Benefit Decision Guide News

Rising health care costs and gaps in health care quality continue to pose formidable challenges:

• Health care cost increases have far outpaced increases in workers’ earnings and overall inflation.  According to the Kaiser Family Foundation, nationally since 2001:
• Family coverage health premiums have increased 78%, but
• Wages have increased 19%
• Inflation has increased 17%
• Health care costs, including the GIC, now comprise 45% of the state’s budget.
• The state faces a $1.3 billion budget gap.
• Numerous studies, including those conducted by the Institute of Medicine and the RAND Corporation, have shown wide disparities in quality of care.
                              
What have other employers done?

• Cut benefits/reduced coverage
• Eliminated choice
• Implemented high-deductible plans
• Eliminated retiree benefits

The GIC has taken a different approach:

• Looked at the health care system itself
• Urged providers (doctors and hospitals) to be part of the solution

The GIC’s Clinical Performance Improvement Initiative for Employee and Non-Medicare Retiree Plans, which began in fall 2003, seeks to:

• Maintain a comprehensive level of benefits
• Improve health care quality and safety
• Maintain participants’ choice of providers
• Control cost increases for enrollees and the Commonwealth
• Educate enrollees about provider performance measures of value and quality
• Encourage members to become informed health care consumers

For FY09, the Clinical Performance Improvement Initiative for Employee and Non-Medicare Retiree Plans will continue to evolve:
Physician office visit co-pays will migrate to three tiers for specialists, as well as Primary Care Physicians in some plans, based on quality and cost-efficiency standards.  Health plans will tier physicians on the group and individual level, depending on the practice type and data available:
***Tier 1 (excellent)
**Tier 2 (good)
*Tier 3 (standard)

Physicians for whom there is not enough data and non-tiered specialists will be assigned the Plan’s Tier 2 co-pay.

See the benefit change section for an overview of each Select & Save plan.  For detailed information about how the plans have tiered providers, and which providers are in which tier, contact the health plans. The most up to date tiering information is on each health plan's website.