FY24 Approved Meeting Minutes

DRAFT FRIC Meeting Minutes
May 3, 2024
Zoom Meeting
1130 AM

Members present:  Julie Urmie*, John Laverty*, Josey Bathke, Mary Charlton, George Hospodarsky, Dan Katz+, Cormac O’Sullivan, Richard Peter, Angela Speers, Sarah Tallman, Anand Vijh, Michael Weaver, Chuck Wieland

*Co-chairs; +Minutes

Members absent: Anya Prince

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Audra Haddy, Erin Litton, Cheryl Reardon, Julie Sexton, Cheri Smith, Dana Stafford, Jessica Wade, Kara Wright, Melissa Twait, Megan Threlkeld

  1. Introductions – Urmie and Laverty
  2. Roll call taken, quorum established
  3. The Chairs and Administrative Staff expressed sincere appreciation for the long and dedicated service of Sarah Tallman to this committee. Sarah will leave the committee at the end of this semester.
  4. Approval of April meeting minutes – Urmie and Schueller
    1. Chuck Wieland moved to approve
    2. Richard Peter second
    3. April minutes approved unanimously
  5. Review/Discussion of Recommended OPM change for Rx (presentation led by Olson)
    • At the April meeting a proposal was made for increases in the pharmacy OPM. Following discussion, the committee requested another scenario with impact analysis using half of the proposed values presented at the April meeting. For instance, the UIChoice Single OPM is currently $1600, was previously proposed to increase to $2100 and was re-proposed this Month to increase to $1850. A table of the revised proposed increases made at this meeting is presented below:
 

UIChoice ($)

UISelect ($)

 CurrentProposedChangeCurrentProposedChange
Single1600185025020002450450
Family3200370050040004900900
  • The estimated impact is as follows: For UIChoice the plan is projected to save $804,000 and 1241 members would reach the OPM maximum based on current spend. For UISelect the plan is projected to save $84,000 and 55 members would reach the OPM maximum. Compared with the April proposal, this revised plan will save $612,000 less and approximately 850 fewer members would reach the OPM maximum.
  • Discussion ensued where the following points were raised: Our plan is still below the Wellmark PPO and HMO averages, medication costs continue to increase, the need to revisit the OPM discussion more frequently so rate increases are introduced more gradually.
    • A motion to approve the revised OPM increases as presented in the table above was made by Chuck Wieland and seconded by Cormac O’Sullivan.
    • Vote: OPM rate change for 2025 unanimously approved.
  1. Update on Weight Management Rx Pilot program for GLP-1 coverage (presentation led by Troester)
    • The goals of the program were defined:
      • To determine effective process, flow and plan design for GLP-1 treatment for weight loss that provides a quality benefit for the patient and is financially sustainable
      • Determine monitoring and program evaluation methodology
      • Evaluate opportunities for retrospective research
      • The pilot will not attempt to determine long-term clinical effectiveness of the GLP-1 medications
    • Pilot Advisory Group members are as follows:
      • Dr. Leon Jons, Dr. Ayotunde Dokun, Dr. Britt Marcussen, Brock Dantuma, Erin Litton, Rebecca Olson, Joni Troester, Angela Speers
    • The draft guiding principles for the Pilot were presented and included:
      • Utilize evidence based best practices
      • Promote choice, flexibility, and accessibility
      • Emphasize quality and value
      • Promote positive behaviors related to health and well-being
      • Design a program that is easy to use by all stake holders (patient, administration, providers)
      • Provide a positive patient experience
      • Financial sustainability
      • Scalability
      • Allow flexibility of design so that plan is adaptable as Pilot information is acquired.
    • It was clarified that for those enrolled in the Pilot, that standard plan coverage would apply.
  2. Pharmacy Benefit Manager Request for Qualifications (PBM RFQL) Update
    • An update on the PBM RFQL process was provided. In May 2024 candidate presentation will have been completed, recommendation to University leadership will be made, a top candidate will be selected, and negotiations will begin. The goal is to complete negotiations by June 2024.
  3. Voluntary Benefits Update
    1. To assess employee interest in four possible voluntary benefits a survey will be sent. The survey will ask (yes/no) if there is interest in Pet insurance, Identity Theft Protection insurance, Legal Assistance Insurance, and Short-Term Disability insurance and place these option in rank order.
    2. Discussion: Long-term care insurance is not an option at this time.
    3. Next steps will be to analyze survey results, issue and RFQL, with a goal of implementing voluntary benefits in Q2 2025.
  4. Access Metrics were presented
    1. Access was mostly unchanged with a slight recent improvement to Specialty Care.
    2. Note was made of downward trend in access to tertiary care.

