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Pensions and Benefits
STATE HEALTH BENEFITS PROGRAM PLAN DESIGN COMMITTEE
MEETING MINUTES 2014
 
STATE HEALTH BENEFITS PROGRAM (SEHBP)
PLAN DESIGN COMMITTEE MINUTES, BY DATE


 

 


2014 Meeting #14 Minutes
July 15, 2014
State Health Benefits Program (SHBP) Plan Design Committee

Adequate notice of this meeting has been provided and filed with and prominently posted in the offices of the Secretary of State. The meeting notice was mailed to the Secretary of State, Star-Ledger and Trenton Times on January 16, 2014. The meeting of the SHBP Plan Design Committee was called to order on Tuesday, July 15, 2014 at 1:15 PM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Committee, Division Staff, and other representatives:

Committee Members:

John Hutchinson, Senior Policy Advisor, Department of Environmental Protection
David Jones, Retired President, STFA
Jeff Keefe, AAUP - AFT
Ken Kobylowski, Commissioner, Department of Banking and Insurance
Kevin Lyons, NJ State PBA
Matthew Murray, Deputy Chief of Staff, Office of the Treasurer
Dave Ridolfino, Associate Deputy State Treasurer, Office of the Treasurer
Hetty Rosenstein, New Jersey Area Director, CWA/District 1
Abdur Yasin, NJ FMBA

Absent:

Richard Constable, Commissioner, Department of Community Affairs
Steven Kreisberg, Director of Collective Bargaining and Health Care Policy / AFSCME
Also in Attendance:
Diane Weeden, Deputy Attorney General
Dave Pointer, Division of Pension and Benefits
Mark Cipriano, Division of Pension and Benefits
Doug Martucci, Division of Pensions and Benefits
Kathleen Ormsby, Division of Pension and Benefits
Ed Fox, Aon Hewitt
Jeffrey Chanin, Aon Hewitt

Sunshine Act Statement: The Sunshine Act Statement and the Executive Session Resolution were read by Mr. Martucci.

Ed Fox and Jeff Chanin from Aon Hewitt were available to answer any questions the Committee had regarding the plan year 2015 retiree prescription drug copay amounts. Discussion was had regarding the regulation that describes how the out-of-pocket maximums and prescription drug copays get indexed each year. Committee Member Rosenstein made a motion to vote on the proposed copays. Committee Member Jones seconded the motion. Discussion ensued as to how the copays were calculated using a two year lag: 2012 and 2013 metrics were applied to 2014 amounts and projected onto plan year 2015. The motion failed (4:5:0, Committee Members Jones, Keefe, Lyons, Rosenstein and Yasin voted nay, and Constable, Kreisberg absent). Committee Member Rosenstein advised that since no agreement was reached the law requires the matter to be referred to a superconciliator.

Committee Member Keefe asked Aon questions regarding plan year 2015 costs and when any figures would be coming out to review the deductibles, copays and prescription drug costs. The discussion turned to the review of the previous presentations of the compound drugs, formularies and alternate health care delivery systems, such as on site clinics. Committee Member Lyons asked if someone from Doug Forester’s company, a new type of health care delivery system operating in Toms River, Ocean County, would be able to make a presentation at the next meeting. Committee Member Jones was able to provide contact information.

Committee Member Rosenstein requested Mr. Pointer to supply information on the high utilization data of SHBP members prior to the next scheduled meeting. Mr. Pointer advised he would be able to gather that information, along with other high cost drivers, for the Committee Members. After discussion about overstated premiums, reserves, and possible projected insufficiencies for subsequent plan years, Committee Member Keefe asked that if premiums were ever overstated, then projected incorrectly the following year, would it be possible to drawn from some type of reserve. Mr. Pointer agreed to look into this issue.

Committee Member Keefe asked Mr. Fox if he could provide a wellness update. Mr. Fox advised that the NJ Well program is currently only six months old and historically wellness programs have good data, but more time would be needed to get metrics on the NJ Well.

There being no further business, Committee Member Yasin made a motion to adjourn. Committee Member Ridolfino seconded the motion; all were in favor. The meeting adjourned at 2:36 PM.

  Respectfully submitted,
 

 

 

  Kathleen Ormsby
Acting Secretary, SHBP Plan Design Committee

 


2014 Meeting #15 Minutes
October 17, 2014
State Health Benefits Program (SHBP) Plan Design Committee

Adequate notice of this meeting has been provided and filed with and prominently posted in the offices of the Secretary of State. The meeting notice was mailed to the Secretary of State, Star-Ledger and Trenton Times on January 16, 2014. The meeting of the SHBP Plan Design Committee was called to order on Friday, October 17, 2014 at 1:07 PM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Committee, Division Staff, and other representatives:

Committee Members:

John Hutchison, Senior Policy Advisor, Department of Environmental Protection
David Jones, Retired President, STFA
Ken Kobylowski, Commissioner, Department of Banking and Insurance
Kevin Lyons, NJ State PBA
Mary Meeker,
Matthew Murray, Deputy Chief of Staff, Office of the Treasurer
Patrick Nowlan,
Dave Ridolfino, Associate State Deputy Treasurer, Office of the State Treasurer
Hetty Rosenstein, New Jersey Area Director, CWA/District 1
Abdur Yasin, NJ FMBA

Absent:

Richard Constable, Commissioner, Department of Community Affairs

Also in Attendance:

Diane Weeden, Deputy Attorney General
Florence Sheppard, Division of Pension and Benefits
Dave Pointer, Division of Pension and Benefits
Mark Cipriano, Division of Pension and Benefits
Kathleen Ormsby, Division of Pension and Benefits
Dave Perry, Horizon
Jim Christ, Aon
Doug Forrester, Integrity Health

Sunshine Act Statement: The Sunshine Act Statement and the Executive Session Resolution were read by Ms. Ormsby.

