Members from Veracity Benefits and Blue Cross Blue Shield met with the City Council on Monday to discuss possible options for a health care plan for city employees.
Veracity, the firm that provides brokerage consulting and employee benefit services for the city, has been negotiating with Blue Cross Blue Shield to try to reach an agreement that would not see city employees paying for unnecessary services, or overpaying for services that they do need.
"We reviewed the initial proposal from Blue Cross, and there's a lot of movement going on in price strategy amongst all of the carriers right now in regard to health care reform," said a representative from Veracity. "There were some new approaches in the initial proposal. The first proposal was not unreasonable overall, but we felt that there were some items that were changing too much too fast."
Blue Cross Blue Shield was asked to take another look at what it could offer the city, and came back with a second option, which was presented to the City Council on Monday. The proposal that was debuted at the meeting showed two possible options - a seven-month contract and a 19-month contract.
Despite the fact that several of the costs associated with this new contract would increase, there are also many that would decrease by a significant amount.
Under the medical administration portion of the contract, patient assistance, behavioral health and disease management would all see increases in their cost to employees. This would result in an annual medical administration cost that would be $16,485.12 more expensive for the city.
For prescription administration however, dispensing fees have been decreased and many discounts have also been increased, which will allow for an annual cost savings of $31,796.53.
New to Blue Cross Blue Shield are quality incentive programs that are in place with various physicians and facilities around the Western New York region. These programs include the nationally recognized patient-centered medical home, which is dedicated to improving primary care; physician quality payment program; case and disease management; and clinical integration.
"(Case and disease management) go hand-in-hand," said a representative from Blue Cross Blue Shield. "Disease management is a focus on chronic conditions, so we provide multiple outreach programs for people with chronic illnesses. Case management is a one-on-one interaction that our nurses will undertake with the sickest of the sick. We work very closely with physicians to make sure that the patients are receiving the benefits."
Currently, 22 percent of city employees are without a primary care provider, one of the major cruxes of this program. This problem is something that the new services offered by Blue Cross Blue Shield aims to tackle head-on.
Part of the philosophy of the patient-centered medical home is to encourage medical professionals to see patients at the top end of their education. Less extreme cases will be given to nurses and physician assistants, freeing up time for primary care providers to focus on chronic and critical diseases.
Currently, the contract renewal date for the city of Jamestown is in June, but the plan year begins January. Should the city choose to go with a 19-month contract, Blue Cross Blue Shield would waive payments for the quality incentive program for the first seven months, an offer that has yet to be extended to any other clients.
A resolution is expected to be presented at the next City Council meeting to determine if the city will accept the offer from Blue Cross Blue Shield.