Self-Funded Insurance Committee

CITY OF HENDERSON SELF-FUNDED INSURANCE COMMITTEE MEETING MINUTES Wednesday, August 16, 2023 I. CALL TO ORDER Vice Chair Brooke Stream called the City of Henderson Self-Funded Insurance Committee meeting to order at 1:05 p.m., in the Mayor and Council Board Room, 4th Floor, City Hall, 240 South Water Street, Henderson, Nevada 89015. II. CONFIRMATION OF POSTING AND ROLL CALL Courtney Redsull, Employee Benefits Manager, confirmed the Self-Funded Insurance Committee meeting had been noticed in compliance with the Nevada Open Meeting Law. PRESENT: Vice Chair Brooke Stream Christopher Aguiar (left at 2:52 p.m.) Maria Gamboa Nick McLemore Shawn Thibeault (arrived at 1:17 p.m.) ABSENT: Chair Dan Pentkowski (excused) Bret Hyde (excused) JJ Moyes (excused) ALTERNATES: Carol Banks Joann Carter (left at 2:46 p.m. and returned at 2:49 p.m.) Michael Charlton Michael Page Michael Openshaw ABSENT: Rebecca Gillis (excused) Charles Hedrick (excused) Carlos McDade (excused) STAFF: Kristina Gilmore, Assistant City Attorney III Courtney Redsull, Employee Benefits Manager Janet Sandifer, Deputy City Clerk Christine Scott, Employee Benefits Specialist III. PUBLIC COMMENT No public comments were presented. Self-Funded Insurance Committee Meeting Page 2 of 11 Wednesday, August 16, 2023 –Minutes IV. ACCEPTANCE OF AGENDA (For Possible Action) (Motion) Member Michael Page introduced a motion to accept the agenda, as presented. The roll call vote favoring passage was: Those voting aye: Vice Chair Brooke Stream, Christopher Aguiar, Joann Carter, Michael Charlton, Maria Gamboa, Nick McLemore, Michael Openshaw, and Michael Page. Those voting nay: None. Those absent: Chair Dan Pentkowski, Bret Hyde, JJ Moyes, and Shawn Thibeault. Those abstaining: None. Vice Chair Brooke Stream declared the motion carried. V. NEW BUSINESS 1 MINUTES SELF-FUNDED HEALTH INSURANCE COMMITTEE JULY 19, 2023 FINANCE DEPARTMENT Self-Funded Health Insurance Committee minutes of July 19, 2023. (Motion) Member Christopher Aguiar introduced a motion to adopt the Self-Funded Health Insurance Committee minutes of July 19, 2023. The roll call vote favoring passage was: Those voting aye: Vice Chair Brooke Stream, Christopher Aguiar, Joann Carter, Michael Charlton, Maria Gamboa, Nick McLemore, Michael Openshaw, and Michael Page. Those voting nay: None. Those absent: Chair Dan Pentkowski, Bret Hyde, JJ Moyes, and Shawn Thibeault. Those abstaining: None. Vice Chair Brooke Stream declared the motion carried. 2 MONTHLY FINANCIAL REPORT FINANCE DEPARTMENT City of Henderson Self-Funded Health Plan monthly financial report for June 2023. Maria Gamboa, Director of Finance, reviewed the following financial reports: Self-Funded Health Insurance Fund (Fund 6051), Retiree Insurance Subsidy, and Stop Loss Restricted Cash, as of June 30, 2023. Self-Funded Insurance Committee Meeting Page 3 of 11 Wednesday, August 16, 2023 –Minutes 3 THIRD-PARTY ADMINISTRATOR QUARTERLY REPORT FINANCE DEPARTMENT UMR, Inc., quarterly report for 2nd Quarter 2023. Russell Garrett, UMR, Inc., presented a summary of this item and highlighted the following information:  Financial Summary  Utilization Summary  Cost Distribution by Claim Type  Financial Summary by Divion  Utilization Summary by Division  High-Cost Claimants (HCCs)  In Network Discounts  Diagnosis Grouper Summary  Top 3 Diagnoses Grouper Top Diagnoses  Inpatient Summary  Emergency Room / Urgent Care Summary  Emergency Room / Urgent Care by Provider  Dental Claims Summary  Quality Metrics Kelly Hall and Sarah Stephenson, with Sierra Healthcare Options, highlighted the following information:  Utilization Management Dashboard Courtney Redsull, Employee Benefits Manager, stated open enrollment materials will focus on the various resource options that are available to the members. 4 BEHAVIORAL HEALTHCARE OPTIONS QUARTERLY REPORT FINANCE DEPARTMENT Behavioral Healthcare Options quarterly report for 2nd Quarter 2023. Belinda Marchoud, Behavioral Healthcare Options (BHO), highlighted the following information from the Behavioral Health and Employee Assistance Program (EAP) Q2 2023:  2023 Q2 EAP Survey Results and Member Feedback  3 Year Trend: Q2 EAP Case Rate  2023 Q2 EAP Utilization  Behavioral Health Utilization Summary 2023 Q2  Key Program Features  First Responder Resources Self-Funded Insurance Committee Meeting Page 4 of 11 Wednesday, August 16, 2023 –Minutes  EAP Utilization 2023 Partnership in Promotion  Our Commitment to You Ms. Marchoud answered questions from the Committee members regarding whether EAP visits also include additional follow-up mental health visits, the differences between residential treatment versus in-patient treatment, and elderly care referrals. Ms. Marchoud said she provided binders containing additional promotional reference materials for Courtney Redsull, Employee Benefits Manager, to use as a resource. 