The Oregon Educators Benefit Board has delayed its request for new proposals until early July because it needs more time to develop the scoring methodology and analyze the performance and review standards. The board intends to meet again April 28 to review those elements.
Ultimately, the new contracts are intended to create more transparency and increase the quality standards for OEBB’s 148,000 members who include school district employees, retirees and dependents.
Insurers that bid on this new contact will be encouraged to participate in the Leapfrog Group survey, which measures performance standards, according to Denise Hall, deputy administrator.
Currently, only nine Oregon hospitals share such data with Leapfrog-- Adventist Medical Center, Kaiser Sunnyside, Providence Medford, Providence Milwaukie, Providence Newberg, Providence Portland, Providence St. Vincent, Providence Willamette Falls and Tuality Healthcare.
The Oregon Health Quality Corporation will also play a role in the new contracts, Hall confirmed, and asking the proposed carriers to measure their quality of care and promote evidence-based guidelines.
OEBB now offers 27 medical plan options including three Kaiser HMO plans, eight Moda statewide PPO plans, eight Moda Summit Network plans and eight Moda Synergy plans.
Under the new contracts, it’s likely fewer health plan options will be available, Hall said. “At this point we don’t know how many plans will be offered, but with fewer plans it will be much less confusing and easier for everyone.”
Whoever decides to submit a bid proposal must offer an integrated model of care, and demonstrate best practices, offer clinical guidelines, abide by the recommendations of the Health Evidence Review Commission, focus on outcomes and adhere to the Triple Aim – lower cost, improving the patient experience and their overall health.
Right now there are also 900 different employee groups in OEBB –which are part of an estimated 500-600 collective bargaining units -- some of whom are represented by the Oregon Education Association and OSEA, a labor union which represents 20,000 education employees. Also, OEBB represents 247 employers, including school districts, educational service districts and community colleges.
Besides medical plans, OEBB also offers dental, vision and long-term care coverage, however those benefits will not be part of the RFP process, because of affordability, Hall said. Under the Affordable Care Act, an excise tax that starts in January 2018 will slap a heavy penalty on health insurers whose medical premiums exceed the established threshold of $10,200 per year for employee-only coverage and $27,500 for family coverage. “That’s why it’s not a good financial decision to combine these plans,” Hall admitted.
In the 2015 plan year, which starts October 1, OEBB needs to keep its inflation rate at 4.4 percent, while the following year, it’s limited to a 3.4 percent increase for the new coordinated care model plans.
Nine school districts remain outside OEBB, and prefer to negotiate their own health insurance contracts. They include Beaverton, Medford, Ashland, West Linn and Wilsonville and together represent 18,000 employees. Up until the 2013 legislature, those districts had to meet a comparability assessment, showing their insurance costs did not exceed those of OEBB.
The Public Employees Benefit Board, which insures 130,000 state employees and their dependents, began its coordinated care model this January and chose the following plans: AllCare and Trillium – both of which limit benefits to Medicaid and Medicare recipients; Kaiser, Moda and Providence. Balance by Trillium.
New administrator
OEBB and the Public Employees Benefit Board have been without a permanent administrator since the departure of Joan Kapowich, over a year ago.
Both boards anticipate convening in the next few weeks to choose her successor, and three candidates are under consideration, Kathy Loretz, PEBB’s deputy administrator, told The Lund Report. Right now, she said, it’s a matter of finding a mutually agreeable time when both boards can meet.
Diane can be reached at [email protected].
