California Education Coalition for Health Care Reform

Transcription

1 California Education Coalition for Health Care Reform

2 Who is CECHCR? CECHCR is You! w Association of California School Administrators w California Association of School Business Officials w California County Superintendents Educational Services Association w California Federation of Teachers w California School Boards Association w California School Employees Association w California Teachers Association w Community College League of California w School Employers Association of California 2

3 CECHCR History w Federal Mediation and Conciliation Services w Local grants: n California Endowment n California Health Care Foundation 3

4 Stronger Together w w w w Management and labor working together Of the education community By the education community For the education community 4

5 CECHCR Strategies w Train & educate on purchase and use of health benefits w Study & share policy info w Assist districts & unions in improving cost & quality of their benefits w Analyze legislation w Support health promotion & wellness 5

6 Three Education Programs Effective Health Benefits Practices for Labor-Management Teams Making Informed Choices: Cost and Quality of Health Care Managing Costs 6

7 Follow-up Services Ø Coaching/Mentoring Ø Creating a plan of action Ø Follow-up consultations Ø Assistance in engaging health benefits plans 7

8 CECHCR s Role w w w To train local districts to be more informed purchasers of health care To educate and coordinate the education community about various reform proposals and how they impact school districts/unions To help districts and unions reduce the cost and improve the quality of their health care 8

9 CECHCR Direct Services Real Time Solution to the Cost-Quality Crisis w Many districts and employees are paying too much, AND w are not getting the best health care Second Opinion Program w Can save you $$$ millions! w Objective and experienced evaluation w Fees based on value w Full transparency w No savings, no fees! 9

10 The CECHCR Approach w CECHCR wants to be sure you hear about ALL the best options for your group w CECHCR utilizes J Glynn & Co. to impartially evaluate your situation and give you solid recommendations to improve your benefits. 10

11 Module V In a Nutshell w CECHCR provides Orientation to explain Module V. w District and unions agree to participate. w Desk review of current benefits situation no fee. n To determine if CECHCR can help. n To estimate amount of savings possible. w Review current renewal. w CECHCR proposal presented to the district & unions. w Comprehensive evaluation & results. 11

12 Module V Success w Module V WORKS because CECHCR: n has a proven track record of success. n studies your unique situation and brings you options that will work best for you. n is your expert guide-by-the-side to work with you to make the changes you decide to make. 12

13 Values and Principles Are Aligned 13

14 Values Disclosures: None! 1. No Commissions 2. No Overrides 3. No money, under no circumstances from the industry or its agents 4. Employees of Jglnn might sign an employment agreement that reflects these values 5. CECHCR/Jglynn charges fees for scope of work for each school district client 6. School district knows exactly what its paying, and what work product is expected CECHCR 14

15 Principles The only goal is to get the best plan as the best price: 15

16 Next Smarter Consumers w Trust but Verify: w Anthem Blue Distinction Designation w UnitedHealth Physician Evaluation Tool n Our goal is to educate using publicly available data on the best providers for school employer and employees IT SAVES LIVES AND MONEY! 16

17 Smarter Consumers Education Classes (no commercials): w Health Care 101: w Getting the most from your doctor office visit! w What to do before, during and after that 8-minute visit with your doctor w w Health Care 102: w Quality Care: Don t take it for Granted! w What you can do to help make sure you are getting good quality care w Health Care 103: w Know Your Patient Rights! w Your fundamental Patient Rights & recourses if you don t get them w Health Care 104: w Taking Charge of Your Own Health Healthy Resources w Check out our topics and tools to help you and your family stay healthy 17