Meeting adjourned. 

Next meeting September 6, 2024 11:30 am.

DRAFT FRIC Meeting Minutes
April 5, 2024
Zoom Meeting
11:30 AM – 1:00 PM

Members present: Julie Urmie*, Mary Charlton+, Josey Bathke, George Hospodarsky, Daniel Katz, Cormac O’Sullivan, Richard Peter, Angela Speers, Sarah Tallman, Anand Vijh, Michael Weaver+, Chuck Wieland, 

*Co-chairs; +Minutes

Members absent: Anya Prince, John Laverty

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Audra Haddy, Erin Litton, Julie Sexton, Cheri Smith, Dana Stafford, Jessica Wade, Melissa Twait, Megan Threlkeld, Dani Schuyler, Cheryl Reardon, Kara Wright

  1. Introductions – Urmie
    • Meeting called to order at 11:32 AM
  2. Approval of March meeting minutes – Urmie
    • Chuck Wieland moved to approve.
    • Cormac O’Sullivan seconded the motion.
    • Chuck Wieland requested correction to spelling of his name. 
    • No other discussion.
    • March minutes were approved unanimously.
  3. Specialty Pharmacy Update - Mike Brownlee and Alex Mersch
    • UIHC Specialty Partnership began in 2019
    • Focus on quality of care, access and cost of care, integration of care, member experience, advocacy
    • Continued increasing trends of more specialty pharmacy – more kinds of drugs to treat more conditions
    • More specialty meds going from brand to generic/biosimilar (e.g. Humira, Stelara)
    • Areas estimated to grow in 2025: 1) Pharmacy: allergy, autoinflammatory, cancer hepatology, pulmonary; Medical: gene therapies, drugs previously covered on medical benefit may be shifting to pharmacy benefit (IV shifting to subcutaneous)
    • Partnership successes: incorporation of downtown campus, relatively seamless transition to biosimilars for Humira, drug shortage navigation
    • Implications for the health plan: increasing trend continues for number of specialty claims and total allowed amount; Autoinflammatory category is the largest category for dispenses and continues to increase, but biosimilars may help decrease drug plan cost increases in the future
    • Services: 100% of members are screened for assistance; nearly all specialty meds have some form of assistance, proactive outreach for enrollment in drug specific programs
    • Also offer some non-specialty pharmacy financial assistance
    • Strong patient satisfaction: Net promoter score=95; highest number to date and higher than comparable organizations
    • Strong provider satisfaction: Net promoter score=92
    • Future activities: Working on text-based reminders, expanded delivery services, adding new medications, improved packaging
    • Question about who determines the specialty status of new drugs (e.g., GLP1)? Answer: Specialty status determined by insurance company and PBM
  4. Mercy IC Transition – Troester
    • 670 contracts: 55% elected UIChoice; 45% elected UISelect; no major concerns about overall impact
  5. UIChoice/UISelect Plan Changes for 2025 – Olson
    • PROPOSED Plan Changes for Discussion
      • $500 increase in UIChoice single RX OPM ($1600 to $2100)
      • $1000 increase in UIChoice in family RX OPM ($3200 to $4200)
      • $900 increase in UISelect single RX OPM ($2000 to $2900)
      • $1800 increase in UISelect family RX OPM ($4000 to $5800)
    • Group discussion about reasons for the magnitude of the increase. Requests to come up with an option of smaller increase options. Questions about the impact of the increases on rate setting. Previous plan was to review every year, but only make changes every 2-3 years – now potentially suggesting more frequent or phased in changes to avoid large increases. Joni/Rebecca will run another scenario to cut the RX OPM increases in half and run impact analysis with Wellmark, and then FRIC can discuss the options and vote at the May meeting. Considerations discussed: we need to keep a spread between UI Choice and UISelect, and a plan savings of $1.5 million will not have a huge impact of our overall spend ~$370 million.
  6. Coverage for GLP-1 Medications for Weight Loss Pilot Program Update - Troester
    • Established Advisory Group Membership – will begin convening in late April/May and then 2-3 weeks through early Fall. Will provide regular updates at scheduled FRIC meetings
    • Had initial meeting with weight management clinic providers on 3/15, and will have another meeting with them on 4/8
    • Expected that the pilot will yield coverage recommendations by Spring 2026 – and some type of coverage based on the results would start Jan 1, 2027 
  7. PBM RFQL Timeline- Troester
    • Received 13 bids that are now under review. Will provide update at May meeting.
  8. Voluntary Benefits Survey Update – Olson
    • Year 2 Strategic Plan – Staff Success (Total Rewards)
    • Formed subcommittee – Met to review charge and approach to gauge employee interest. Met with staff and faculty groups. Moving forward with finalizing survey questions – will conduct a random sample survey (2500-3000 faculty/staff). Will analyze results and make recommendations and implement new voluntary benefits by 2nd quarter 2025
  9. Access Metrics – Troester
    • Continuing to work on these metrics, which remained mostly steady. Issues not unique to UI Healthcare and we are generally moving in the right direction.