5 GALLAGHER BENEFIT SERVICES QUARTERLY CLAIMS REPORT FINANCE DEPARTMENT Gallagher Benefit Services quarterly claims report for 2nd Quarter 2023. Shawn Adkins, Gallagher Benefit Services, presented a summary of this item and answered inquiries from the Committee members regarding the following highlighted reports:  GBS Estimated Accrual Plan Status Report – All Benefits  GBS Estimated Accrual Medical Plan Status Report – Active Versus Retiree  Monthly Claim Summary – Medical & Rx  Large Claim Summary  Large Claim Analysis for Plan Years 2020 through 2023 YTD  Self-funded Medical and Rx Historical Claims and Enrollment Analysis  Medical and Rx Paid Claims Historical Claims and Enrollment Analysis  Medical and Rx Paid Claims Medical Cost Analysis  Monthly Claim Report – Dental (SHO Network)  Dental Paid Claims – (SHO Network)  Monthly Claim Report – Dental (Delta)  Dental Paid Claims (Delta)  Monthly Claim Report – Vision  Vison Paid Claims Historical Claims and Enrollment Analysis Self-Funded Insurance Committee Meeting Page 5 of 11 Wednesday, August 16, 2023 –Minutes 6 PLAN YEAR 2024 SELF-FUNDED HEALTH PLAN RENEWAL REPORT AND FUNDING RATES FINANCE DEPARTMENT Review Plan Year 2024 Self-Funded Health Plan renewal report that includes estimated projected funding rate requirements for Plan Year 2024, including possible modifications to medical / prescription, dental, employee assistance program, basic life insurance, and long term disability plan funding. Direct staff to implement the funding rate model selected by the Committee. Funding rate model options include:  Retaining current funding model for medical/prescription drug, dental, and vision rates for active employees, COBRA participants, and retirees, and absorbing any anticipated funding shortage through plan reserves.  Adjust the funding model to increase medical/prescription drug, dental, employee assistance program, basic life insurance, and long term disability funding to account for projected shortfalls in the funding of these plans. This option will increase funding by an estimated 5.62 percent, or $1,150,202.88 (active employees), in Plan Year 2024.  Any additional funding model the Committee may suggest, consider, and approve. Shawn Adkins, Gallagher Benefit Services, presented a summary of this item and noted the recent legislative update that will allow pharmacists to write oral contraception prescriptions, effective January 1, 2024. Courtney Redsull, Employee Benefits Manager, stated this could present potential administrative challenges when determining whether the claim should be processed under the medical plan or the pharmacy plan. Mr. Adkins stated Carelon Rx is adamant they will not run consultant fees through the pharmacy side of the plan; therefore, they will go through UMR. He further explained the reasons this may create issues when processing the claims and the steps that are being taken to streamline the process. Russell Garrett, UMR, Inc., provided information regarding the recent legislative update that is related to gender affirmation surgeries being available to individuals under the age of 18 years of age. Mr. Adkins stated the last figure on page 78 of the backup materials for the Suggested Rate Action should reflect a total of 5.0 percent instead of 0.0 percent. Self-Funded Insurance Committee Meeting Page 6 of 11 Wednesday, August 16, 2023 –Minutes Ms. Redsull stated the parenthetical in option two of this item should reflect “for everyone” instead of “active employees.” Kristina Gilmore, Assistant City Attorney III, stated this agenda item accompanies the next item and should be considered together; therefore, Items 6 and 7 were heard together, but voted on separately. A lengthy discussion ensued regarding the benefits and drawbacks related to each option. (Motion) Member Shawn Thibeault introduced a motion to approve the funding model chosen by the Committee for Plan Year 2024 and directed staff to implement Option 1 to:  Retaining current funding model for medical/prescription drug, dental, and vision rates for active employees, COBRA participants, and retirees, and absorbing the anticipated funding shortage of approximately $1,150,000.00 through