18 Our Experience w When we show up: Rates w Recently n $326,000 n $ 18

19 Non-Medical Expenses & Small Group Volatility A Brokerage Fees and Sales Commissions Health Plan Brokerage Fees Sales Commissions Annual Compensation 2 Health Plan $3.50 PMPM 6.00% $ 303,939 3 Health Plan $40 new members; $5 renewals 3.00% $ 67,587 4 Health Plan $0 - $3.25 Per member 0.07% $ 45,713 5 $1.13 PMPM $ 25,669 6 Dental $0.90 PEPM, $0.39 PEPM 9.90% $ 18,450 7 Vision $1.00 PEPM 1.00% $ 6,281 8 Total Annual Compensation $ 467,638 9 Cost Per Employee Per Year #DIV/0! B Non-Medical Health Plan Costs 10 Health Plan Medical Loss Ratio Medical Claims Administrative Costs 11 Health Plan Actual: 85% (Jan'14 70%) #REF! #REF! 12 Health Plan 2012 Large Groups: 84.8% #REF! #REF! 13 Health Plan Actual: 86.3% #REF! #REF! 14 Total Annual Compensation #REF! #REF! 15 Cost Per Employee Per Year #REF! C Volatility of Large Claims In Small Groups 16 Health Plan Large Claim Cost % Total Claims 17 Kaiser 2013 #REF! #REF! 18 Kaiser 2012 #REF! #REF! 19 Cost Per Employee Per Year (2012/2013) #REF! #REF! Commission Exhibit.xlsx - Fee Summary 8/11/14 1