Minutes: Ms. Ormsby advised that the minutes from the last meeting were not yet available for review.

Nominations were taken for Chairperson of the Committee: Being that co-chair Keefe had resigned his position, Committee Member Jones made a motion to nominate Committee Member Hutchison as co-chair. Committee Member Ridolfino seconded the motion, approved 10:0:0, (Committee Member Constable, absent). Committee Member Jones made a motion to nominate Committee Member Lyons as co-chair. Committee Member Ridolfino seconded the motion, approved 10:0:0, (Committee Member Constable, absent).

Addition of 2015 Dental CDT Codes: Committee Member Lyons made a motion to approve 2015 CDT codes. Committee Member Jones seconded the motion, approved 10:0:0, (Constable, absent).

Outlier Services presentation by Horizon: Dave Perry from Horizon presented four areas of business identified as high cost and utilization with SHBP/SEHBP members in comparison to Horizon’s book-of-business (BOB) members. The areas focused on were: emergency room, benefits, out-of-network and Florida Substance Abuse utilization.

The emergency room was looked at for both the copay amount and the utilization. Mr. Perry advised that SHBP/SEHBP copays for ER visits for NJ Direct 10 and NJ Direct 15 are $25 and $50 respectively, while Horizon’s standard copay for an ER visit is $100. This ensures the member is truly in need of emergent care. The utilization of SHBP/SEHBP members is 32% higher than Horizon’s commercial business. Through discussion, Mr. Perry advised that the Accountable Care Organizations (ACO’s) have expanded coverage and are an alternative to an ER visit.

In regards to the SHBP/SEHBP benefits, there were three areas outlined: acupuncture, therapy limits and the reasonable and customary fee schedule. Acupuncture is not a common benefit offered and over $30 million annually is spent on this benefit, mostly to out-of-network providers. Mr. Perry also added that an option to reduce utilization could be a requirement to attain a prior authorization. Committee Member Nowlan asked what an alternate treatment facility would be and Mr. Perry advised that there are pain management centers the member could be directed to, and/or in addition, a cap could be placed on the number of visits. The non-HMO products of the SHBP/SEHBP have no benefit period visit limit for therapies, while other products or employers may impose limits to control over-utilization. Horizon is moving away from the charge based systems like FairHealth when calculating an out-of-network claim, and they are now applying a Resource Based Relative Value System (RBRVS) when evaluating the reasonable and customary fee schedule. This system is currently used by Centers for Medicare and Medicare Services (CMS). More than 700 commercial sector groups of the Horizon BOB are utilizing RBRVS. Annual increases to this reimbursement are tied to the Consumer Price Index (CPI) and are therefore more controlled than increases in provider charges as in the current FairHealth model. Models that can be followed are:

Horizon Current Commercial Sector
  Groups
Percent
150% of CMS 467 66.4%
180% of CMS 172 24.5%
250 % of CMS 64 9.1%

About two thirds of the commercial group has chosen the 150% of CMS reasonable and customary fee schedule.

Out-of-Network Utilization- NJ Direct 10 has approximately 76% of its spend utilizing in-network providers while NJ Direct 15 has approximately 81%. On average, Horizon’s non SHBP/SEHBP in-network utilization is about 86%. Each 1% shift toward in-network providers represents approximately $10 million in savings for SHBP/SEHBP. Several benefit outliers are: physical therapy, acupuncture, chiropractic and behavioral health. The per cent in claims of in-network dollars of these above therapies is less than 40%.

Florida Substance Abuse Utilization- Members are accessing Florida substance abuse facilities at an extraordinary rate for Inpatient, Partial Hospitalization and Intensive Outpatient care. The unit cost is up to four times greater than the unit costs in non-Florida facilities. Committee Member Kobylowski asked if the overall spend could possibly be considered less, due to the ‘one and done’ philosophy. Mr. Perry advised he would take that question back as a follow up.

On-Site Clinics Presentation: Mr. Forrester discussed the onsite clinic in Toms River, NJ. The concentration is the Toms River Board of Education, of which there are approximately 5300 members. This is a voluntary program. They can attend the clinic or go to their own provider. They need at least 1500 members to participate to maintain the onsite clinic. Every person saves the school system $106.11. The health system contains a: doctor, laboratory, x-ray equipment, pharmacy, pain management area. No copay is charged for the clinic visit. It was established to produce health: they focus on health outcomes; healthy outcomes are measured there; they have the opportunity to promote health. There are no relationships between big networks or big discounts. Mr. Forrester advised that high deductible plans will cost more in the long run and are unwise.

