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HomeMy WebLinkAboutReports - 2023.11.16 - 40710 AGENDA ITEM: Contract Extension with Trustmark Health Benefits, Inc. for Healthcare Administrative Services DEPARTMENT: Human Resources MEETING: Board of Commissioners DATE: Thursday, November 16, 2023 9:30 AM - Click to View Agenda ITEM SUMMARY SHEET COMMITTEE REPORT TO BOARD Resolution #2023-3457 Motion to approve a one (1) year contract extension with Trustmark Health Benefits, Inc, through December 31, 2024, in an amount not to exceed $541,049 with no change to terms and conditions or pricing. ITEM CATEGORY SPONSORED BY Contract Gary McGillivray INTRODUCTION AND BACKGROUND Oakland County utilizes a contracted provider to maintain healthcare administrative services. The current provider, Trustmark Health Benefits, Inc., was awarded a five (5) year contract running January 2019 through December 2023. The Human Resources Department has received and is evaluating bids for a healthcare administration provider for the next contract to begin January 1, 2025, and is requesting approval of a one (1) year contract extension, to expire December 31, 2024, with the same pricing, terms, and conditions identified in the current contract. POLICY ANALYSIS The contract extension is $541,049, which is a 0% increase from last year, and is adopted within the current budget. This contract is for medical claims administration, claims determinations, and teledoc/behavioral health administration for Post-65 Retirees/spouses. Medicare is primary and Trustmark is secondary coverage. BUDGET AMENDMENT REQUIRED: No Committee members can contact Michael Andrews, Policy and Fiscal Analysis Supervisor at 248.425.5572 or andrewsmb@oakgov.com, or the department contact persons listed for additional information. CONTACT Heather Van Poucker Katelyn Marvin ITEM REVIEW TRACKING Aaron Snover, Board of Commissioners Created/Initiated - 11/16/2023 AGENDA DEADLINE: 11/16/2023 9:30 AM ATTACHMENTS 1. HR - Trustmark Memo 2. HR - Trustmark Health Benefits 2024 Renewal_090623 COMMITTEE TRACKING 2023-10-24 Legislative Affairs & Government Operations - Recommend to Board 2023-11-16 Full Board - Adopt Motioned by: Commissioner Yolanda Smith Charles Seconded by: Commissioner Philip Weipert Yes: David Woodward, Michael Spisz, Michael Gingell, Penny Luebs, Karen Joliat, Kristen Nelson, Christine Long, Robert Hoffman, Philip Weipert, Gwen Markham, Angela Powell, Marcia Gershenson, Janet Jackson, William Miller III, Yolanda Smith Charles, Brendan Johnson, Ajay Raman (17) No: None (0) Abstain: None (0) Absent: Charles Cavell (1) Passed OAKLAND COUNTY EXECUTIVE DAVID COULTER Sunil Asija, Director Human Resources 2100 Pontiac Lake Road | County Executive Building 41W | Waterford, MI 48328 | OakGov.com TO: David T. Woodward, Chairman of the Board of Commissioners Gary McGillivray, Chairperson of the Legislative Affairs and Government Operations Committee FROM: Heather Van Poucker, Manager, Compensation and Benefits Katelyn Marvin, Supervisor Employee Benefits RE: Trustmark contract extension DATE: October 9, 2023 Trustmark has provided healthcare administrative services for our 2,240 post-65 retirees since January 1, 2019. As required by procurement policy, after five years we have received bids and are evaluating them for next contract to begin on 1/1/2025. In the meantime, we request approval to extend the existing Trustmark contract through 12/31/2024. The proposed contract extension contains the same pricing and terms and conditions as the it has for the past 5 years, which is included in the approved budget. Administrative Services Proposal PREPARED FOR: Oakland County Effective Date: 1/1/2024 Proposal Date: Client Manager p: 586-405-3846 e: JSlezak@hlthben.com Jenny Slezak 9/6/2023 How do we do it? Targeted Claims Processing Generates an Additional 15% Savings You are at the Center of Everything We Do Trustmark’s values are more than just corporate-speak—they are values that govern the decisions we make, the solutions we offer, and how we interact every day with our clients and brokers. Our philosophy of service puts you and your members at the center of all we do, and we are honored to serve you. Thank you for trusting us to deliver your health plan benefits to your employees. Trustmark Health Benefits’ 3-year medical cost trend leads the industry with a low 1.3% average, translating to real savings for our clients. Trustmark Delivers Value Our results-driven strategy includes a combination of targeted claims processing, data driven insights and recommendations, effective products and solutions, and flexibility and innovation. Targeted claims processing includes hospital bill audits, intensive reviews of high-cost services and diagnoses, subrogation review, fraud review, and waste and abuse analysis. Expert claim analysts review high-cost claims to capture billing errors, waste, abuse, and negotiate savings opportunities. We purposely limit our auto-adjudication rate to 65% so that 35% of impactful claims get high touch