Specifications include, but are not limited to: Competitive and Affordable Overall Cost o Control cost and increases to both the employer and employees Consolidated Risk Pool o Maintain single risk pool and utilize a third-party administrator to administer the plan o Provide long term management of overall costs Comprehensive, Broad Provider Network o Offer broad network in terms of the number, breadth, quality and location of network providers offer a tiered or narrow network within the broad network with cost effective, high performing providers based on plan design o Limit provider/patient relationship disruption that employees may experience in the event of a change in provider network o Provide access to providers outside the local geographic service area for retirees, students who are dependents, and employees who are working Hybrid work schedules Customer Service o Provide outstanding customer service o Provide responsive customer service o Easy to use member portal and online services Plan Options and Design o Match the existing plan designs and features as closely as possible o Offer alternative plan designs/models that are actuarially equivalent to the current plan designs that help to manage cost (possibility of increased copays and decreased deductibles to better predict cost) o Build incentives on the Rx copays to drive employees to lower cost retailers o Offer a model with clinic tiers clearly identified by the clinics (not by providers within the same clinic) o Continue to provide employees with choice and flexibility o Explore the feasibility of continuing to offer a carrier-administered fully insured Medicare Supplement and/or Medicare Advantage Plan to Medicare eligibles that provides comprehensive, broad access to providers outside the service area o Easy to search member provider directory o Minimize provider disruption Plan Administration o Provide outstanding administrative services o Provide responsive account management Quality o Offer employees meaningful and usable data and information regarding the quality, outcomes and cost of episodes of care o Encourage employees to utilize higher quality, more efficient providers Health Improvement, Education and Wellness Programs o Partner with administrator to design and offer comprehensive programs o Explore innovative, positive incentives for participation in these programs Disease and Other Care Management Programs o Offer assertive disease management and care management programs o Offer employees care support in the form of decision support tools and health care coaches or patient advocates, if cost effective. This would most likely be for those who have been identified as being at risk for or diagnosed with a particular condition or disease.
