The Oregon Educators Benefit Board is spending $341,000 a year on a contractor that helps teachers pick the most cost-effective health plan for their healthcare needs, but enrollees who chose their own plan actually saved more than those who received assistance.
The Truven informed enrollment tool crunches the numbers for premiums, cost-sharing and deductibles based on the claims data of each enrollee and based on the share of the premium covered by each school district. It then guides members to pick the best plan based on those inputs.
Enrollees in a group of 13,000 OEBB members saved an average of $74 on healthcare costs from 2012 to 2013 when given advice from Truven on switching plans. But the 16,000 members left in the control group saved $117.
Jason Abaluck, a Yale economics professor and consultant who assisted OEBB with the Truven tool, explained the numbers by noting that many people who received advice didn’t take it, and the school district’s share of the cost was often wildly off -- members entered this data point themselves, and often had no idea how much their district puts into the health plan.
“The tool is not working,” said board member J.J. Scofield, a human resources manager from the city of Grants Pass. “If we have a broken tool, why are we spending $340,000 unless we have a plan to fix it?”
The new PEBB administrator, James Raussen, also expressed his misgivings with the consulting contract, but the board decided to keep the Truven informed enrollment tool as an option to members, while asking for a potential re-vote in June after staff and the consultants have a chance to make the tool work.
In other business, the OEBB board voted to trim benefits by creating a separate deductible for out-of-network care for members enrolled in Moda Health plans. The board also voted to raise drug copayments by a median of 50 percent for people with the statewide, standard Moda plan, unless neither of Moda’s coordinated care options -- Synergy in the Willamette Valley and Summit in Eastern Oregon -- were available.
In real dollars, “value” drugs now free for these consumers would cost $4; generics would go up from $8 to $12, preferred brand drugs will rise from a maximum of $50 to $75 and other brand-name drugs from a maximum of $150 to $175.
Specialty drugs -- typically biologics -- would rise from a monthly cap of $100 to $300 to $200 to $500.
OEBB’s primary actuarial consultants from Willis Towers Watson also outlined the process for the RFP for a new overall medical insurance contract for OEBB, which will take place during this summer and fall now that a permanent director has been hired.
Jenny Marks, a Towers Watson health and welfare benefits consultant, painted a picture similar to the process the Public Employees Benefit Board underwent two years ago. The board will create a scoring tool to rate health plans, and solicit bids for both a statewide plan and regional plan. The winning bidders are likely to complement the existing option from Kaiser Permanente.
