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Agenda
Meeting Location In – Person
2051 Kaen Rd, Oregon City, OR 97045
PSB building, 3rd Floor, Suite 369A
Vendor Topics of Discussion
- Review 2024 utilization with carriers
Presentations:
1:30 – 2:00 pm Aptia Meeting Kelly Austin, Aptia
2:00 – 2:10 Break / Kaiser Setup
2:10 – 3:20 Kaiser Utilization Tammy L. Rivas, Kaiser
Reva Ricketts-Loriaux, Kaiser
Melanie Hall, Kaiser
Ky Thai, Kaiser – Dental
Dr. Cyrus Lee, Kaiser – Dental
3:20 – 3:30 Member Reports BRC
Minutes
This document is intended to be a meeting summary.
Attendance and Minutes:
Voting Members Present: Cheryl Bell, Cynthia Kodachi, Phillip Mason-Joyner, Paula McDonald, Ryan Miller,
Greta Nickerson, Jon Santana, Sandra Montoya, Ron Wierenga, Alex Gonzalez, Rob Sadowsky, Gretchen Pacheco, Bob Skinner
Voting Members Not Present: Nancy Bush, Calley Dean, John Lee, Deena Mehdikhan, Fred Yungbluth, Rachelle Bonsi, Cynthia Boettcher
Minutes: Toni McGarvey
Facilitator: Cynthia Kodachi
Attendance:
- Attendance taken. Quorum present.
Introductions:
- Aptia presenter – Kelly Austin
- Facilitator – Corey Falls
- Commissioner Ben West
Aptia: Dependent Audit project vendor
Presenters: Kelly Austin
Contract Intro:
- Able to handle the fiduciary responsibilities during contract fulfillment
- Process will remove ineligible dependents
- Multi-functional, user-friendly website portal will be used to interface with employees and county
- Portal will be designed to easily upload substantiating documents from multiple sources including cell phone
- Translation services will be available to employees needing assistance
- Implementation timeline: 7 weeks
- Verification timeline: 5 weeks
Questions and Comments:
- Have past audits been conducted? An audit of this type has not been performed since the county became self-insured.
- What if employees do not provide documentation as requested? They will continue to appear on a report compiled by Aptia and provided to the county team for removal. The employee will be able to re- add the dependent during open enrollment and submit substantiating documents.
- Will the employee have to wait until open enrollment to add dependents? What if they find documents prior to open enrollment? Employees will be given adequate time to respond and will receivecommunications at several stages of the project. If they do not respond and provide the needed documents they will have to wait until open enrollment to re-add.
- Will there be any "grace period"?
- The goal is to stick to the five week timeline for verification, and Aptia reports that the majority of participants (based on past projects with similar agencies to the county) find the five week timeline to be adequate.
- If documents are in process and Aptia is just waiting on materials to be uploaded, then the Aptia team will work with those employees to help them meet the requirements of the audit.
- Five weeks seems reasonable but life happens. The team will work toward the deadline and will respond to those needing additional assistance on a case by case basis.
- Don't our insurance providers automatically term/remove overage dependents? How will this process support or differ? Currently the county does not ask for substantiating documents up front, and there is no mechanism in place to track and update over time. The addition of Aptia as our contractor will provide much needed assistance with the burden of administering a process that we were not completing prior.
- Aptia will assist with this one time process and the administrative burden, but we are not adding new requirements, is this correct? There will be a procedural change that will be instituted to ask for dependent documents up front. As we already ask for documentation of life changes (birth, death, marriage), we will now, as process, be good stewards and apply the same diligence to the dependent process.
- At what age is a dependent no longer covered? They are covered up to age 26.
- To clarify, this is a one time "catch-up" or is this an ongoing process? Industry standard is to audit self- insured plans every 3-5 years, as it can impact pricing.
- Are there any standard benchmarks Aptia tracks for first time audits? Return on investment in completing these audits can be substantial as erroneous enrollments are removed. There is an average 5% change experienced by conducting dependent audit, which directly impacts our claims.
- Will there be communications coming from the county prior to this audit? There is an extensive communications plan being developed that will reach out to and inform all groups in the county.
- Will everyone have to participate? Yes. Everyone will have to participate in this audit.
- Can we forewarn employees? Not necessary as this is not a punitive about the process, there will be no monetary impact. This is just an opportunity for plan hygiene, we will not be "looking back" but implementing structure for the future.
- Will this include a policy upgrade at the county? Yes, employees can now add documents through PeopleSoft upload, and all new hires are required to provided dependent documents/info.
- What sort of documents will be required? Social security card, marriage certificate, adoption papers, birth certificate. For domestic partners joint financial information will be needed such as a utility bill where both names appear, tax return, bank record, vehicle registration. There will be many options fordocuments that comply with the audit requirements and Aptia call center reps will be available to assist employees in obtaining and uploading documents.
- Is digital the only option for uploading or providing documents? What about those that are not tech saavy? Participants will be able to mail documents to Aptia using a pre-addressed envelope that can be provided by Aptia staff. Faxing of documents will not be supported.
Cynthia: Please do not announce this project to staff yet. We will have a full communications plan ready to launch soon (in the next couple of weeks) and the project will go live this summer.
BREAK
Kaiser Permanente: Utilization Report
Presenters: Tammy L. Rivas, Reva Ricketts-Loriaux, Melanie Hall, Ky Thai, Dr. Cyrus Lee
- Presentation of Clackamas County BRC Annual Review
- Increase in access points for Kaiser members looking for care
- Creates more ease in scheduling (as reported by members)
- Decreases the need for Urgent Care visits
- Lifestyle Risks Overview 2022 to 2024 – notable changes
- 1.5% increase in obesity
- 2.7% increase in Childhood obesity
- .2% increase in borderline or high cholesterol screenings
- .1% increase in high blood pressure
- .7 decrease in smoking rates, as reported
- Preventive Services Overview 2022 to 2024 – notable changes
- 8.30% increase in cervical cancer screening
- Enhances heart disease screenings such as calcium calcification screenings for cardiovascular disease, and other preventive screening measures currently not available. What is Kaiser looking to offer to provide more diagnostic and preventive measures/screenings? Lifestyle programs with integrated medical services coming soon.
- Dental care access has increased 5% over 2024
- In chair scheduling is mitigating wait times for appointments and having to call and check status on waitlist appointments
- Dental cleaning short notice hygiene appointment opportunities increasing
- Self service portal enhancements are providing more ease in scheduling
- Greta specifically shares that there is improvement in scheduling. Ticketing system working great.
Additional locations for scheduling are being considered when there is a wait time. "The needle is moving". - Additional diagnostic tools and healthcare screenings are being provided at Kaiser dental appointments – your mouth is part of your body.
- Flu Shots and other vaccines (COVID) being given
- Care gaps are being closed
- Diabetic care referrals closing care gaps
- KPNW is beginning to offer Wellness and Lifestyle Coaching, more to come.
Member Reports:
- Not much time left for member reports outside of questions and discussion during vendor presentations. BRC members encouraged to bring items, questions, concerns to the next meeting on June 12th
Meeting Adjourned:
Cynthia Kodachi adjourns the meeting
Next meeting: June 26th, 2025 – Meeting will occur remotely. A Zoom link will be provided.