BENEFITS ADVISORY COMMITTEE

MINUTES OF MEETING

MAY 18, 2006

[In these minutes: Medica Review]

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

PRESENT: Gavin Watt (chair), Linda Aaker, Tina Falkner, William Roberts, Karen Wolterstorff, Rhonda Jennen for Rita McCue, Penny Morton, Sandi Sherman, Curt Swenson, Don Cavalier, Joseph Jameson, Michael Marotteck, Carla Volkman-Lien, Amos Deinard, Richard McGehee, Peh Ng, Theodor Litman, Rodney Loper, Dann Chapman

REGRETS: Jody Ebert, Carl Anderson, Gladys McKenzie

ABSENT: Carol Carrier, Frank Cerra, George Green, Fred Morrison, Keith Dunder

GUESTS: Medica representatives Caroline Bauleke, Ann Earl, John Enger, Christina Finn, Judy Reger, Christel Webber

OTHERS: Bob Altman, Linda Blake, Ted Butler, Karen Chapin, Ronald Enger, Nancy Fulton, Betty Gilchrist, Shirley Kuehn, Kathy Pouliot, Christina Swenson, Katie Theis

I). Gavin Watt called the meeting to order.

II). Employee Benefits’ Announcements:

a). Dann Chapman introduced Benefits Specialists Katie Theis and Christina Swenson.

b). The Twin Cities campus farmer’s market will open on Wednesday, July 5 and run through August 30^th; hours will be from 11:00 – 2:00. The Duluth campus will also hold a farmer’s market on Wednesdays through mid-September from 2-4:30 in front of Kirby Plaza.

c). Members were urged to participate in the Wednesday Wellness Walks. On the first Wednesday of each month between May and September, when the siren sounds, employees are encouraged to walk for 20 minutes on work time. If this time is not good, employees can make alternative arrangements with their supervisors.

III). Medica Vice President of Strategic Accounts Christine Finn thanked members for the opportunity to address the committee, and asked that her Medica colleagues introduced themselves:

• Ann Earl, director, Care Management
• John Enger, manager, Client Services
• Judy Reger, senior strategic account executive
• Christel Webber, account manager
• Carolyn Bauleke, supervisor, Customer Care

Judy Reger noted that Medica implemented six different plan designs for University employees. Information concerning plan enrollment through March 2006 was provided:

• Elect/Essential – 4,433 employees (49% of Medica total UPlan contracts)
• Choice – Regional – 1,118 employees (12%)
• Choice – National – 1,833 employees (20%)
• Insights – 1,353 employees (15%)
• HRA – 196 employees (2%)
• HSA – 58 employees (.6%)

1. Medica Elect/Essential is the base plan and lowest cost option for employees on the Twin Cities and Duluth campuses. This plan has both in-network as well as out-of-network coverage. Individuals enrolled in this plan must designate a primary care clinic; however, family members may select different clinics within a chosen network. Clinic changes are permitted on a monthly basis. The Elect/Essential product allows for open access to ob-gyn care within the participants care system and to chiropractic care, mental health/substance abuse care, preventive eye care and urgent care within the network. Out-of-network coverage is also available.

2. The Choice Regional product is the base plan for Greater Minnesota. This plan utilizes the Medica Choice network with over 12,000 physicians and over 190 hospitals. Choice Regional is an open access plan, which does not require referrals, and does not require selection of a primary care clinic. Under this plan, coverage is available when accessing out-of-network providers.

3. Medica Choice National allows members’ access to more than 600,000 physicians and health care providers through United HealthCare’s national network when traveling outside the Medica service area. Other plan features include: open access, no need to select a primary care clinic and in-network and out-of-network coverage.

4. Insights by Medica is an open access, tiered network plan. Tiers are based on cost, efficiency and quality. Co-payments vary by tier. Plan participants can access any provider in the network in any tier without a referral and there is no need to select a primary care clinic. Both in-network and out-of-network coverage are available through this plan.

5. Medica Direct HRA and HSA plans utilize the Medica Choice network. These plans are open access and there is no need for members to select a primary care clinic. Both in-network and out-of-network coverage is available under these plans. All services are subject to a deductible. Once the deductible has been satisfied, coverage is at 90% for the HRA and 80% for the HSA.

Ms. Reger noted that in working with the University account network concerns have been identified in California, Western Michigan and Montana. Currently, 23 employees are being impacted. United HealthCare’s Pacificare acquisition is expected to broaden the provider access in California by early 2007. This acquisition will also provide increased access to Montana providers. Medica will continue to work to contract with providers in Western Michigan, however; in the meantime, members should continue to rely on the Multiplan network.