claims processing. The result is another 15% savings on those claims. Our experts analyze bundling/unbundling, invalid coding, exceeding maximum reasonable units, procedure frequencies that are out of line, physician notes, radiology results, and consistency of billing practices for ongoing services. Confidential Information of Trustmark Health Benefits, Inc. 2 Core Solutions for Billed Price Reductions Increase Savings by $13 PEPM Reference Based Pricing Produces a 40% Lower PEPM PBM Contract Management and Oversight Produces Double Digit Savings Data Driven Insights Trend and Cost Management Solutions We offer 50 network options and analyze geography, access, fees, and network requirements to recommend the best solution for you. We deliver average in-network discounts of 54% to our clients. We have the flexibility to maintain and administer custom networks for new and cutting-edge options. Our out of network solutions produce an average 61% savings using the MultiPlan/Data iSight approach and an average of 65% savings using ClearHealth Strategies reference-based pricing. By implementing the MultiPlan/Data iSight approach we increased discounts from 45% to 61%, thereby increasing savings by $13 per employee per month. Trustmark offers reference or metric based pricing (RBP) strategies for clients as an alternative to a traditional network reimbursement methodology. Trustmark has partnerships with Clear Health, ELAP Services, Advanced Medical Pricing Solutions (AMPS), HST and ClaimDOC. Each vendor is unique in the approach and repricing methodology and offers alternative fee structures. We ensure RBP is the right approach for our clients by analyzing geography, key provider acceptance, and ensuring appropriate member education, advocacy and support are in place. Our Connect concierge service has been key in ensuring high member satisfaction with their benefits under reference-based pricing. Trustmark reference-based pricing clients experience a 40% lower per employee per month cost, and the percent of our business using RBP has tripled since 2018. We audit our preferred PBMs and continuously evaluate our contracts to ensure they are market competitive, with appropriate utilization management, flexibility, and member satisfaction. Our contract management has resulted in a 15% annual increase in rebates and a 12-15% total network cost savings compared to prior contract terms. We use data to make recommendations that will help control your costs such as changes to your prior authorization list to control overutilized services, dependent eligibility audits, specialty drug management, and preferred stop loss relationships. Each client we work with is unique, and through our experience and use of data analytics, we will help you build the solution that will provide value and lower costs for you and your members. We are honest about savings, through vetting and scrutinization of the savings and ROI data to ensure there is true value in the programs we recommend. Client specific population needs are addressed through condition specific programs for diabetes, oncology, dialysis, and maternity. Claim type analysis programs target emergency room, outpatient surgery, behavioral health, advanced imaging, and specialty RX. Confidential Information of Trustmark Health Benefits, Inc. 3 Results and service make the difference and Trustmark delivers results while maintaining excellent service and support to you and your members. Trustmark Drives Value You Choose, We Deliver Core Administrative Services & Management ▪ Medical Benefits Administration ▪ Dental Benefits Administration ▪ Flexible Spending Account Benefits Administration ▪ Healthcare Management (Utilization Management & Case Management) ▪ Health Reimbursement Arrangement Benefits Administration ▪ Health Savings Account Integration ▪ Pharmacy Benefits Integration and Class Action Participation Services ▪ Short Term Disability Benefits Administration ▪ Vision Benefits Administration ▪ COBRA Benefits Administration ▪ Eligibility & Enrollment Management ▪ Fiduciary for Claim Determinations & Claim Appeals ▪ High Deductible Health Plans ▪ Multi-Tiered Network Plans Cost Containment Solutions ▪ Enhanced Claims Control through: − Critical Claims Unit − Hospital Bill Review − Out-of-Network Savings − Dialysis Centers of Excellence − Fraud, Waste and Abuse Review − Medical Specialty Drug Management − Subrogation ▪ Network Management ▪ Reference-Based Pricing Options ▪ Stop Loss Reinsurance Plan Protection ▪ Telehealth visits through Teladoc Health (Medical, Behavioral Health, Dermatology, Caregiving, myVirtualCare Access, Primary 360) ▪ Transplant Centers of Excellence Employer Support Services & Tools ▪ Claim Fund Accounting Support ▪ Comprehensive Data Analytics ▪ Compliance Services and Support ▪ myTrustmarkBenefits.com Employer Web Portal ▪ Simplified List Billing Employee Assistance & Decision Support Tools ▪ Advocacy & Navigation through Included Health ▪ Connect Member Advocacy ▪ Digital Savings Solution ▪ Healthcare BluebookTM Cost & Quality Transparency Tool ▪ Health Shopper Discount Program ▪ MyNurse 24/7 ▪ myTrustmarkBenefits.com Employee Web Portal ▪ myTrustmarkBenefits Mobile App ▪ myTrustmarkBenefitsWire ▪ myHealthCenter ▪ myHealthCenter Mobile App ▪ Online Payment Manager ▪ PayActiv Financial Wellness Tool ▪ Simplicity Payment Plans Population Health Solutions ▪ Diabetes Management ▪ Fitness Membership Discounts ▪ Integrated Behavioral Health ▪ Oncology Management ▪ Special Delivery Maternity Management ▪ Wellness and Disease Management Ancillary Administrative Services ▪ Dependent Eligibility Audits ▪ Retiree Services ▪ Medicare D Administration Confidential Information of Trustmark Health Benefits, Inc. 4 Oakland County Renewal Date:January 1, 2024 Health Benefits Administration Ees Current Fee One Year Renewal Fee Medical Claims Administration 2240 17.78$ 17.78$ Final Claims Determination 2240 0.10$ 0.10$ Teladoc ($0 copay) with Behavioral Health 2240 2.25$ 2.25$ 541,094.40$ 541,094.40$ 0.00% Please note: other vendor fees (i.e. PPO access fees, etc.) are subject to change and cannot be guaranteed Contract Option Accepted: Signature Line: % increase/decrease No Surprises Act/Transparency in Coverage Act Compliance fee of $1.35 PEPM will be applied to the monthly claims fund register. In addition, 30% of Savings for the Qualified Payment Amount (QPA) process when Multi-Plan is the vendor will apply, and Independent Dispute Resolution (IDR) fees are charged at cost. Health Benefits Administrative Renewal Annualized Fees Date Accepted: Signed By (please print): Confidential Information of Trustmark Health Benefits, Inc. 5 Oakland County Dental Claims Administration Vision Claims Administration Short Term Disability Claims Administration Flexible Spending Accounts - Discrimination Testing $750 .00 annual fee Replacement FSA debit cards COBRA Administration* 24/7 Nurseline Health Reimbursement Accounts $3.00 per employee per month $3.80 per employee per month Oncology Care Program Healthcare Bluebook (Doctor Quality, Rewards and Care Connect) - Buyup Medicare D Option 1: Full Service - plan creditability plus letter services $.50 pepm + $150 per hour for plan creditability services Medicare D Option 2:Plan Creditability analysis only $150 per hour $.50 pepm Non-Standard Billing and Funding Fees Paper or Manual Eligibility Processing Ancillary Billing Services Cash Location Billing Services Memo Billing Services Invoice Payment Services Manual Release of Claims Multiple Funding of One Check Register Special Funding Report Requests *Fee subject to change pending confirmation of enrollment Population Health Management Population Health Management Package - Essential (6 conditions)$5.00 per employee per month $15 per bill $25 per vendor Dependent Eligibility Audit $1500 implementation fee plus $15.00 per dependent per audit plus postage $2.25 per employee per month $0.50 per employee per month $30 per bill Population Health Management Package - Complete (19 conditions)$5.50 per employee per month Biometric Physician Forms $16.00 per form $1.00 per employee per month $50 per funding location $25 per report Medicare D Option 3: Mailing and Customer Service Medicare D Retiree Subsidy Services Over 50 employees 30% of subsidy. Less than 50 employees, $6000 flat fee for each application. $1.50 per employee per month + per case fees Digital Savings Solution Package A: Includes Teladoc $0 copay, medical, behavioral health, transparency tool with engagement rewards and doctor quality, and ROI guarantee. $3.95 per employee per month Digital Savings Solution Package B: Includes Teladoc $55 copay, medical, behavioral health, transparency tool with engagement rewards and doctor quality, and ROI guarantee. $3.25 per employee per month $0.85 per employee per month + 2% of collected premium (monthly minimum of $125) Health Savings Accounts Administration (Health Equity)$2.25 per participant per month $5.00 per card Health Benefits Financial Summary Additional Service Offerings and/or Optional Services check (√) if accepting $3.35 per employee per month $1.00 per employee per month $1.25 per employee per month Flexible Spending Accounts (FSA) with Debit Cards for ees and deps over 18 years of age. Monthly minimum $250. Medical, Dependent Care, Combined Medical/Dependent Care, Transit.$5.50 per participant per month Connect - 24/7 Benefits Navigation, Member Advocacy and Clinical Guidance $5.75 per employee per month $0.75 per employee per month Diabetes Management with Livongo $67 per participant per month (6 month min) Initiation fee - $800. Monthly Fee - $469 (1st month $1,269) Primary360 Virtual Primary Care Solution - $0 Medical Consult ($165 initial patient visit; $99 established patient visit) Health Savings Accounts (Integration with other vendor)$0.35 per participant per month + banking fees $4.00 per participant per month Primary360 Virtual Primary Care Solution - $55 Medical Consult ($165 initial patient visit; $99 established patient visit) Confidential Information of Trustmark Health Benefits, Inc. 6