BENEFITS ADVISORY COMMITTEE

MINUTES OF MEETING

MAY 15, 2003

[These minutes reflect discussion and debate at a meeting of a committee of the University Senate or Twin Cities Assembly; none of the comments, conclusions, or actions reported in these minutes represent the view of, nor are they binding on the Senate or Assembly, the Administration, or the Board of Regents.]

PRESENT: Linda Aaker, Gavin Watt, Pam Wilson, Karen Wolterstorff, Jody Ebert, Brenda Peltzer, Don Cavalier, Carla Volkman-Lien, Wendy Williamson, Frank Cerra, Gailon Roen, Susan Brorson, Steve Chilton, Richard McGehee, Peh Ng, Marjorie Cowmeadow, Theodor Litman, Dann Chapman, Keith Dunder

REGRETS: Fred Morrison (chair), Joseph Jameson, Carol Carrier, George Green, Amos Deinard

ABSENT: Ronald Enger

OTHERS: Karen Chapin, Chris Hulla, Kathy Pouliot, Jackie Singer, Pat Yozamp, Kathy Witherow

I). Vice Chair Gavin Watt called the meeting to order. Mr. Watt indicated he was filling in for Professor Morrison whose mother passed away. The Committee extended its sympathy to Professor Morrison.

II). Mr. Watt announced that following the May 1, 2003 BAC meeting the Polycom conference phone was stolen from room #101 Walter Library. If anyone knows where it may be or saw anything suspicious, they are asked to contact Renee Dempsey, Senate staff.

III). Dr. Frank Cerra, on behalf of the administration, provided members with the administration’s recommendations to the BAC Report on proposed changes in health care benefits. A handout was distributed which outlined the administration’s recommendations. Dann Chapman noted and corrected a few typos.

Dr. Cerra noted, from an administrative perspective, it is very apparent how much effort the BAC put into their recommendations and final report. He further noted that the administration was able to preserve all covered service benefits, which was no small feat. To frame his presentation, Dr. Cerra used a chart to illustrate projected increases in total compensation per full-time employee between fiscal year 2001 and 2005 in terms of salary and fringe. Assuming no changes were made to the benefits and compensation structure in 2004 and 2005, fringe costs would increase by 30% and salary costs would increase by 14%.

To preface his comments on the administration’s recommendations, Dr. Cerra noted that these recommendations are pending bargaining unit contract negotiations and, thus, not final. Listed below are the administration’s recommendations, a majority of which are the same as the BAC recommendations, but not all: (Please note – all changes are proposed to take effect January 1, 2004 unless otherwise noted. Also, * indicates that the administration’s recommendation differs from BAC recommendation.)

Double office co-pays as of January 1, 2004.
Make co-pays uniform across all zones.
Increase prescription co-pay to $15 for formulary, $30 for non-formulary and $50 for lifestyle drugs.
Maintain current prescription out-of-pocket (OOP) co-pay for 2004 ($500 employee only coverage and $1,000 for family coverage) and in 2005 increase the maximum OOP co-pays to $750 and $1,500, respectively.
Standardize prescription-dispensing amounts.
Reimburse to UPlan co-pay limits for prescription COB to pure carve out.
Eliminate lab co-pays.
Offer an opt-out option.
Institute a longer waiting period for new employees to be covered by health insurance. These employees will be able to purchase coverage through the University until their benefits become effective.
Offer family coverage as an option for families where both spouses/partners are University employees.
Increase stop loss insurance (already done).
University contribution to the base plan for employee only and family coverage will be paid at 90% in 2004. *In 2005, the University’s contribution for employee only coverage in the base plan will remain at 90% but be reduced to 85% for family coverage.
University contribution to the dental plan for employees will be paid at 90% and 60% for families in both 2004 and 2005. In order for this to occur it will be necessary for Delta Preferred to become the base plan option.
*The University of Minnesota Physicians (UMP) care system will be left in the base plan. By doing this, University savings will be reduced by $1.3 million. The main reason this variable was retained is because of employee demand. With current data it is impossible to decipher how much of the cost of the UMP care system is attributable to UMP versus Boynton Health Services. Boynton offers a multitude of services for the University above and beyond health care. Additionally, the administration will be investigating what portion of UMP costs can be assigned to acuity versus inefficiency. The University will be sending a very clear message to the UMP care system that their performance is on notice. University of Minnesota Physicians will be provided with University data once it has been collected and expectations will be set, especially if this is an efficiency issue.
*Retain 2-tier structure for 2004 and consider either a 4 or 5-tier system or even possibly a defined contribution plan for 2005.
Operate under the 2% of gross salary rule from January through June 2004 only at this point.