Next, John Enger, manager of the Call Center, noted that the goal of the call center is ‘first call resolution’ by providing responsive service to members. Once hired, agents go through intensive training to ensure they are able to provide the best service possible.

Innovative tools used in the Call Center include:

• Intelligent Desktop – a customized software, which provides agents with the information they need to assist members.
• mymedica.com – a portal, which gives members the ability to go on-line to order identification cards, etc.
• Self-service IVR phone system.
• eWFM – an automated agent scheduling system.
• ROC Room – ‘Real-Time Operation Center’, which monitors call volumes to make sure the Call Center is staffed adequately.

Mr. Enger stated that the Call Center is staffed with 1 Customer Care Professional (CCP) for every 7,500 members, which is a very high ratio especially when compared to other call centers. The average tenure of the CCP team is 2 ½ years.

Medica has dedicated lines (952-992-1814 or 877-252-5558) for University of Minnesota members, which are staffed Monday through Friday from 7:00 a.m. – 6:00 p.m. CST. Before concluding, Mr. Enger shared year-to-date customer service statistics.

Moving on, Ann Earl, Care Management director, noted that Care Management is a department within Medica that is made up of approximately 50 staff of which 80% are registered nurses. These nurses provide case management, authorization of services and continuity of care services. Care Management statistics for the University of Minnesota were shared:

• Medical continuity of care reviews – 10. These reviews are conducted by Medica in instances where a member’s previous provider is not in the Medica network, and the member wants to continue with that particular physician.
• University members participating in case management programs – 35.
• Members referred to Harris HealthTrends – 3.

Care Management typically works with chronically ill patients and their families. Examples of clinical conditions Care Management works with include, but are not limited to: cardiac, endocrine, gastrointestinal, and neurological.

Ms. Reger noted that United Behavioral Health (UBH) is Medica’s vendor for mental health and substance abuse services. All of the plans offered by Medica access UBH as the in-network provider for mental health and substance abuse services. UBH offers 2,937 providers within the Medica service area of Minnesota, North Dakota, South Dakota and western Wisconsin. Members may contact UBH directly when seeking its services. Through the end of April, a total of 760 UPlan members were served by UBH.

Next, Ms. Reger shared claim expenses through March 2006 and noted the following:

• Overall claim costs on a per employee per month basis were $304.21.
• Overall claim costs on a per member per month basis (all members - employees and dependents) were $145.26.
• Over 95% of all claim dollars were processed as in-network claims.
• The University receives a minimum of a 40% provider discount on all in-network claims.

Comparing Medica’s community rate with the University’s performance through March indicates that the University is outperforming Medica’s other clients.

Feedback received from University employees concerning Medica’s performance thus far was shared with members. Of particular note, was the need for Medica and the University to work together to educate UPlan participants about Medica’s products and services.

Mr. Watt called on Professor Ng and Karen Wolterstorff who had collected feedback from University employees to get their overall impression of the comments they received. In general, Professor Ng and Ms. Wolterstorff thought the comments were positive, and, as with any new vendor, issues will arise, which will need to be worked through. With this said, concerns over billing errors and poor communication ranked the highest amongst those received. Ms. Reger noted that thanks to the University’s input, Medica modified its Explanation of Benefits (EOB) to be more detailed, and is sending it out regardless if the member paid a co-pay or not.

Mr. Watt asked Kathy Pouliot from Employee Benefits of her impression of the transition to Medica. Ms. Pouliot stated that from Employee Benefits’ standpoint, the transition to Medica was one of the smoothest Employee Benefits has ever experienced.

Professor Ng requested that high claims data by plan be provided at a future meeting. Ms. Reger indicated that this would not be a problem, and she would be happy to do so. For member’s information she noted that to date 6 UPlan members have incurred claims between $50,000 - $100,000.

Comments/questions from members included:

