Posted 8:55 a.m. Monday, Nov. 22, 2021

Marsh view in fall

ETF Update: GIB Approves Medicare Advantage Contract Extension

The Group Insurance Board today approved a contract extension with UnitedHealthcare for the Medicare Advantage plan through 2025. The Board also reviewed multiple strategic initiatives related to the State of Wisconsin Group Health Insurance Program.

The Department of Employee Trust Funds provided an update on the following strategic initiatives of the Board:

  • Specialty drugs and sites of care present potential cost savings. One percent of specialty drug scripts accounted for 49% of overall pharmacy costs in 2020. Specialty drugs, also known as specialty-tier drugs, are medications that traditionally treat complex, chronic, or rare conditions. ETF will work with the program’s pharmacy benefits manager, Navitus, members, and stakeholder groups to understand the full breadth of issues and concerns. Staff will identify different approaches for the Board’s consideration.
  • Social determinants or drivers of health can impact the health and wellbeing of program participants. Key social determinants of health include economic stability, education, neighborhood, health care system, and social context such as support systems. ETF will work with members and stakeholder groups to develop engagement plans and ensure the program meets members’ needs.

ETF Secretary John Voelker presented an overview of the agency’s strategic plan and insurance-related modernization efforts.

ETF has contracted with Benefitfocus to implement a new insurance administration system that will offer online self-service for enrollment and eligibility, communications, reporting and analytics, health insights, and billing and payments. The system will be rolled out in phases and is planned to be fully implemented in 2024.

In other business:

  • The Board approved changing the contract period for supplemental dental, vision, and accident plans from two years to three years, which will provide a more consistent member experience.
  • WebMD, the third-party administrator of the Well Wisconsin Program, is piloting a stress and resilience digital coaching solution available on the web and via a mobile application for a select group of state agencies. Preliminary results should be available in the spring.
  • Navitus and Delta Dental, the third-party administrator of the dental plan, received passing grades in standard, comprehensive audits.
  • The Board received an update on individual health plan’s compliance with data security reporting requirements and discussed the potential consequences for plans not in compliance by March 2023.

The Board’s next regularly scheduled meeting is on February 16, 2022.

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