BENEFITS ADVISORY COMMITTEE

MINUTES OF MEETING

JUNE 1, 2006

[In these minutes: Employee Benefits’ Announcements, HealthPartners 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, Karen Wolterstorff, Jody Ebert, Rhonda Jennen for Rita McCue, Penny Morton, Sandi Sherman, Curt Swenson, Joseph Jameson, Michael Marotteck, Carl Anderson, Carol Carrier, George Green, Amos Deinard, Richard McGehee, Fred Morrison, Theodor Litman,

REGRETS: William Roberts, Don Cavalier, Carla Volkman-Lien, Peh Ng, Rodney Loper, Dann Chapman

ABSENT: Frank Cerra, Keith Dunder

GUESTS: HealthPartners representatives Gregg Dahlgren, Sue Hoel, Marcus Thygeson, and Karen Trouba

OTHERS: Linda Blake, Ted Butler, Karen Chapin, Ronald Enger, Nancy Fulton, Betty Gilchrist, Shirley Kuehn, Lori Loberg, Kathy Pouliot

I). Gavin Watt called the meeting to order.

II). Employee Benefits’ Announcements:

a). Karen Chapin called members attention to the email they received on Tuesday, May 30th, which contained an electronic copy of the newsletter that will be sent to UPlan members in early June. The primary purpose of the newsletter is to provide information about Medex, the UPlan’s travel assistance program. The newsletter also includes brief updates on HealthConnections from UPlan Wellness, MinuteClinic and QuickCare.

b). Dental benefits for graduate assistants, eligible fellows and trainees will be provided by Boynton Health Service rather than the University’s School of Dentistry starting next fall.

c). Kathy Pouliot introduced Benefits Specialist Lori Loberg.

d). Members were urged to participate in the Wednesday Wellness Walks. On the first Wednesday of each month between May and September 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.

e). 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.

II). Gavin Watt welcomed today’s guests from HealthPartners, Gregg Dahlgren, Sue Hoel, Marcus Thygeson, and Karen Trouba. To begin, Dr. Marcus Thygeson, vice president and associate medical director of health initiatives, highlighted HealthPartners transformational goals, which are intended to take HealthPartners in new directions:

• Provide additional support to members in terms of medical decision-making.
• Improve coordination of primary care, specialty care and hospital services, and make the process seamless for members.
• Offer affordable services. With this said, HealthPartners is in the process of developing an affordability index for its services.
• Manage variation in supplier sensitive services (e.g. office visits), which are the key cost drivers in health care. Unmanaged use of supplier sensitive services are wasteful. HealthPartners is undertaking a strategic initiative to better manage the issues around supplier sensitive services.
• Improve optimal lifestyle behaviors. Twenty percent of health care costs are associated with unhealthy lifestyles.
• Reduce identified disparities in health care associated with diverse ethnic backgrounds.

Dr. Thygeson emphasized the importance of partnerships when it comes to the delivery of high quality healthcare. Partnerships with providers to drive quality and efficiency, partnerships with members to improve health and for making informed healthcare decisions, and partnerships with purchasers to provide value-based insurance designs were all noted.

In terms of consumerism, the following factors are essential for success:

• Benefit design must be affordable, and value-based. Value-based benefits provide richer benefits for high value services and leaner benefits for services of low or indeterminate utility.
• Consumer medical decision support tools must be made available to members.
• Consumers must be reminded and prompted to take advantage of opportunities to be more informed consumers.

Next, Dr. Thygeson described in detail several programs HealthPartners has put in place to improve provider performance and ultimately member’s health. Examples cited included programs for improving diabetes care, heart care, tobacco treatment, depression care and back pain.

Currently, HealthPartners provides case management services for the University. Dr. Thygeson mentioned two noteworthy items:

1. HealthPartners is the only healthcare organization that incorporates a medical decision support approach as part of its case management techniques.
2. Claims data reviewal to identify at risk members to help coordinate their care has reduced HealthPartners’ hospitalization rate by approximately 10%.

Examples of healthcare tools and resources that HealthPartners makes available to its members include:

• Annual healthcare cost calculator.
• Plan comparison calculator.
• Mailboxes for members on the HealthPartners website, which allows for the secure exchange of electronic correspondence with HealthPartners’ staff. This site can also be used to receive personal health alerts and reminders, health plan news and updates as well as electronic EOBs (explanation of benefits). (Available late 2006).
• Tools for identifying providers.
• Electronic health content service delivered by Healthwise. Healthwise focuses on developing consumer health content to help people make health decisions that are right for them. (Available early 2007).
• On-line decision support services.
• Phone support services – Nurse Navigators, CareLine, BabyLine, Personalized Assistance Line, PAL, to help members facing mental health concerns.
• Member Services call center.