Meeting adjourned

  • Motion to end meeting moved by Chuck Wieland
  • Seconded by Richard Peter
  • Committee agreed to adjourn unanimously at 12:55 PM

Next Meeting: May 3, 2024, via Zoom - Katz will take minutes

DRAFT FRIC Meeting Minutes
TENTATIVE AGENDA
March 1, 2024
Zoom Meeting
1130 AM

Members present: Julie Urmie*, John Laverty*, Josey Bathke+, Mary Charlton, George Hospodarsky, Daniel Katz, Cormac O’Sullivan, Richard Peter, Angela Speers, Sarah Tallman, Anand Vijh, Michael Weaver, Chuck Wieland

*Co-chairs; +Minutes

Members absent: Anya Prince

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Audra Haddy, Kate Klefstad, Erin Litton, Britt Marcussen, Cheryl Reardon, Julie Sexton, William Silverman, Cheri Smith, Dana Stafford, Melissa Twait, Jessica Wade, Kara Wright, Megan Threlkeld

  1. Introductions– Urmie and Laverty
    • Meeting called to order at 11:32AM
  2. Approval of February meeting minutes – Urmie and Laverty
  • Chuck Wieland moved to approved
  • Dan Katz seconded the motion
  • No discussion
  • February minutes were approved unanimously
  1. Investment Management Consultant selection – Troester
    • Captrust selected by RFIC to be investment management consultant
    • Timeframe reviewed w/anticipated beginning in Q2 of 2024
    • Initial goals discussed for the 3 plans
  2. Update on Mercy IC Transition – Troester
    • Health Plan Covered Lives - UI Self-Funded Employer Plans
      1. Enrollment as of 2/23/24 was:  666 total with 368 in UI Choice and 298 in UI Select
      2. Final enrollment numbers will be shared at FRIC’s April Meeting
    • Level One vs Level Two Coverage
      1. Draft communication to FRIC members on 2/29/24
        1. Mercy/UIHC Downtown is a Level One facility with Level One providers
        2. Other locations (like Solon, etc.) are also Level One facilities
        3. Independent providers at Mercy/UIHC Downtown are considered Level Two
      2. Message will be finalized and sent to all employees the week of 3/4/24
      3. All employee questions on this should be sent to Wellmark or UI Benefits websites
  3. Review/Discussion of Recommended Dental Plan Change – Olson/Troester
    • OPTION:  Annual Deductible for Premier and Non-Par Networks (recommended by Benefits staff)
      1. Current is $0 deductible
      2. Proposed change:   $15 annual deductible when using Premier and Non-Par Networks
      3. Estimated $405K plan savings because approximately 27K members (53% of members @ $15)
      4. Peer comparison:  ISU similar plan charges $50 annual deductible
      5. Additional Info requested:
        1. Dentists in the PPO network = 5
          1. Can this be expanded?  Can we ask Delta to expand this network?
          2. UI Benefits will go back to Delta and ask
        2. UI College of Dentistry Wait Times
          1. Endodontics & Periodontics – Feb openings
          2. Operative – March openings
          3. Pediatric – April openings
        3. Members using each network
          1. PPO = 33%
          2. Premier = 64%
          3. Out of Network = 3%
      6. Discussion:
        1. This option will only cover approx. half of the $1M deficit
        2. Providers and size of network reviewed
        3. $15 vs larger deductible? 
      7. Chuck Weiland moved to approve
