous plan design to get to the 6700 there wouldn't be as many folks to get there. so as a result of that logic then the 6700 was left there to reduce the overall rates to the city and county. >> it's about risk at the end of the day >> just one more reminder the national ppo plan that we're offering as far as -- there is no deductible all of the copays mirror the existing shield 65 + plan. so the likelihood of hitting this out-of-pocket maximum is probably very slim. >> all right. thank you.

continue >> following the xiktexhibits that concludes my portion of the presentation >> all right. are there further fe from the board >> i have a question i'm concerned about here. where are the pluses the minuses are here. >> i would like to raise one issue you identified this i think correctly. and it is in your disadvantages around this particular program without clinical management. and i want to say to our actuary and to the director that should we adopt this plan this will be an area of continued monitoring concern during the year. i think it's something we will

have to pay attention to. we try to talk about large community based disease management programs and so port we haven't done an expert job at that even though we have at other plans the fact that we're acknowledging it's not there that gate or whatever it is that threshold is not there is a concern for me it is one of the thingses we will have to actively monitor closely at the end of the day it will inmruns our rates the risk of this group it's something we have to pay attention to. i don't know if your plan designs in a larger context with all of the wellness things medicare and others have been talking about if that is not a point of emphasis you want to consider to be a future feature of this plan you know what the comment ailments are for this

population hert disease diabetes that would be something you want to incorporate into your design going forward >> it's a good point i would add that when they're paying 80% of the bill doing disease management when actually cms ends up getting the benefit of that work it's not cost effective for us with the active population in the aco work we do that doesn't apply here we have seen really good work er emissions down and length of