The health center is run by a:
1) Primary care center with a Primary Care Physician
2) Care coordinator

The health center reduced ER visits by 25% in the first 90 days. Committee Member Jones asked if this could be reality for a State location. Mr. Forrester responded that it would depend on how the State negotiated the contract. The discussion ensued that unlike the Toms River BOE facility, there are many State locations that only have traffic on weekdays and may not get the member’s dependents in for visits.

In unrelated discussion, Committee Member Lyons and Jones asked Mr. Christ from Aon if he could get some statistics on the Hepatitis C drugs and the new gel form of OxyContin being made from a compound drug. Currently that drug is not regulated by the FDA.

There being no further business, Committee Member Jones made a motion to adjourn. Committee Member Lyons seconded the motion; all were in favor. The meeting adjourned at 3:14 PM.

  Respectfully submitted,
 

 

 

  Kathleen Ormsby
Acting Secretary, SHBP Plan Design Committee



2014 Meeting #16 Minutes
November 21, 2014
State Health Benefits Program (SHBP) Plan Design Committee

Adequate notice of this meeting has been provided and filed with and prominently posted in the offices of the Secretary of State. The meeting notice was mailed to the Secretary of State, Star-Ledger and Trenton Times on January 16, 2014. The meeting of the SHBP Plan Design Committee was called to order on Friday, November 21, 2014 at 1:02 PM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Committee, Division Staff, and other representatives:

Committee Members:

John Hutchison, Senior Policy Advisor, Department of Environmental Protection
David Jones, Retired President, STFA
Kevin Lyons, NJ State PBA
Mary Meeker, Benefits Specialist, AFSCME Department of Research
Matthew Murray, Deputy Chief of Staff, Office of the Treasurer (via teleconference)
Patrick Nowlan, AAUP – AFT (via teleconference)
Abdur Yasin, NJ FMBA

Absent:
Richard Constable, Commissioner, Department of Community Affairs
Ken Kobylowski, Commissioner, Department of Banking and Insurance
Dave Ridolfino, Associate State Deputy Treasurer, Office of the State Treasurer
Hetty Rosenstein, New Jersey Area Director, CWA/District 1

Also in Attendance:

Danielle Schimmell, Deputy Attorney General
Mark Cipriano, Division of Pension and Benefits
Kathleen Ormsby, Division of Pension and Benefits
Doug Martucci, Division of Pension and Benefits
Jim Christ, Aon Hewitt
Jennifer Moyer, Aetna
Dave Perry, Horizon

Sunshine Act Statement: The Sunshine Act Statement and the Executive Session Resolution were read by Ms. Ormsby.

Minutes: Committee Member Lyons asked that the July 15, 2014 minutes be deferred to next month.

Approval of the 2015 Meeting Dates: Committee Member Lyons made a motion to accept the dates as presented. Committee Member Jones seconded the motion, approved 7:0:0, (Committee Members Constable, Kobylowski, Ridolfino and Rosenstein absent).

NJ Well Presentation: Doug Martucci from State Health Benefits, Policy and Planning, Division of Pensions and Benefits, presented information on year 1, and gave an overview on plans going forward for year 2 of the Wellness Program. Many types of communication have been utilized to advertise the program including attendance at the NJEA convention, radio advertisements on NJ 101.5, webinars for both employers and Wellness Champions and direct mail campaigns. Year 1 was about knowing your numbers, while year 2 is about action and engagement. There will be more preventative services that a member can participate in, including online services in 2015, that will earn points, and therefore a larger dollar reward:

Participation was lower than expected for Year 1, but with added activities for Plan Year 2 and continued exposure, the focus is on wellness action and engagement.

Discussion of the Super Conciliator for Retiree Copays: Mr. Cipriano, Division of Pensions and Benefits, reminded the Committee of the request from the July 2014 SHBP PDC Meeting in which a request was put into PERC for a conciliator due to a decision not being reached on the retiree copay issue. Mr. Cipriano supplied the Committee with a copy of the 2013 documentation from the Super Conciliator when the same issue had been raised. Committee Member Jones expressed that he did not feel a Super Conciliator was needed at this time since a determination was pending with a lawsuit filed against the State on the same issue. Committee Member Lyons and Hutchinson asked Ms. Schimmel for further advice to clarify whether since the request was made for the Super Conciliator, could it be delayed until after the decision is handed down by the Appellate Division. Ms. Schimmel will take that question for follow-up.

NJWELL - Year 2 (2015) Action and Engagement

wellness


Additional Follow-Up Questions on Hepatitis C:
Committee Member Lyons stated that he still had a few additional follow-up questions on previous treatments and cure rates compared to cost rates. He would submit those questions for the December meeting, at which time a representative from Express Scripts could be in attendance.

There being no further business, Committee Member Jones made a motion to adjourn. Committee Member Lyons seconded the motion; all were in favor. The meeting adjourned at 2:09 PM.

  Respectfully submitted,
 

 

 

  Kathleen Ormsby
Acting Secretary, SHBP Plan Design Committee


 


 

 
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