Based on these recommendations, the administration estimates gross fringe pool savings at approximately $14 million. Dr. Cerra reminded members that for every million dollars saved, this translates into 17 – 20 University jobs and reduces the need for programmatic reductions.

Additional items for consideration in FY 2004 include:

A University-wide pharmacy management benefits (PMB) plan.
A strict HMO for UMP/Boynton patrons.
Continued efforts on implementing a wellness program.

The brunt of premium increases in 2004 will be borne by University employees at a ratio of approximately 4:1. Then, in 2005 these ratios basically flip flop. To conclude, Dr. Cerra noted that the University and its employees will contribute nearly equally to the incremental cost increases in health care for 2004 and 2005.

Discussion highlights following Dr. Cerra’s presentation:

It is critical that the UMP care system feel the same pressure to operate efficiently as other care systems. Dr. Cerra agreed and noted that the reason behind UMP’s inability to operate cost effectively needs to be determined. Is it an efficiency issue or is it due to the acuity of UMP patients? If it is the inefficiency of the care delivery, the UMP Board of Directors and the Boynton Health Services Board of Directors need to be notified that this is not acceptable and a plan must be put in place to correct it. If the problem remains, UMP would need to be removed from the base plan. Presently, risk adjusted models fail to explain the component of the UMP care system that is responsible for the efficiency issue. If a majority of the problem is attributable to the acuity of UMP patients or an efficiency issue that could be corrected with incentives, premiums and/or the risk management structure of the care system could be adjusted to take these factors into account. Dr. Cerra recommended the BAC take an active role in monitoring the UMP care system’s performance. After all, retaining UMP costs the University $1.3 million annually and this is money that is subsidized across the system.
How has UMP’s efficiency been measured up to now and how will it be measured in the future? Going forward, data stored in the Ingenix, Inc. data warehouse will be used to evaluate UMP’s performance. Prior to this, the University relied on claims data tapes from Blue Cross/Blue Shield (BCBS) and Medica. The BCBS & Medica data was never properly shared with the BAC according to Dr. Cerra. This data suggests strongly that the cost of the UMP care system was primarily due to an acuity issue.
A member announced that the University Education Association (UEA), the Duluth faculty bargaining outside of the medical school, regards the existence of UMP as a subsidy that is given to Twin Cities faculty but not given to UMD faculty. If UMD faculty want to access a tier III facility they have to pay for it because it is not part of their base plan. Dann Chapman stated that the UEA has filed a grievance around this issue.
Is UMP aware of the University’s concern about its performance? Dr. Cerra noted that the UMP leadership is aware of the concerns and he is confident that soon UMP physicians at large will also be aware.
When can the Committee expect to hear a report on UMP? Dr. Cerra said that information should be available around November 2003. In the meantime, the University will be learning how to use the new data warehouse and query the information that it wants to extract. Gailon Roen of Boynton Health Service requested to be involved in the data collection and review process. Up until now Boynton Health Service has been frustrated by the lack of data on their performance as part of the UMP care system. Currently, Boynton knows what they bill and what they get paid but does not know how this relates to other care systems.
A member requested more information about the idea of a strict HMO that the administration plans to look at in 2004. Dr. Cerra replied that the idea of a rigid HMO for employees who want to receive their care on-site at the University has only been discussed briefly. Questions that remain to be answered include:

What care systems or portions of care systems would participate?
Would Fairview University Medical Center (FUMC) be the hospital of choice for the HMO?
Will the HMO be able to offer a quality basket of covered services?
What would this type of HMO cost?

Dr. Cerra believes that the BAC would definitely need to be involved as discussions on this idea move forward. This would not be an easy model to assemble. Risk corridors are much different with a model that involves 4,000 – 5,000 people as opposed to 30,000 people. From a theoretical level, this is an idea that deserves more attention to determine its feasibility.

