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Tucson Unified School District No. 1
Employee Benefits Trust Meeting
Board Room, Morrow Education Center
1010 East Tenth Street
Tucson, Arizona 85719
October 16, 2012
5:30 p.m.
Committee Members Present:
Dr. Neil West
Dr. Stegeman
Mark Mansfield
Robert Harbour
Committee Members Absent:
Yousef Awwad
Others Present:
Shannon Roberts – Employee Relations Director
Janet Underwood – Recordkeeper
Louis Montoya – Buck Consultants
Pat Mause requested to speak.
QUORUM - The Board affirmed that a quorum was present


A motion was made, and seconded to move 2nd Level Appeal to being heard first Pat Mause introduced himself as representation for 2nd level appeal claimant. He presented general information regarding the 2nd level appeal: In order to protect the privacy of the claimant, a summary of  
Mr. Mause’s statement is held separately.
Mark Mansfield made a motion to grant the request for this to be tolled (and set a date that tolling begins [state certain] and end date), but that Buck comes back to let us know from a compliance view that we are not violating the Plan by using the the legal comments.   tolling review and that the TUSD Legal lead also review, and that we also set up a   next meeting expeditiously. Bob Harbour seconded the motion; carried 4-0. GAP score was explained again; the claimant is now on LTD. The question then is should the Trust Board hear the appeal. Dr. Stegeman would like to come out of this with an understanding of how we will interpret this incapacitation issue Dr. West reported on teleconference call held in September. AmeriBen had reported that they would send a letter to the claimant that we needed a signed HIPAA release which was complied with (permits release of information to AmeriBen). Review Minutes
Minutes for the 8/21/12 meeting were reviewed; Mark Mansfield made a motion to approve the August minutes as presented; Dr. Stegeman seconded; motion carried 4-0. Old Business / New Business
Agenda Items 4b (D. Pedicone meeting) and 7d (Trust Board membership/diversity) Yousef and Dr. West met with Dr. Pedicone on 9/10/12 and reviewed the RFP process used for the Pharmacy bid, which will provide significant improvement in costs of the pharmacy plan, recognition of pharmacy RFP committee members, plan enrollment, plan structure (TPA, network, consultant, stop loss). Additional topics included that the Trust Board’s main role is fiscal integrity of the funds, considering expanding the risk pool per se with county, or some similar pool, and board diversity. Dr. West indicated that the Governing Board would have to decide if the Trust Board could be expanded and more diversity introduced. Also wanted to explore the terms of the trust board members. The terms are indefinite per Dr. Stegeman. Dr. West would like to ensure succession planning in the Trust Board. Mark Mansfield inquired about mandatory terms and wanted to understand the goal as turnover can introduce turmoil; he has seen that alternates are used that helps get a new person up to speed. Dr. West feels the major issue is the gender/racial mix currently. The community members are currently set up as indefinite terms. 4c: Report on ACO discussion with TMC Dr. West related the meeting with TMC. An ACO (Accountable Care Organization) is designed to provide shared savings. TMC reviewed for TUSD their interests and outlined their efforts to-date. An ACO is designed to produce better outcomes of care provided. Ms. Underwood, who also attended the TMC meeting, recounted that an ACO is a valiant effort but also an effort that so far may be hard to rein in; so far we have not seen huge strides in ACO’s. Dr. West would like the tax IDs of their ACO members and bump it up against AmeriBen to see which of their ACO physicians are already treating our members. Mark Mansfield thought there was a new feature in the PPACA law whereby if the person is readmitted the hospital would be fined. Mark Mansfield questions if this would be more or less creating a new network; Louie said that with an ACO if you are not using your network, it would be an outside payment arrangement and would have to address with BCBS and may be challenging for the TPA to administer. Dr. West feels it is premature and was good to get the preliminary information and perhaps begin with the tax ID. Louie cautioned that the TMC ACO providers may have different tax IDs in the ACO. Dr. West also stated that it is UHC that is working with TMC; Aetna is working with Banner in Phoenix. His suggestion is to get periodic reports from TMC; he is not advocating that TUSD be a commercial pioneer in this area. Bob Harbour indicated he would have to abstain from voting in this area should it ever come up since his firm represents many of these partners mentioned. Buck has not seen an immediate trend to enter an ACO environment at this time. 4d: Report on Exploration of Expanded Wellness Program. Dr. West reported that he had a follow up conversation