plan reserves. The roll call vote favoring passage was: Those voting aye: Vice Chair Brooke Stream, Christopher Aguiar, Joann Carter, Michael Charlton, Maria Gamboa, Nick McLemore, Michael Openshaw, Michael Page, and Shawn Thibeault. Those voting nay: None. Those absent: Chair Dan Pentkowski, Bret Hyde, and JJ Moyes. Those abstaining: None. Vice Chair Brooke Stream declared the motion carried. Self-Funded Insurance Committee Meeting Page 7 of 11 Wednesday, August 16, 2023 –Minutes 7 SELF-FUNDED HEALTH PLAN ACTIVE EMPLOYEE MONTHLY PREMIUM RATES FOR PLAN YEAR 2024 FINANCE DEPARTMENT Discuss active employee monthly premium rate tier structure options from the City Self-Funded Health Plan Proposed Funding Rates Plan Year 2024 report and consider continuing the current active employee rate tier structure, or implementing another structure as selected by the Committee. The following tier structures are available options: Option 1 – Retain Current Rate Tier Structure – Active Employee Funding Rate Not Increased. Employee Only - $92.24 Employee Plus Spouse - $220.56 Employee Plus Child(ren) - $171.09 Employee Plus Family - $280.94 Option 2 – Increase Rate Tiers by approximately 1.1 percent. Employee Only - $93.00 Employee Plus Spouse - $223.00 Employee Plus Child(ren) - $172.00 Employee Plus Family - $284.00 Option 3 – Any other Rate Tier Structure the Committee may suggest, consider, and approve. Note: This item was heard together with Item 6 but voted on separately. Courtney Redsull, Employee Benefits Manager, presented a summary of this item. She stated the purpose of this item is to formally set the rates for next year for active employees. She also said based on the fact the Committee voted to retain the current funding model under Item 6, she recommended the Committee select Option 1. Following the inquiry from Member Nick McLemore regarding how this information would be marketed, Ms. Redsull stated staff is always cognizant regarding citywide mass communications that do not apply to all employees; however, this information will be included in the open enrollment materials. Vice Chair Brooke Stream stated employees may not be aware of all the health and wellness benefits that are available to them. She said staff is working to identify the many resources that are available to release that information to the employees. She said the City does a lot of great things for its employees, and she wants to ensure they recognize them and avail themselves to those benefits as well. Self-Funded Insurance Committee Meeting Page 8 of 11 Wednesday, August 16, 2023 –Minutes (Motion) Member Shawn Thibeault introduced a motion to approve the active employee monthly premium rate tier structure selected by the Committee and directed staff to implement: Option 1 – Retain Current Rate Tier Structure – Active Employee Funding Rate Not Increased. Employee Only - $92.24 Employee Plus Spouse - $220.56 Employee Plus Child(ren) - $171.09 Employee Plus Family - $280.94 The roll call vote favoring passage was: Those voting aye: Vice Chair Brooke Stream, Christopher Aguiar, Joann Carter, Michael Charlton, Maria Gamboa, Nick McLemore, Michael Openshaw, Michael Page, and Shawn Thibeault. Those voting nay: None. Those absent: Chair Dan Pentkowski, Bret Hyde, and JJ Moyes. Those abstaining: None. Vice Chair Brooke Stream declared the motion carried. 8 EARLY TERMINATION OF PHARMACY BENEFIT MANAGER SERVICES AGREEMENT FINANCE DEPARTMENT Discuss and consider early termination of existing three-year CarelonRx Agreement for Pharmacy Benefit Manager Services, effective January 1, 2024, at an estimated one-time cost to the City Self-Funded Health Plan of $50,000.00, to be absorbed through plan reserves. The existing CarelonRx contract term is January 1, 2023 - December 31, 2025. CarelonRx was one of two finalists in the Pharmacy Benefit Manager Services procurement conducted by Gallagher Benefit Services on behalf of the City Self-Funded Health Plan in 2022. CarelonRx was selected by the Self-Funded Health Insurance Committee due to projected cost savings over the three-year term of the Agreement. Early termination of the CarelonRx Agreement would be due to incompatibility of CarelonRx service model with the City Self-Funded Health Plan approach to member service, and associated member service disruptions. Courtney Redsull, Employee Benefits Manager, provided a detailed summary of this item and noted early termination of the CarelonRx Agreement would be due to incompatibility of CarelonRx service model with the City