It’s been anything but dull at the GIC this past year and I’m happy to report we’ve made some huge progress (and are still standing). As most of you know, the GIC went out to bid for all health plan benefits this year as well as for the mental health carve-out program for the UniCare State plans and Tufts Navigator and Spirit members. As part of the Massachusetts Health Care Cost Control law, the GIC was required to move to alternative payment systems, and these goals were included in the health plan RFR. Traditionally, doctors, hospitals and other health care providers have been paid on a fee for service basis, which has resulted in the overuse of tests and procedures, often to the detriment of patients. The GIC’s model aims to improve patient health, population health and lower per capita costs with its Integrated Risk-Bearing Organizations model, frequently known as Accountable Care Organizations (ACOs). These changes will help shake up the health care market, improve care delivery and contain costs.
So what will this mean to members?
- Encouraged to designate a Primary Care Provider (PCP) with their health plan
- Can now choose nurse practitioner or physician assistant as PCP
- Care coordinated by a PCP who knows you
- Focused networks
- Incentives to use quality, lower cost providers
- Should lead to limited or declining premium changes over next five years
After a rigorous procurement, the Commission voted today to award 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 Plan Basic, PLUS, Community Choice and Medicare Extension (OME)
Plan design changes for these plans include implementation of some state and federal mandates, tobacco/smoking cessation counseling, gym membership coverage of $100 per family, and portable oxygen concentrator coverage. PCPs will no longer be tiered in the UniCare plans and there will be some changes to UniCare specialist copays. Fallon Select will begin tiering hospitals. Details of these changes will be spelled out in the Benefit Decision Guides. Rates were voted at the March 6 Commission meeting.
On February 15, the Commission also voted to award a new contract to Beacon Health Strategies as the mental health carrier for the UniCare State Plans, Tufts Navigator and Spirit. Beacon Health Strategies is a Boston-based behavioral health company that was founded in 1996 and that covers 8.2 million members. Their model includes co-location with the health plans, which will lead to more coordinated and integrated care for our members. Employees with Fallon or Neighborhood already have their mental health benefits through Beacon. We are meeting with them on Tuesday to begin the process of ensuring a smooth transition.
For State Employees Only
We held a special open enrollment for Long Term Disability from April 10 to an extended end date of June 14 for coverage effective October 1, 2013.
Municipal News and Retiree Dental Plan
The Town of Dracut joined the GIC for health benefits effective July 1. Additionally, 13 municipalities offered the GIC Retiree Dental Plan for the first time and their retirees and survivors enrolled during annual enrollment for July 1 coverage.
GIC Coordinator Training
This is a natural segue to this year’s GIC Coordinator training, which took place during the first week of April. See the Coordinator Training Video for details.
Other Important Reminders
Provider networks change each July 1 as do tiering designations. Be sure employees have checked to be sure their doctors and the hospitals their doctors are affiliated with are still in their plan’s network. They need to be specific if they are asking the doctor’s office (e.g., Harvard Independence or Primary Choice), so it’s safer to visit the plan website or call the plan. The health plans will have their websites ready in time for annual enrollment; we’ll have more specific dates at the training sessions.
Members can’t change health plans during the year, unless they move out of the plan’s service area. This applies even if their doctor or hospital leaves a plan. If that happens, the member must pick a new provider in order to have in-network coverage.
Benefit Decision Guides were shipped to agencies and municipalities beginning April 3. They are available as content and as a download on our website.
This information provided by the Group Insurance Commission.