Before concluding his presentation, Dr. Thygeson reported that HealthPartners has received very positive external evaluations by eValue8, HEDIS (Health Plan Employer Data Information Set), and U.S. News and World Report.

Next, Sue Hoel reported on the plan design changes that took effect as of January 2007 when Classic Plus was instituted at the University:

• No referrals for specialty care.
• Expanded network.

Ms. Hoel highlighted the following HealthPartners statistics relative to the University account:

• 15,975 members – This number represents University employees and their dependents. HealthPartners has 8006 contracts with University employees.
• Of the 15,975 members, almost 70% have enrolled at HealthPartners Medical Group, and 13.5% have enrolled at either Boynton or UMP.
• Year to date 2006, HealthPartners has received 87,600 claims, and only 27 have been appealed.

There are 29 HealthPartners clinic locations with over 600 physicians. Last fall, HealthPartners opened its St. Paul Specialty Center. Prior to this most specialty care was housed at Regions Hospital. A second specialty center, adjacent to the St. Paul Specialty Center, will open in 2007.

A member asked whether HealthPartners has considered working with Metro Transit to have buses service the St. Paul Specialty Center location. Ms. Hoel was unsure, but agreed to follow-up on this suggestion.

HealthPartners Medical Group and Clinics is one of the better performing groups within the HealthPartners’ health plan in the following categories:

• Optimal diabetes care.
• Optimal Coronary Artery Disease (CAD) care.
• Optimal depression care.
• Body Mass Index (BMI) assessment.
• Chlamydia screening in women ages 16 – 25.

In terms of electronic medical records, HealthPartners laid the foundation for a total eCare experience for its members with the introduction of their electronic medical record system (EMR) more than 10 years ago. HealthPartners is using EPIC software for its EMR.

A member asked whether a link exists so that HealthPartners’ dentists can access patient’s electronic medical records. No, not yet replied Ms. Hoel, but this is a direction that HealthPartners intends to move in the not too distant future.

Ms. Hoel highlighted other technology used by HealthPartners:

• On-line appointment scheduling.
• MyChart.
• eVisits.

With respect to eVisits, this was a program that HealthPartners had piloted for 6 months. During this 6 month period only 9 people took advantage of this service. HealthPartners’ Research Foundation is exploring why such a small number of people used eVisits. Some members commented never having heard about eVisits. Ms. Hoel noted that participating clinics were responsible for promoting the service. It is unclear at this point whether these clinics did not do a good job of advertising the service, whether members were reluctant to pay the co-pay associated with eVisits, or if members felt they would not receive the same level of service. Dr. Thygeson stated that he is not surprised by the small uptake on eVisits. He added that currently most email communication is used for administrative purposes as compared to clinical interactions. Overtime, however, he predicts that a growing number of people will use this method of communication to talk with their physicians.

Ms. Hoel noted that most of the feedback received on HealthPartners was very positive. However, there were a few issues, which included:

• Frequent Fitness – Some members were wondering why they do not have access to Frequent Fitness. Ms. Hoel recognizes that this has been a difficult communication issue for both the University and HealthPartners. She noted Frequent Fitness is a program that is available to members for groups that are fully insured. The UPlan is a self-insured client of HealthPartners. For self-insured clients there is a cost for Frequent Fitness, which the University did not purchase as the program did not yet have a proven return in investment (ROI).

A member asked how many of HealthPartners’ self-insured clients pay for Frequent Fitness. Ms. Hoel noted that a very small number of HealthPartners’ self-insured clients pay for Frequent Fitness. She added that for self-insured clients they like to know the return on investment (ROI) when investing in such a program. Currently, HealthPartners’ Research Foundation is studying whether there is a ROI with the Frequent Fitness program. Once this study is completed later this summer it will be shared with the University. At the request of a member, Ms. Hoel agreed to provide information on the participation rate of members for self-funded employers and for those that are fully insured with HealthPartners.

• Lack of coordination of electronic medical records – Ms. Hoel noted that each clinic system has its own electronic medical record (EMR) system and these systems currently do not communicate with each other. Therefore, when patients visit multiple clinic systems, their EMRs cannot be shared between providers. Dr. Thygeson added that HealthPartners is working with a community collaborative to build a RHIO (regional health information organization) that can build an interface(s) between the various EMR used at different clinic systems. The goal is to have a community-wide health information network so at bare minimum key medical information such as medications, allergies, etc. can be widely shared.

