GIC Chooses Health Plans for FY14 – FY19

Procurement Emphasizes Improving the Way We Get and Pay for Health Care Services

All GIC health plan contracts come to an end on June 30, 2013, so the agency went out to bid last fall to select plans for the new five-year contract period.  The procurement incorporated the basic elements of Chapter 224, the state’s new Health Care Payment Reform law, as well as the federal Affordable Care Act.  Both laws emphasize coordinated care, price transparency, and new ways of paying providers – shifting from fee for service to some form of global payment.  The new laws also emphasize primary care as the focal point for achieving better patient care, better population health, and lower per capita costs.  The GIC used its procurement to require plans to work with providers to establish integrated systems of care, and offered financial incentives for achieving budget targets and adopting the new payment systems, or penalties for not meeting these benchmarks.

What does this mean to members?

  • You are encouraged to designate a Primary Care Provider (PCP) with your health plan;
  • You can now choose a nurse practitioner or physician assistant as your PCP;
  • You should get more coordinated, integrated care;
  • You have incentives to use quality, lower-cost providers; and
  • Your premiums should stabilize or even go down over the next few years.

Health Plan Options Remain the Same, No Major Benefit Changes, and Excellent Rates

After a rigorous procurement, the Commission awarded new contracts to all of the GIC’s incumbent vendors and their current plan offerings:

  • Fallon Direct Care, Select Care, and Senior Plan
  • Harvard Pilgrim Independence, Primary Choice and Medicare Enhance Plans
  • Health New England HMO and MedPlus
  • Neighborhood Health Plan – NHP Care
  • Tufts Health Plan Navigator, Spirit, Medicare Complement, and Medicare Preferred
  • UniCare State Indemnity Plan/Basic, Community Choice, Medicare Extension (OME), and PLUS

The GIC’s aggressive approach to bending the cost curve benefits both members and Commonwealth taxpayers.  Not only were we able to avoid cutting benefits, we were also able to add required new state- and federal-mandated benefits, and some modest benefit enhancements, while alsoachieving an overall 3.5% premium increase for FY14.  This compares extremely favorably to other employer trends, which according to Mercer’s fall National Survey of Employer-Sponsored Health Plans, will increase by an average of 7.4% in 2013 if they do not cut benefits. 

Clinical Performance Improvement (CPI) Initiative Continues – Select & Save

Employees and Non-Medicare Retirees and Survivors:  Be sure to consider physician and hospital tiers when choosing a provider.  You pay the lowest copay for Tier 1 doctors and hospitals.  The GIC’s Clinical Performance Improvement (CPI) initiative gives you an incentive to use doctors with higher quality and/or cost-efficiency scores.  Millions of physician claims are analyzed for differences in how physicians perform on nationally recognized measures of quality and/or cost efficiency.  You pay the lowest copay for the highest-performing doctors:

***Tier 1 (excellent)

**Tier 2 (good)

  *Tier 3 (standard)

Physicians for whom there is not enough data and non-tiered specialists are assigned a plan’s Tier 2 copay.

! Employees and Non-Medicare Retirees/Survivors: During annual enrollment, check your doctor’s and hospital’s tier, as they can change each July 1 with new data. 

This information provided by the Group Insurance Commission.