20 Greater LA Hospital Ratings 2015 Participating Provider Networks and Quality Ratings by Carrier & Plan As of August 2014 with in a 30 Mile Radius of See warning below. 8/7/14 Hospital Quality Ratings # Hospital Name Anthem PPO Anthem Traditional HMO Shield PPO United Healthcare HMO HealthNet SmartCare HMO Blue Distinction Center (4) Leapfrog Group Hospital Safety Grade (5) CalQuality Care Surgical Care Measure Rating (6) 1 AHMC Garfield Hospital Medical Center Yes Yes Yes Yes Yes C Superior 2 Alhambra Hospital Medical Center Yes Yes Yes No Yes A Average 3 Anaheim Regional Medical Center Yes Yes Yes No No B Average 4 Aurora Las Encinas Hospital No No Yes No No N/A N/A 5 Barlow Respiratory Hospital Yes Yes Yes No No N/A N/A 6 Beverly Hospital Yes Yes Yes Yes Yes Not Rated Average 7 California Hospital Medical Center Yes Yes Yes Yes Yes C Superior 8 Cedars- Sinai Medical Center Yes Yes Yes No No BD A Superior 9 Canyon Ridge Hospital No No Yes No No N/A N/A 10 Centinela Hospital Medical Center Yes Yes No No No NO BD A Superior 11 Chapman Medical Center Yes Yes Yes Yes Yes BD C Above Average 12 Children's Hospital of Los Angeles Yes Yes Yes No No Not Rated Not Rated 13 Childrens Hospital of Orange County Yes Yes Yes No No Not Rated Not Rated 14 Citrus Valley Medical Center Yes Yes Yes Yes No B Average 15 Citrus Valley Medical Ctr- Queen of the Valley Yes Yes Yes Yes Yes B Average 16 City of Hope National Medical Center Yes Yes Yes No No Not Rated Average 17 Coast Plaza Hospital No No No No Yes Not Rated Not Rated 18 Coastal Communities Hospital Yes Yes Yes Yes Yes D Average 19 College Hospital Costa Mesa No Yes No No No N/A N/A 20 Community Hospital of Huntington Park No No Yes No No Not Rated Not Rated 21 Community Hospital of Long Beach Yes Yes Yes No No C Average 22 Doctors Hospital of West Covina Yes Yes No No Yes Not Rated Not Rated 23 Downey Regional Medical Center Yes Yes No Yes Yes Not Rated Average 24 East Los Angeles Doctors Hospital No No Yes No Yes Not Rated Not Rated 25 East Valley Hospital Medical Center No No Yes Yes Yes Not Rated Not Rated 26 El Monte Community Medical Center No Yes Yes No Yes N/A N/A 27 Encino Hospital and Medical Center Yes Yes No No No Not Rated Average 28 Foothill Presbyterian Hospital Yes Yes Yes Yes Yes C Average 29 Fountain Valley Regional Hospital Yes Yes Yes No Yes BD + A Average 30 Garden Grove Hospital and Medical Center Yes Yes No Yes Yes NO BD A Superior 31 Glendale Adventist Medical Center Yes Yes Yes Yes Yes BD + C Average 32 Glendale Memorial Hospital and Health Center Yes Yes Yes Yes Yes BD C Average 33 Good Samaritan Hospital Yes Yes Yes Yes Yes BD + C Average 34 Greater El Monte Community Hospital Yes Yes No No No Not Rated Not Rated 35 Healthbridge Childrens Hospital Orange CA LP Yes Yes No No No N/A N/A 36 Hoag Memorial Hospital - Presbyterian- Irvine No Yes Yes Yes No NO BD B Superior 37 Hoag Memorial Hospital Newport Beach No Yes Yes No No B Average 38 Hoag Orthopedic Institute Yes Yes Yes No No BD Not Rated Not Rated 39 Hollywood Community Brotman Medical Center Yes Yes No No No NO BD Not Rated Superior 40 Hollywood Presbyterian Medical Center Yes Yes Yes No Yes C Average 41 Huntington Beach Hospital Yes Yes Yes Yes No C Not Rated 42 Huntington Memorial Hospital Yes Yes Yes Yes Yes BD A Superior 43 Kaiser Anaheim No No No No No A Superior 44 Kaiser Baldwin Park No No No No No A Superior 45 Kaiser Downey No No No No No A Superior 46 Kaiser Harbor City No No No No No A Superior 47 Kaiser Hollywood No No No No No A Superior 48 Kaiser Irvine No No No No No A Superior 49 Kaiser Los Angeles No No No No No A Superior 50 Kaiser Panorama City No No No No No A Superior 51 Kaiser Woodland Hills No No No No No A Superior 62 La Palma Intercommuity Hospital Yes Yes No No No Not Rated Not Rated 63 LAC USC Medical Center No No Yes No No C Average 64 Lakewood Regional Medical Center Yes Yes Yes No Yes NO BD A Average 65 Long Beach Memorial Yes Yes Yes Yes Yes NO BD A Average 66 Los Alamitos Medical Center Yes Yes Yes No Yes BD + A Superior 67 Los Angeles Community Hospital No No Yes No Yes Not Rated Average 68 Los Angeles Orthopedic Medical Center Yes Yes No No No N/A N/A 69 Los Robles Regional Medical Center Yes Yes No Yes No BD A Superior 70 Marina Del Rey Hospital Yes