• Members were cautioned to not put too much stock in the statistics shared today because it is very preliminary.
• Some complainants did not understand the relationship between Medica’s HRA and HSA plans and RxAmerica. It was noted that HRA and HSA members submit their claims to Medica because all pharmacy claims go towards the individual’s deductible.
• There is a lack of distinction by many UPlan members concerning what was a design change made by the University versus a Medica issue, particularly regarding the HRA and HSA.
• A request for demographic information as it relates to which employee groups have chosen which plans would be interesting to receive.
• Please describe the relationship between Medica and United HealthCare. Ms. Finn stated that Medica relies on United HealthCare to provide some minor services such as enrollment and claims processing. The cost to incorporate these services into Medica would be astronomical. Medica feels fortunate that it can tap into United HealthCare’s technology and expertise. Also, from a network standpoint, Medica’s ability to take advantage of United HealthCare’s broad network has made Medica more successful.
• In terms of the HRA and HSA plans, does Medica only track data after the deductible has been reached? Ms. Finn noted that all claims received by Medica for processing are tracked including those up to the deductible.
• Please comment on the move by an increasing number of employers (e.g. Target Stores) in the marketplace to only offer consumer driven health plans. It was noted that, unfortunately, it is impossible to know what employers will be doing in the next 2 – 5 years with respect to their health care offerings.
• Definity was able to handle prescription payments at the point of sale versus submitting paperwork for reimbursement. While acknowledging this difference in capabilities, it was noted that Medica has not adopted this philosophy, in part, because of the consumer driven nature of the Medica Direct product and the importance of educating members about the cost of drugs. Medica believes its approach makes members better consumers when they have to pay for their drugs at the point of sale.
• Is United HealthCare a for-profit company? Yes, United HealthCare is a for-profit company, which is a vendor and a partner to Medica. Medica is a non-profit entity.
• Please explain the UBH/Medica relationship. It was noted that Medica contracts with UBH to provide mental health and substance abuse services. UBH, in turn, contracts with individual providers that provide these services. If there are ever concerns about the number of UBH providers for mental health and substance abuse services, members should contact Medica, and Medica will contact UBH to see if additional providers can be credentialed for Medica.
• Do all of the plans have out-of-network coverage? Yes, all of the University’s plans have out-of-network coverage including mental health and substance abuse coverage.
• How many Medica members use the bilingual service? This information can be obtained, and shared with the committee at a future date.
• How does Medica determine the satisfaction level of those that use the bilingual service? Does Medica ever record these services and have an independent, third party translate the conversations? It was noted that Medica uses AT&T’s bilingual service and has not monitored the accuracy of the conversations. All customer service calls are randomly recorded as part of Medica’s quality program. In terms of member satisfaction with its translation service, Medica does satisfaction surveys, but has not specifically asked about translation satisfaction.
• What types of customer satisfaction tools does Medica use? Throughout the year Medica uses different approaches to capture customer satisfaction information including IVR surveys for individuals that call Medica as well as randomly selected written surveys, which are sent out across the Medica population. Medica seeks to measure satisfaction from not only its members, but its customers as well.
• Please describe in more detail what case management involves? This department works with plan participants and/or their family members who have chronic illnesses or complex problems. Case managers are also referred to as care coordinators and provide coordination of care. Case Management services are voluntary.
• How does the Case Management Department receive its cases? These cases are received through a variety of sources including:
• Prior authorizations.
• Home care notifications.
• Provider and member referrals.
• Claims data.
• Hospital authorizations.
• Call Center triage.
• When a member calls the nurse-line, does this information get sent to the provider? No, it is the patient’s responsibility to share this information with his/her provider. Members were reminded that the University’s nurse-line services are contracted through Harris HealthTrends and Mayo Clinic.
• The University intentionally carved out its pharmacy benefits management and wellness management, how has this impacted Medica? It was noted that Medica has not had enough experience with Harris HealthTrends to comment at this point. In terms of RxAmerica, Medica experienced some process challenges in the beginning, but believes these issues have been resolved. The problems with RxAmerica had to do with data exchanges and the files received. RxAmerica has been very motivated to work through the issues that have arisen and resolve them as quickly as possible.
• Please describe how Medica protects UPlan member’s private health data that is shared with RxAmerica and Harris HealthTrends? Medica follows strict file transfer protocol whenever it transfers information with its vendors. Also, Medica has signed a confidentiality agreement with the University and the University’s other vendors.
• What prohibits United HealthCare from making claims comparisons with the Medica data it has access to? United HealthCare has limited access to claims data and it is strictly for the purposes of paying claims. Also, Medica and United HealthCare have a confidentiality agreement. There are numerous rules and regulations around data privacy and the sharing of data. Medica’s relationship with United HealthCare is such that it trusts that they are not using the data inappropriately.
• Please explain the 1:7500 staffing ratio in the Call Center that was mentioned earlier. This ratio is used as a budgeting tool to determine how many agents are needed to adequately service the population.

Mr. Watt thanked the Medica representatives for their presentation, and Professor Ng and Ms. Wolterstorff for collecting UPlan member’s feedback.

IV). The next BAC meeting is on June 1, 2006 when the committee will receive a presentation from HealthPartners. Then, at either the June 1^st or June 15^th meeting, the consultant’s report from the RxAmerica site visit will be shared.

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

Renee Dempsey

University Senate