Self-Funded Health Plan approach to member service, and associated member service disruptions. Ms. Redsull said with Pharmacy Benefit Manager Services change, Smith’s pharmacies would no longer be covered; however, Solutions Specialty Pharmacy would, which may please approximately 100 members. Self-Funded Insurance Committee Meeting Page 9 of 11 Wednesday, August 16, 2023 –Minutes (Motion) Member Michael Charlton introduced a motion to approve and direct staff to proceed with early termination of existing three-year CarelonRx Agreement for Pharmacy Benefit Manager Services, effective January 1, 2024, at an estimated one-time cost to the City Self-Funded Health Plan of $50,000.00, to be absorbed by plan reserves. The roll call vote favoring passage was: Those voting aye: Vice Chair Brooke Stream, Christopher Aguiar, Joann Carter, Michael Charlton, Maria Gamboa, Nick McLemore, Michael Openshaw, Michael Page, and Shawn Thibeault. Those voting nay: None. Those absent: Chair Dan Pentkowski, Bret Hyde, and JJ Moyes. Those abstaining: None. Vice Chair Brooke Stream declared the motion carried. 9 NEW AGREEMENT FOR PHARMACY BENEFIT MANAGER SERVICES FINANCE DEPARTMENT Discuss and consider directing staff to negotiate a new three-year Agreement for Pharmacy Benefit Manager Services with previous Pharmacy Benefit Manager, Express Scripts, Inc. at an estimated increased cost to the City Self- Funded Health Plan of $200,000.00 annually. This estimated increased annual cost is due to a combination of more favorable drug pricing discounts, and less favorable minimum drug rebate guarantees with Express Scripts, Inc. as compared to current Pharmacy Benefit Manager, Carelon Rx. Despite, the estimated annual increase over current cost, the City Self-Funded Health Plan is still expected to save an estimated $3,900,000.00 over 2022 pharmacy benefit costs to the Plan with this transition back to Express Script, Inc. CarelonRx and Express Scripts, Inc. were the two finalists in the Pharmacy Benefit Manager Services procurement conducted by Gallagher Benefit Services on behalf of the City Self-Funded Health Plan in 2022. CarelonRx was selected by the Self-Funded Health Insurance Committee due to projected cost savings over the three-year term of the Agreement, however, early termination of the CarelonRx Agreement is being recommended due to incompatibility of CarelonRx service model with the City Self-Funded Health Plan approach to member service, and associated member service disruptions that were not experienced previously with Express Scripts, Inc. Courtney Redsull, Employee Benefits Manager, provided a summary of this item. Self-Funded Insurance Committee Meeting Page 10 of 11 Wednesday, August 16, 2023 –Minutes (Motion) Member Maria Gamboa introduced a motion to approve and direct staff to negotiate a new three-year Agreement for Pharmacy Benefit Manager services with previous Pharmacy Benefit Manager, Express Scripts, Inc. at an estimated increased cost to the City Self-Funded Health Plan of $200,000.00 annually, effective January 1, 2024. The roll call vote favoring passage was: Those voting aye: Vice Chair Brooke Stream, Christopher Aguiar, Joann Carter, Michael Charlton, Maria Gamboa, Nick McLemore, Michael Openshaw, Michael Page, and Shawn Thibeault. Those voting nay: None. Those absent: Chair Dan Pentkowski, Bret Hyde, and JJ Moyes. Those abstaining: None. Vice Chair Brooke Stream declared the motion carried. 10 PLAN DESIGN CHANGE CLARIFICATION FINANCE DEPARTMENT Clarification from staff on the plan design change to the hearing aid benefit approved by the Self-Funded Health Insurance Committee at the May 17, 2023, meeting of the Self-Funded Health Insurance Committee. Courtney Redsull, Employee Benefits Manager, provided a summary of this item. She stated the subject of the agenda item does not specify that the deductible still applies to this benefit, however deductible does apply, and this has not changed. VI. CHAIRMAN\MEMBER COMMENTS There were no Chairman\Member comments presented. VII. SET NEXT MEETING Courtney Redsull, Employee Benefits Manager, stated the next meeting date would be Wednesday, September 20, 2023; however, it may be cancelled. VIII. PUBLIC COMMENT There were no public comments presented. Self-Funded Insurance Committee Meeting Page 11 of 11 Wednesday, August 16, 2023 –Minutes IX. ADJOURNMENT There being no further business to discuss, Vice Chair Brooke Stream adjourned the meeting at 3:06 p.m. Respectfully Submitted, /s/ Janet Sandifer Janet Sandifer, Deputy City Clerk