• Clinic closings – Besides the mental health facility on University Avenue (psychiatrists are being moved to the Riverside location and psychologists were moved at an earlier date), there are no plans to close other HealthPartners’ Medical Group clinics.

• Explanation of Benefits (EOB) – Starting this year patients have been receiving an EOB for all services they rendered, regardless if they paid a co-pay or not. The rationale for doing this is to give members information about the cost of care.

• Emergency room co-pay – Hospitals can keep a patient up to 24 hours without admitting that individual. If a patient is not admitted as an in-patient that individual is responsible for an emergency room co-pay. Ms. Hoel encouraged members that have billing questions to call HealthPartners to discuss these issues further. In terms of accurate billing, HealthPartners relies on hospitals and clinics to accurately code their invoices. A committee participant stated that the University should clarify its contract with HealthPartners and make it clear to members that there is a difference between being admitted and being held for observation.

Questions/comments from members included:

• What is HealthPartners doing to make sure that physicians review patients’ test results, and, if appropriate, contact the patient with the results? Dr. Thygeson noted that the EMR creates a standard, systemized process for following up on lab results. In addition, HealthPartners has adopted the ‘care model’ process which is a systematic approach to handling the workflow of clinical care. Under this model, the care process is broken down into a series of steps, pre-visit, visit, post-visit and inbetween-visit period. Each step has specific tasks assigned to accountable people on the HealthPartners’ Medical Group delivery team.
• In response to a billing concern, Ms. Hoel noted that when a clinic system owns a hospital, sometimes services are coded as hospital services when in fact they are clinic services. Again, Ms. Hoel encouraged members to call Member Services to get the matter resolved. Ms. Chapin added that the University’s contracts with HealthPartners and Medica stipulate that facilities charges are not allowed.
• In terms of the tool that helps members identify a physician, do the different number of ‘$’ associated with a physician mean there is a different co-pay for each? No, this information is provided to members to raise awareness so they know which physicians are more or less expensive.
• Is HealthPartners considering having different co-pays depending on the number of ‘$s’ associated with a physician? Ms. Hoel noted that HealthPartners has a tiered product called Distinctions, but this is not the product chosen by the University. She noted that HealthPartners only has a handful of clients that have elected a tightly managed primary care product such as Classic Plus.
• With HealthPartners rating the physicians in its care systems, how is the consumer to know that HealthPartners isn’t steering patients to its providers versus providers in other care systems such as Park Nicollet, etc.? Dr. Thygeson indicated that he believes HealthPartners brings a different value to the table when dealing with other care systems than does Medica. While HealthPartners and Medica may offer many of the same clinics, patients are not necessarily getting the same results. Dr. Thygeson admitted that HealthPartners faces a potential conflict of interest when it rates providers. With this said, HealthPartners is very careful to use an objective process to rank physicians. HealthPartners values its relationship with its contract providers and is very frank about quality deficiencies in any of its own clinics.
• Does HealthPartners have its own mental health providers? Yes, stated Ms. Hoel. She noted that HealthPartners has a behavior health network, which is open access.
• What assurance does HealthPartners have that Harris HealthTrends and RxAmerica are treating the data provided to them confidentially? Ms. Hoel stated that HealthPartners has signed confidentiality agreements with both Harris HealthTrends and RxAmerica, which stipulate that member’s privacy will be respected and that HIPAA rules and regulations will be followed. Dr. Thygeson added that it is the UPlan’s responsibility to make sure that all their contracted vendors are HIPAA compliant and that the requirements outlined in these agreements are being followed. HealthPartners is not in a position to police the University’s other vendors. Ms. Chapin noted that the University is in a position to monitor the performance of its vendors and it does.
• What is the relationship between HealthPartners’ clinics and HealthPartners’ corporate office? According to Ms. Hoel, the clinics are one of the business units under the corporate office. The clinics are a fully owned subsidiary of HealthPartners corporate. The health plan is a separate subsidiary.
• Medica contracts out some of its services such as claims processing, does HealthPartners contract out any of its services? Dr. Thygeson stated that with the exception of its pharmacy benefits manager, HealthPartners provides all of its own administrative services.
• What is Ingenix? Ms. Chapin noted that Ingenix is a data cooperative that is used by many large employers in the Twin Cities. The data collected by Ingenix allows the University to understand how the UPlan is performing compared to the market. UnitedHealth Group created Ingenix.

III). In light of time, Mr. Watt tabled the RxAmerica update. Hearing no further business, Mr. Watt adjourned the meeting.

Renee Dempsey

University Senate