State Employee Health Plans and Cost Containment Initiatives (2020)

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Survey Questions for State Employee Health Plan Administrators

Survey Questions for State Employee Health Plan Administrators

We fielded this survey between September 15 and December 7, 2020 and received responses from 47 state employee health plan administrators.

SECTION I – Overview 

  1. Your State _______
  2. Your Contact Information (this will be kept confidential)
    1. Name: _______________________________
    2. Email address: ________________________
    3. Your state agency: _____________________
  3. Provide the number of lives covered under the state or public employee plan options administered by your agency. Do not include retirees.
    1. Number of individual employees covered: ___________
    2. Number of spouses + dependents covered: __________
  4. In addition to active state agency employees, which workforces are eligible to participate in the plan options administered by your agency (select all that apply)?
    1. School district employees – teachers
    2. School district employees – staff
    3. Local, municipal or county employees
    4. State university employees – faculty
    5. State university employees – staff
    6. Legislators
    7. Any others: ____________
    8. N/A
  5. Does your agency have the authority to execute contracts with plans and/or third-party vendors, such as Third-party Administrators (Third-Party Administrator (TPA): Also sometimes known as an Administrative Services Only (ASO) entity, these entities deliver services like claims processing and employee benefit management for employers who self-fund health benefits instead of purchasing them from an insurer), Administrative Services Only entities (ASOs), benefit advisory firms, or Pharmacy Benefit Managers (Pharmacy Benefit Manager (PBM): A third party administrator of prescription drug benefits. These entities are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims)?
    1. Yes
    2. No
    3. Other: _________
  6. Does your agency also administer health benefits for retirees? Y/N
    1. If N, which state agency is responsible for administering benefits for retirees? _______
  7. Do the employees eligible for the health benefits administered by your agency have a choice of: (Do not include any dental or vision plan options. If your answer varies by workforce population, please answer for state agency employees).
    1. 1 plan option
    2. 2-4 plan options
    3. 5 or more plan options
  8. Does your agency offer eligible employees a High Deductible Health Plan (HDHP) (deductible is $1,400 or more for a self-only plan; $2,800 for a family plan)? Y/N
    1. If Y, how many active employees are enrolled in the HDHP option with the greatest number of enrollees? Please include dependents_________
    2. If Y, does your agency offer it in conjunction with a Health Savings Account? (Health Savings Account (HSA): A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses if you have a High Deductible Health Plan (HDHP)) Y/N
    3. If Y, does your agency contribute to the HSA? Y/N
  9. Does your agency contribute to a Health Reimbursement Arrangement or Account (Health Reimbursement Arrangement or Account (HRA): Employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year)? Y/N
  10. Does your agency offer eligible employees (NOTE: If you offer more than one of any of the following plan options, please respond for the plan option with the largest enrollment) (select all that apply):
    1. a closed network plan option (e.g., HMO or EPO) (a plan design that provides no out-of-network coverage)
    2. HMO with out-of-network option
    3. an open network plan option (e.g., PPO) (a plan design that provides lower cost-sharing for in-network coverage and partially covers some out-of-network services)
    4. an indemnity plan option? (a plan design, sometimes also referred to as a fee-for-service plan, that allows enrollees to see any health care provider and pays providers a set amount per service)
  11. If your agency provides multiple plan options, do all active employees have the ability to choose any of the plans? Y/N
    1. If N, explain: _____________
  12. Is there a collective bargaining agreement in place with one or more state employee unions? Y/N (If you have multiple collective bargaining agreements in place, please answer the following for the agreement that covers the largest number of active employees)
    1. If Y, does the union (or unions) participate in benefit design decisions (e.g., scope of benefits, level of cost-sharing)? Y/N
    2. If Y, does the union (or unions) participate in network design decisions? Y/N
    3. If Y, what is the duration of your collective bargaining agreement?
    4. 1 year
    5. 2-3 years
  13. 4+ years
  14. Which of the following entities is responsible for network negotiations (select all that apply)?
    1. Your agency
    2. Other state agency
    3. Third-party Administrator (TPA) or Administrative Services Only (ASO) organization
    4. Employee union
    5. Benefit advisory firm, consultant or broker
    6. Other: _______
  15. Beyond enrollee premiums, how is the state employee health benefits program—both benefit and administrative costs—funded (select all that apply)?
    1. State appropriation
    2. State general fund
    3. Agency assessment
    4. Other: __________
  16. Are the plan options administered by your agency:
    1. All self-funded (a type of plan where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third-party administrator, or they can be self-administered)
    2. All fully insured (a health plan purchased by an employer from an insurance company or managed care organization)
    3. Both self-funded and fully insured
  17. Do you purchase any stop loss coverage? Y/N
  18. If available, what is the weighted average or range of actuarial values across all offered plan options? (Actuarial Value: the percentage of the total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, the average enrollee would be responsible for 30% of the costs of all covered benefits) _________________
  19. Over the last five years, has the weighted average or range of actuarial values shifted:
    1. Higher
    2. Lower
    3. Stayed the same
    4. Not available
  20. What percentage of the total premium does the state contribute for (NOTE: If you contribute different amount for different types of employees, please respond for full-time, salaried employees):
    1. Employee only? ________
    2. Employee + spouse, partner, or one dependent? _______
    3. Employee + children? _______
    4. Family coverage? _______
  21. Over the last 5 years, has the share of the state contribution to premiums increased, decreased, or stayed the same over the last 5 years?
    1. Increased
    2. Decreased
    3. Stayed the same
    4. Not Available
  22. Are more than 50% of employees eligible for the health benefits administered by your agency enrolled in a single plan option?
    1. Yes
    2. No
    3. I don’t know

If Y, please answer Section II. If N, proceed to Section III

SECTION II – Plan Details

If your state offers multiple plan options, please respond to the rest of these questions for the plan option with the greatest number of active state agency employees.