with Dan Johnson, WELCO’s Executive Director regarding incentives. Dr. West suggests that the Trust Board have WELCO back in to begin planning this. In connection with WELCO, TUSD received a renewal award for Progress, Process and Leadership in Worksite Wellness Promotion. Several companies that were recognized for significant savings based on wellness efforts. Mark Mansfield added that we need a discovery session for the 13-14 Plan Year with time to price out any benefit changes. Louie added that wellness efforts reduce spend in that it slows the spend down. Dr. Stegeman encouraged the use of actuarial data. Mark Mansfield would also like Yousef and Buck to identify the TUSD financial needs in that a certain level of savings can assist in the reduction of teachers or staff perhaps. Dr. Stegeman added that we operate on a break-even mode. Drill Down / Pharmacy: Handout provided and report by Buck Consultants:
TUSD’s top 5 drug spend was on Specialty drugs. From a high level, ask first – is there really a problem? He broke It out in 2 periods (Oct 10-Sep 11 and Oct 11 to Sept 12). Note that the startup month is blank and then the amounts begin to fold in. The average monthly amounts are shown at about $376 to $436 from one period to another; however enrollment remained about the same. That is a significant change in costs. There was a 29% increase in the medical plan costs. The Rx costs then look flat so looked at therapeutic classes to see plan cost & cost per prescription change from prior period. Looking at 2012, everything increases except for proton pump inhibitors while member numbers are not going up. Looking further then, we can see that the ten highest drugs in 2012, annualized with Rx counts, etc. to total billed amount there is about a 1% and about 5.1% increase in cost. Average Rx cost is noted – especially Metformin 1000 mg which is now $1.80 versus $0.22. We will need to discuss with Caremark how they can review this with the providers under Academic Detailing. Note that this data is from the Rx plan administered by US Script. In the top 50 drugs, for 1Q 2012, there is a 19% increase in average Rx costs; average days has not changed. Dr. West asked how we can work with AmeriBen and Caremark on Academic Detailing. There could be ways to control costs; such as with Specialty drugs using a 30 day supply to remove waste on getting a 90 days Specialty and finding it does not meet treatment goals. Couponing was brought up; this can be addressed with Step Therapy. Buck provided a US Script report showing the top 50 drugs by dollar amount. Janet stated that any new controls that are introduced in the Plan, with our new PBM, must be accompanied by a specific, targeted communication plan. Drill Down / ESRD/Oncology/Higher Cost Vendors - pended
Financials: pended
Appeals or Subrogation:
• 2nd Level appeal – investigate tolling (see above); the TB would like to see written response on the use of tolling from Buck’s compliance area and from TUSD’s Legal dept. • 2nd level appeal - reviewed; based on the information provided and based on the Plan Documents, this is an excluded benefit unless the member can show there is documented mental illness diagnosis. Dr. Stegeman made a motion to deny the appeal; seconded by Mark Mansfield; carried 4-0. Enrollment Plan Results(9/1/12 to 10/1/12, after Open Enrollment) : EPO – 1.45% increase PPO – 4.8% decrease HDP – 24.3% increase Buck reported the increase will be about $5100 or .9% - a very acceptable renewal. It is Buck’s recommendation that we accept the renewal. The Specific deductible remains at $400k and the Aggregate is at $160k (this again speaks to allowing for a separate line item in the Financials and builds the Reserve up.) Motion made by Mark Mansfield and seconded by Bob Harbour to accept the renewal; Dr. Stegeman supports this on the condition we look at the Specific next year and additional options; this would need to conclude by May 2013. Motion carried 4-0. Mark Mansfield reported on the AmeriBen conference. Half the conference was focused on leadership and AmeriBen values were prevalent. Health Care Reform was visited and there are new Comparative Effectiveness Tax fees in 2014 with respect to PEPM fees. Stop Loss topics were visited in that small self insured plans may be being forced out, which may be a way to force those employees into an exchange. Some plans are really aggressive on smoking, etc. AmeriBen is associated also with TeleDoc and 80% of the time the Dr. can prescribe medication. Per Louie Montoya from Buck, this fee may be a fee to the TPA and then passed on to the employer. AmeriBen did a fabulous job on the conference; it was well thought out and managed well. Janet reported on attending the Wellness presentation, and the Retirement Planning session. Next meeting is scheduled tentatively as Monday, January 14, 2013. H:\EBT TRUST BOARD\Meetings\2012.10.16\Minutes 10 16 12 final.doc  


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