A member asked for an explanation of why savings estimates need to be adjusted to include the graduate assistant health insurance plan. Dr. Cerra noted there was an underestimate in the inflation cost of the graduate assistant health insurance plan by approximately 3.5%, which translates into approximately a $3 million problem. As a result, the final fringe pool cash that was expected to be available in the University’s budget, $14.1 million, needs to be recalculated and $3 million subtracted to account for the increased cost of the graduate assistant plan. Therefore, the net gross estimate of the fringe pool is approximately $11 million. Dr. Cerra noted that President Bruininks has asked the Administrative Work Group to explore whether the graduate assistant insurance plan should be incorporated into the self-insured UPlan. Again, the BAC’s involvement in this matter will be critical.
A multi-tier system is not being considered for 2004 because it would represent “too much change”. What does “too much change” mean? Because of the already large number of cross subsidies that will be occurring within the UPlan in 2004, the administration felt it would not be wise to implement a multi-tier system in light of all the changes that will be occurring. There will be further investigation into the impact of implementing a multi-tier system as well as the possibility of offering a defined contribution option for 2005.
Is there still the assumption that there will be no salary increase in 2005? No, Dr. Cerra stated that the budget model for 2005 includes a 2.5% salary increase. There is no central money, however, for that salary increase; it is all unit-based because the University will not receive money from the State for it.
How many employees are expected to opt out of purchasing University health insurance for 2004? Roughly 1,400 employees will probably opt out. The opt out option has been predicted to be cost neutral. A member expressed the concern that some people may choose to opt out without other coverage and if they become ill it is likely they would miss more work than someone with health insurance. Dann Chapman noted there was a great reluctance on the part of the administration to offer an opt out option but under the circumstances there is no choice.
What is the University’s vision for the future? Dr. Cerra stated frankly that in his opinion the University has no clear vision of where it will be in 5 years; there are too many unknowns. Dr. Cerra also believes the University lacks a vision for a compensation plan. There are approximately $31 million of reductions in administrative costs and program reductions currently in process. Some of the vision for the University will be defined based on these unit reductions but the vision for the whole University does not equal the sum of the units. The vision will ultimately have a lot to do with the University’s continued decline in State funding and what the University thinks of itself on several levels. Dr. Cerra agreed wholeheartedly that the University needs a formative vision of its future because a vision drives a university’s finances.
Has the University factored into its figures the cost of the additional .5% for the Minnesota Care Tax? No, because this is not a University expense but rather an expense of each care system.

To conclude, Dr. Cerra reiterated his earlier comment and thanked the Committee for their thorough and thoughtful analysis. Gavin Watt verified with Dr. Cerra that the information he shared with the Committee is public but subject to bargaining negotiations. The information shared with the Committee today is the basis of Dr. Cerra’s and Dann Chapman’s presentation to the Board of Regents in June.

Dann Chapman added that the administration truly values its relationship with the BAC. The administration took the BAC’s recommendations very seriously when considering its own recommendations.

IV). Karen Chapin explained a change that Employee Benefits plans to implement on January 1, 2004 for calculating basic life insurance premiums. Currently, premiums for basic life insurance are calculated using an average premium of $5.10 per person, per bi-weekly pay period. This same methodology is used to calculate premiums for part-time employees and former employees on COBRA who pay for their own basic life insurance.

A more typical approach is to use a specified rate per $1,000 of coverage per month. By using an average calculation, lower paid employees (up to $50,000/year) are paying more than they should for coverage and higher paid employees ($75,000 +) are paying less than they should.

Effective January 1, 2004, the University intends to change the method of premium payment for basic life insurance to the actual bi-weekly rate per $1,000 of coverage. Reasons for the change in how life insurance premiums are calculated include:

This is a more accepted approach to calculating premiums.
This approach is more equitable because employees pay for their own coverage versus an average rate.

Dann Chapman noted because the basic life insurance plan is an insured plan, the University cannot risk underpaying Minnesota Life without serious consequences. As a result, the University has had to slightly pad the premiums and pay them more through the end of each year at which time Minnesota Life will reimburse the University for any overpayment. Implementing this approach solves some of the risk in terms of the plan’s administration.

V). Interim employee insurance coverage will only be available for medical coverage for three reasons:

It is complicated to administer.
Other insurance coverages offered by the University are through insured plans and it is difficult to make arrangements through these plans for such short periods of time. There is increased risk when offering temporary, short-term insurance because the individuals that enroll usually need the coverage.
The BAC meeting discussions have focused on medical insurance.

Employees signing up for interim coverage will be given a limited amount of time to make this election and will need to pay by check. Payment will need to be received before coverage would go into effect.

VI). Other Business: A member asked what happened to the University’s funds in reserve at the State? Those funds are still in dispute according to Mr. Chapman. This member believes that that money belongs to University employees. The administration agrees that the money belongs to University employees and if the University receives the money, input will be solicited and a decision will be made as to how to use the funds to benefit employees. The University is considering whether to pursue this matter legally. Additionally, there has been talk that the Minnesota legislature may try to take these funds.

VII). Future Meeting Schedule: Mr. Watt announced that the next BAC meeting is on June 5^th, 2003. A member asked whether any meetings are planned for July or August. Renee Dempsey, Senate staff, noted that there is a meeting scheduled for July 31^st, 2003. It was also noted that there is a tentative BAC meeting scheduled for June 19^th, but this meeting is only tentative at this point in time.

VIII). Hearing no further business, Mr. Watt adjourned the meeting.

Renee Dempsey

University Senate