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HomeMy WebLinkAbout09 22 2015 CMZ-C�3 CITY OF CHUBBUCK COUNCIL MEETING MINUTES SEPTEMBER 22, 2015—1:OOPM CALL TO ORDER; Mayor England called the meeting to order at 1 pm and turned the time over to Mark Semons, the City of Chubbuck's Health Insurance Broker. GENERAL BUSINESS: 1. Discussion on Employee Health Insurance. Mark stated that the first decision to make this afternoon is whether or not the Council is comfortable with reference based pricing. Mark has set up a conference call between the City Council, Phyllis Merrill with MBA, and Stacy Carp with ELAP Services. Councilmember Lewis asked why we don't take the contract price with the hospital and then let ELAP step in and negotiate from that point. Mark answered that there is no contract with the hospital because the contract would prevent the ability for ELAP to negotiate. Councilmember Lewis asked Stacy to introduce ELAP Services and explain Reference Based Pricing. Stacy Carp stated that ELAP Services is a pioneer in health care cost containment. ELAP performs a cost analysis and prepares a matrix based pricing model. With this matrix there are two ways to reimburse the provider. First, ELAP will look at the cost of the service provided and add 12%. Second ELAP will compare the cost of the service provided per the Federal Governments Medicare Schedule and add 20%. ELAP would then suggest that the higher of those two reimbursements be remitted to the provider. ELAP looks at both the cost and the appropriateness of the claims. Councilmember Lewis asked how, if ELAP looks per procedure, how they catch the appropriateness of claims? ELAP will look at the pay by procedure schedule; however, they will scrub the bill for each code on the bill. ELAP Services will only be looking at inpatient services. They do provide legal protection for both the plan and the members of the plan. ELAP's law firm is headquartering in Atlanta Georgia. Councilmember Lewis asked if they have contracts with the hospitals. ELAP does not have contracts with the hospitals. Councilmember Lewis asked how we protect our employees without the contract. ELAP provides legal services to the plan and the member. ELAP will be having the conversation with the hospital on behalf of the member. This will require educating the individual employees so they will know what to do when they receive a balance bill. Councilmember Lewis asked how the employees are protected against credit reporting and judgments if a balance bill is disputed and litigated. Members are only ever responsible for what the plan designates as their maximum out of pocket. Under the ELAP model, ELAP would step in once a balance bill is rendered and would remain as the principle player through the end of the process, no matter how far through the process, credit reporting, judgements, it goes. If impairment to a member's credit is initiated and ELAP decides that there is no further reason to litigate, then they will negotiate a conclusion to the case. Councilmember Lewis asked about litigation. ELAP's attorneys are experienced with this litigation. They have been extremely successful. The argument used is that the member's payment was reasonable, if the hospital doesn't agree with its reasonableness then the hospital is requested to provide documentation for its pricing. Usually the hospitals do not want to reveal their pricing so they move toward negotiation. Councilmember Ellis asked if there was a difference in reasonable cost because of geographies. Phyllis answered that there are many variables that go into the charge computation. MBA has clients across states rural and urban. Certainly there are differences in price because of the cost of doing business in different geographical locations. Councilmember Lewis asked about the number of bills that would go through the ELAP process and end up balanced billed. Phyllis responded that approximately 10% of the City's total claims would be eligible for ELAP review and of that 10% between 15% and 20% percent will be balanced billed. It is a small number of claims. Councilmember Marshall asked how the City will be paying for ELAP. The charges for ELAP are built into the premium quote. Councilmember Lewis asked who initiates ELAP getting involved. ELAP is always involved on the repricing side. The member will get ELAP involved if there is a balance billing. It is the employee's responsibility to report a balance billing. ELAP will not be involved with a secondary insurance. Councilmember Lewis asked about Portneuf Medical Hospital and if MBA and ELAP have metric base pricing experience with the hospitals in the area. MBA does have experience with Portneuf and does not see any differences with our hospital compared to others when it comes to the number of balanced bills. Councilmember Lewis asked about the small bill program. ELAP explained that there can be limit set, on small bills, to get them settled quickly rather than defend every single bill, usually $2,000 or less. Councilmember Lewis asked about declaratory relief. ELAP will initially send a letter of dispute of the balance bill. It is not proactive. Councilmember Lewis asked how a contract between the employer and the administrator can bind the hospital. In the courts, the plan document has becomes the contract between the hospital and the administrator. There are several reasons for this. Some are that this is an ERISA plan. ERISA is a federal law, in the plan it is stated that a reasonable price for the service will be paid. When hospitals call the administrator to verify benefits they are told what the reimbursement will be. Councilmember Ellis motioned to self -fund health insurance with MBA as the Health Benefit Administrator. This will include a contract with ELAP Services for reference based pricing. Also, a directive to pursue a contract with BPA for EAR services, at a level of 3 visits per incident. Councilmember Morrison seconded. Roll Call Vote: Ellis -Yes, Morrison -Yes, Lewis -Yes, Marshall -Yes. ADJOURN: �% The meeting was adjourned at 2:57pm ,A.,: ..._ Kevin Engla ayor ' Rich Morgan -Cit Jerk