Yes Yes No No BD Not Rated Average 71 Memorial Hospital of Gardena No No Yes No No Not Rated Average 72 Methodist Hospital of Southern CA Yes Yes Yes Yes Yes BD C Average 73 Miller Childrens Hospital Yes Yes Yes Yes No Not Rated Not Rated 74 Miracle Mile Medical Center Yes Yes Yes No No Not Rated Average 75 Mission Community Hospital Panorama Yes Yes Yes Yes Yes C Average 76 Monrovia Memorial Hospital Yes Yes No No No N/A N/A 77 Monterey Park Hospital Yes Yes Yes Yes Yes D Average 78 Northridge Hospital Med Ctr Roscoe Campus Yes Yes Yes Yes Yes BD C Superior 79 Olympia Medical Center Yes Yes Yes No No B Average 80 Orange Coast Memorial Medical Center Yes Yes Yes Yes Yes BD + A Average 81 Pacific Alliance Medical Center Yes Yes Yes No Yes Not Rated Above Average 82 Pacific Hospital of Long Beach Yes Yes No No No Not Rated Not Rated 83 Pacifica Hospital of the Valley No No Yes No Yes Not Rated Not Rated 84 Placentia Linda Hospital Yes Yes Yes No Yes BD + B Superior 85 Pomona Valley Hospital Yes Yes Yes Yes Yes B Average 86 Presbyterian Intercommunity Hospital Yes Yes Yes No No BD + B Superior 87 Promise Hospital of East Los Angeles Yes Yes Yes No No Not Rated Not Rated 88 Promise Hospital of East Los Angeles - Suburban M Yes Yes No No No Not Rated Not Rated 89 Providence Holy Cross Medical Center Yes Yes Yes Yes Yes BD + C Superior 90 Providence Little Company of Mary - San Pedro Yes Yes Yes Yes No B Above Average 91 Providence Little Company of Mary- Torrance Yes Yes Yes Yes Yes BD + A Superior 92 Providence St Joseph Medical Center/Burbank Yes Yes Yes Yes Yes BD + B Superior 93 Providence Tarzana Medical Center Yes Yes Yes Yes Yes C Average 94 Ronald Reagan UCLA Medical Center Yes Yes Yes No No BD C Superior 95 San Antonio Community Hospital Yes Yes Yes Yes Yes C Average 96 San Dimas Community Hospital Yes Yes Yes Yes Yes C Average 97 San Gabriel Valley Medical Center Yes Yes Yes Yes Yes C Superior 98 Santa Monica- UCLA Medical Center Yes Yes Yes No No BD + C Superior 99 Santa Paula Hospital Yes Yes No No No NO BD A Average 100 Sherman Oaks Hospital Yes Yes No No No B Average 101 Shriners Hospital for Children- LA Yes Yes Yes No No Not Rated Not Rated 102 Simi Valley Hospital and Health Care Services Yes Yes No Yes No D Average 103 Southern California Hospital at Culver City Yes Yes Yes No Yes?? 104 St Francis Medical Center Yes Yes Yes Yes Yes C Average 103 St Joseph Hospital Yes Yes Yes Yes No BD + A Superior 104 St Jude Medical Center Yes Yes Yes No No BD A Average 105 St Mary Medical Center Yes Yes Yes Yes Yes BD A Superior 106 St. John's Health Center Yes Yes Yes No No A Average 107 St. Johns Pleasant Valley Hospital Yes Yes No No No No BD A Superior 108 St. Vincent Medical Center Yes Yes Yes Yes Yes NO BD A Superior 109 Temple Community Hospital Yes Yes No No No Not Rated Not Rated 110 Torrance Memorial Medical Center Yes Yes Yes Yes Yes BD + A Superior 111 Tri City Regional Medical Center Yes Yes Yes No No BD Not Rated Average 112 UC Irvine Medical Center Yes Yes Yes No No BD B Average 113 USC Keck Hospital Yes Yes Yes No No A Average 114 USC Kenneth Norris Jr. Cancer Hospital Yes Yes Yes No No BD Not Rated Not Rated 115 USC Verdugo Hills Hospital Yes Yes Yes No Yes C Superior 116 Valley Presbyterian Hospital Yes Yes Yes Yes Yes D Average 117 West Anaheim Medical Center Yes Yes No No No NO BD A Superior 118 West Hills Hospital and Medical Center Yes Yes No Yes No C Average 119 Western Medical Center Anaheim Yes Yes Yes Yes Yes D Average 120 White Memorial Medical Center Yes Yes Yes Yes Yes B Average 121 Whittier Hospital Medical Center Yes Yes No No Yes D Average (1) CalPERS /Anthem Blue Cross of California - (2) CalPERS / Blue Shield of California - benefits/active- employee/netvalue- hmo/service- area.sp#la (3) CalPERS / United HealthCare HMO - a- doc.html (4) BD/BD + indicates the hospital was designated as a Blue Distinction Hospital by Anthem Blue Cross of California. (5) Leapfrog Group, Hospital Safety Score, Spring (6) CalQuality Care, Surgical Care Rating - Greater LA Provider WARNING: Networks- Quality This Ratings information - August 2014.xlsx is subject - Summary to change during the course of the plan year. Please review the links noted above for the most current informati Page 69 of 82