State Employees Health Plan Reprocurement for Market Competitiveness
Explore the re-procurement of the State Employees Health Plan to ensure market competitiveness by shortening contract terms, incorporating definitive expectations, and considering innovative solutions. Goals include providing comprehensive healthcare coverage at affordable costs. Stay updated on the current status and next steps as of December 9, 2024.
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Presentation Transcript
Department of Human Resource Management RE-PROCUREMENT OF STATE EMPLOYEES HEALTH PLAN HEALTH INSURANCE REFORM COMMISSION December 9, 2024
PURPOSE & SCOPE Why now? Ensure market competitiveness Current contract term deemed too long (10 years) Shorten term and include specific deliverables Incorporate Definitive Expectations Consider new, innovative solutions, such as values-based models Scope Plan administration for the three self-insured health plans (two fully- insured plans are excluded) and our Pharmacy Benefit Manager December 9, 2024 DHRM 2
GOALS & OPPORTUNITIES Provide the Commonwealth s plan participants with comprehensive healthcare coverage at affordable costs to the participants and the Commonwealth Opportunities Pharmacy Express Scripts lost the active business in 2019 and provided a 9% reduction for the retirees this past year. If the re-solicitation results in lower fees, that results in savings to employees and the Plan. For example, a 9% reduction for the active plan would equate to $30 million in savings. Innovative administrative parameters- Savings opportunity Healthcare administrators must be a plan fiduciary Utilize CMS as the claims processing standard Always pay lesser of billed charges or contracted rate No pay for performance December 9, 2024 DHRM 3
CURRENT STATUS COMPLETED Solicitation for the three current self-insured health plans and the pharmacy benefit manager closed in October (four components) COVA Care COVA HDHP COVA HealthAware Proposals reviewed and scored Interviews held with all qualified offerors NEXT STEPS Negotiation meetings planned for finalists in all four components Conduct references Expect to issue Intent to Award by end of January December 9, 2024 DHRM 4
QUESTIONS ? December 9, 2024 DHRM 5