  1. In addition to active state agency employees, which workforce populations are eligible to participate in this plan option (select all that apply)?
    1. School district employees – teachers
    2. School district employees – staff
    3. Local, city, or county employees
    4. State university system – faculty
    5. State university system – staff
    6. Legislators
    7. Any others: ____________
  2. What type of plan is this?
    1. Closed network plan option (e.g., HMO or EPO)
    2. HMO with out-of-network option
    3. Open network plan option (e.g., PPO)
    4. Other: _________________
  3. Is this a HDHP? Y/N
    1. If Y, is it eligible for an HSA? Y/N
  4. What is the actuarial value for this plan option for active state employees?  ______
  5. Is this plan option:
    1. Self-funded?
    2. Fully insured?

SECTION III – Cost-Containment Initiatives

Note: Your responses to questions 9 through 13 will be aggregated with other state responses and will not be attributed to your agency or your state.

  1. In the last 3 years has your agency implemented any of the following initiatives to help contain costs (select all that apply)?
    1. Not applicable (state employee plans are all fully insured) (skip questions 1-4)
    2. Benefit design initiatives
      1. Value-Based Insurance Design
      2. Reference pricing
      3. Right to Shop
      4. Wellness incentives that result in an increase or decrease in premiums or cost-sharing based on enrollee’s achievement of a target health metric (i.e., BMI, cholesterol level).
      5. N/A
    3. Provider payment and network design initiatives:
      1. Narrow provider networks
      2. Tiered provider networks
      3. Centers of excellence
      4. Pegging provider reimbursement to a reference price, such as a percentile of the Medicare rate (sometimes referred to as “reference pricing”)
      5. Risk-based contracts with health care providers
      6. Direct negotiation or contracting with providers
      7. Primary care-based initiatives (e.g., worksite clinics, near worksite clinics, DPCs, patient-centered medical home)
    4. Utilization management initiatives
      1. Case management for high-cost enrollees
      2. Disease management for enrollees with one or more chronic conditions (e.g., diabetes, heart disease)
      3. Prior authorization and other methods of utilization management (e.g., primary care physician referral for specialty care)
      4. N/A
    5. Other initiatives
      1. Annual spending growth target or cap
      2. Price transparency initiatives (e.g., Member shopping tools – plans/providers)
      3. Behavioral health management strategies or benefit carve out
      4. Auditing of claims (i.e., utilization auditing, payment accuracy, fraud identification)
      5. Procurement strategies (e.g., reverse auction, invitation to negotiate)
      6. Other: ____________________
    6. Our agency has not implemented any cost-containment initiatives in the last 3 years.
  2. For the cost-containment initiatives selected in the questions above were any of them implemented as part of a:
    1. cross-agency purchasing strategy, i.e., with your state Medicaid agency, state-based marketplace, or other state purchasing agencies? Y/N
      1. If Y, which initiative(s)?
    2. purchasing collaboration with other states? Y/N
      1. If Y, which initiative(s)?
    3. employer purchasing coalition with private employers? Y/N
      1. If Y, which initiative(s)?
  3. Have you identified any documented cost savings from the cost-containment initiatives selected in questions above? Y/N
    1. If Y, which initiative(s)?
    2. If you can quantify cost savings, what were they and how did you measure them? If possible, break it down by initiative ______________
  4. Of the cost containment initiatives implemented in the last 3 years
    1. have any of them been expanded? Y/N
      1. If Y, which initiative(s)?
    2. have any of them not resulted in savings or been eliminated? Y/N
      1. If Y, which initiative(s)?
  5. Does the state employee plan contribute claims data to an All-Payer Claims Database (All-Payer Claims Database or APCD: Statewide databases that include all medical, pharmacy and dental claims collected from all private and public payers)? Y/N
  6. Does your agency use data from the APCD to assess cost trends/drivers in the state employee plan program? Y/N
  7. Does your agency have access to claims data from its Third-Party Administrator (TPA)? Y/N/NA
    1. If Y, does your agency use those claims data to assess cost trends/drivers? Y/N
    2. If Y, is claims data analysis performed (select all that apply):
      1. In-house at the agency?
      2. By the carrier/TPA?
      3. By a consultant?
      4. Other: _________?
  8. If a collective bargaining agreement has a duration of greater than 1 year, are you able to make mid-course changes to the agreement in order to implement cost-containment initiatives?
    1. N/A, because there is no collective bargaining agreement in place
    2. Yes
    3. No
  9. Is the state considering the implementation of any new cost-containment initiatives in the next 1-2 years? Y/N
    1. If Y, please describe: ________________
  10. What are the primary barriers to your agency implementing cost-containment initiatives (select all that apply)?
    1. Governance structure
    2. Terms of the collective bargaining agreement
    3. Procurement policies and requirements
    4. Resistance from stakeholders (e.g., providers or enrollees)
    5. Limited or no evidence of return on investment
    6. Legislative mandates or requirements
    7. Other: ________
  11. Please identify the single highest cost driver for your plans:
    1. Prices of hospital services
    2. Prices of physician and other ambulatory services
    3. Prices of prescription drugs
    4. Excessive or inappropriate utilization
    5. Other: ________
  12. Which of the following benefit categories does your agency primarily target when considering cost-containment initiatives (select all that apply)?
    1. Prices of hospital services
    2. Prices of physician and other ambulatory services
    3. Prices of prescription drugs
    4. Excessive or inappropriate utilization
    5. Other: ________
  13. If available, please share any relevant public reports or agency documents evaluating the cost-containment initiatives above and about any cost savings produced. If you would rather send us publicly accessible links, please email them to Maanasa.Kona@georgetown.edu.