the triple focus of health care · 2021. 1. 11. · the triple focus of health care don moulds...
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The Triple Focus of Health Care
Don MouldsChief Health Director
Dr. Julia LoganChief Medical Officer
Marta GreenChief, Health Plan Researchand Administration
Danny BrownChief, Legislative Affairs
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AgendaHealth Program Strategic Priorities
Affordability
Quality and Access
Federal and State Legislative Update
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Our Goal: High-Quality, Affordable Health CareImprove health care quality, access, and affordability
Ensure our members receive high-quality care
Ensure the care we provide is affordable
Ensure our members have access to care when and
where they need it
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COVID-19 impacts to health care delivery system
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Health Care Affordability
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Increasing Competition
Insurer Competition
Provider Competition
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Pharmaceutical Strategies
• Acquisition-based pharmacy benefit manager (PBM) contract• Biosimilars First• Next frontier for specialty drugs
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Improved Rate Development Process More transparent and new timeline
Board approval of plan, service area, and benefit design changes
November
Develop baseline ratesReconcile with plan proposalsNegotiate with plans
January – May
Preliminary rates presented
June
Final rates approved
July
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Expanding Plan Choice
2022 plan, service area, and benefit
changes
2022 PERS Platinum and Gold
PPO plans
2023 PPO benefit design
planning in 2021
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Risk Mitigation via Portfolio Rating
Price Plans on Value, Not Risk
Reduce premium volatility & large
increases
Remove adverse selection member migration patterns
Price plans based on value of network, and benefit design
Stabilize Basic Plan portfolio & implement cost
saving programs
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Health Care Quality & Access
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COVID-19 Impacts – What We Know Now
Ensuring continued delivery of high
quality care
0.57% overall impact on
2021 premiums
Mainstream adoption of telehealth
Delayed and deferred
care
Health Disparities became forefront
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COVID-19 Vaccine Update
Largest vaccination program in history
Science behind the vaccine
Distribution• Statewide rollout• County protocols• Timelines vary• How it’s working
on the ground
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Behavioral Health
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Ensuring High-Quality Care
Aligning health plan
requirementswith other purchasers
Clinical quality improvement
measures
Health data quality
Health equity
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Health Equity
Everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential. (WHO)
Race
Ethnicity
LanguageSexual Orientation
Gender Identity
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Federal and State Policy & Legislation
Federal Legislative Issues
State Legislative Issues
Transition Priorities
Governor’s Budget Issues
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Questions & Discussion
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Public Comment
The Triple Focus of Health CareAgendaOur Goal: High-Quality, Affordable Health CareCOVID-19 impacts to health care delivery systemHealth Care AffordabilityIncreasing CompetitionPharmaceutical StrategiesImproved Rate Development ProcessNovemberJanuary –MayJuneJuly
Expanding Plan ChoiceRisk Mitigation via Portfolio RatingPrice Plans on Value, Not Risk
Health Care Quality & AccessCOVID-19 Impacts –What We Know NowCOVID-19 Vaccine UpdateBehavioral HealthEnsuring High-Quality CareHealth EquityFederal and State Policy & LegislationQuestions & DiscussionPublic Comment
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