Comparison of PCMH Groups:

David Williams of Milliman, Inc. led off the meeting with a comparative analysis of the performance of the two Patient-Centered Medical Homes (PCMH). This included the following:

The PCMH, identified as "Group 1" and "Group 2", were compared to a "Base" group (composed of active state employees) and an "Expected" group on four key indicators: ER visits, "Consults" (referrals to specialists), physicals and office visits. There were observable differences between the two groups. Group 1 showed fewer consults, a higher incidence of physicals and fewer office visits. Group 2 showed significantly more consults, a lower incidence of physicals and more office visits. Both groups showed a lower incidence of ER visits than the base, but incidence of ER visits for patients in both practices was higher than the expected group.

Both groups showed a higher incidence of physicals and office visits (positive) and consults than the base and expected groups. The usage of consults needs analysis to determine whether the practices can handle more matters in office as opposed to making specialist referrals.

Milliman presented graphs depicting "established" (continuing) and new patients' use of "preventive services" (limited to the annual physical), which showed that (1) established visits since 2008 have modestly trended upward for women but have remained fairly constant for men; and (2) new visits since 2008 have been fairly constant for women and men. These graphs further illustrated that there is a stark gender disparity in the rate at which participants obtain physicals; men are far less likely to seek preventive care. This is an area that might benefit from further review and consideration of campaigns like AARP's initiative on engaging women (who are already inclined to seek care) to encourage their spouses to obtain preventive screenings.

* Milliman presented graphs depicting incidence of mammograms and colon screenings; there was an upward trend for mammograms between 2007 and 2010 (rate of only 593 per 1,000) and a downward trend for colon screenings between age 50 and 53.

Discussion centered on the relatively high incidence of consults for Group 2 (more detail is being sought) and use of physicals (rate, gender disparity). Tom Woodruff queried whether there is evidence of access issues related to an inadequate number of PCP's. Milliman responded that there may be some indications that capacity is an issue.

Open Enrollment Schedule/Health Fairs

Tom Woodruff advised that the open enrollment period will start August 22nd and end September 15th. Staff gave information on plans for health fairs, and distributed a list of participating vendors. The first fair will be held at the Capitol from 10:00 to 3:00 on Wednesday, July 27th.

Flu Shot RFI

Scott Anderson reported that last year the OSC determined that contracting with a provider to administer flu shots at state agencies would reduce the cost of such benefits. The OSC recently issued a request for proposals, and responses are due on July 11, 2011. The State hopes to select a vendor by the beginning of August to be in place for the upcoming flu season. Scott indicated that the contract this is not intended to displace an individual's preferred source of flu shot (e.g. through physician), but to create another option for those who might prefer to obtain a flu shot at work.

Medicare Part D Reimbursement

Tom Woodruff explained that the Affordable Care Act (ACA) and Caremark's ability to administer the program with a single prescription identification card have made it advantageous for the state to shift from the RDS option (under which the state receives a flat 28% subsidy of covered drugs) to the Employer Group Waiver Plan (EGWP) option, which provides federal subsidies for prescription drugs dispensed to Medicare participants in the "donut hole" or "coverage gap"; in 2011, there will be a 50% subsidy of brand-name drugs and discounts on generics. Under EGWP, the subsidy usually kicks in during the latter part of the calendar year, when Medicare recipients begin to hit the donut hole. Anticipated savings are in the range of $30 million in reimbursement per year. Because the State state's plan year begins on July 1st, and EGWP is a calendar year program the anticipated savings will be lower for this fiscal year because we will only have a half year of participation.

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