      8. Cormac O’Sullivan seconded the motion
      9. No additional conversation held
      10. Motion approved unanimously
  4. Review/Discussion of Recommended OPM change for Rx – Olson/Troester
    • Previously discussed both medical and pharmacy OPM but this conversation is now focused on Pharmacy OPM only
    • Proposal:  change to RX OPM
      1. UICHOICE today single is $1,600 increase to $2,100; today family is $3,200 increase to $4,200
      2. UISELECT today single is $2,000 increase to $2,900 ; today family is $4,000 increase to $5,800
      3. Annual savings of $1.5M for UI Choice and $157K for UI Select
      4. Members impacted for UI Choice are 2,008 and UI Select are 141
      5. More discussions to be held next month
  5. Discuss Wght Mgt. Rx strategy and pilot program for GLP-1 coverage – Troester
    • Last month FRIC expressed support for a pilot program
    • Proposed pilot utilizes a step therapy/prior authorization approach as we develop an approach and refine
    • Best practice is still evolving related to treatment and coverage
    • Proposed Pilot Structure:
      1. 2 year pilot program for employee members only in UI Choice and UI Select 
        1. Y1 2025 – up to 500 enrollees
        2. Y2 2026 – additional enrollees TBD; dependent on year one
      2. Utilize step therapy approach and prior authorization
      3. Multidisciplinary Advisory Group to be created to advise on admin, eval and outcomes
        1. Benefits Administration
        2. Campus Health Officer
        3. Medical Providers
        4. Pharmacist
        5. Possibly a researcher
    • Chuck Weiland motioned to support the proposed pilot program as presented
    • Cormac O’Sullivan seconded the motion
    • No additional discussion held
    • The motion was unanimously approved
  6. PBM RFQL Update – Troester
    • 13 bids received, 6 viable after review
    • April 2024 – Committee reviews top candidates; select candidates to proceed
    • May 2024 – Candidate presentations end with committee; choose top candidate
    • May 2024 – Negotiations begin
    • June 2024 – Negotiations completed
  7. Access Metrics – Troester
    • January 2024 access metrics reviewed 
    • Specialty Care trending up; not yet at 80% 
    • Troester noted that it is still too early in the Mercy acquisition to know how/if the additional members will impact access 
    • There are educational opportunities related to how/if members should use Downtown campus ER

Next FRIC Meeting

April 5th from 11:30 a.m. to 1:00 p.m.

Via Zoom

DRAFT FRIC Meeting Minutes
February 2, 2024
Zoom Meeting
11:30 AM – 1:00 PM

Members present: Julie Urmie*, John Laverty*, Josey Bathke, George Hospodarsky, Daniel Katz, Cormac O’Sullivan, Richard Peter, Anya Prince, Angela Speers, Sarah Tallman, Anand Vijh, Michael Weaver+, Chuck Wieland

*Co-chairs; +Minutes

Members absent: Mary Charlton

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Audra Haddy, Kate Klefstad, Erin Litton, Julie Sexton, William Silverman, Cheri Smith, Dana Stafford, Jessica Wade, Britt Marcussen, Melissa Twait

  1. Introductions – Urmie and Laverty
    • Meeting called to order at 11:32 AM
    • An additional meeting has been added for April 19, 2024 (if needed)
  2. Approval of November meeting minutes – Urmie and Laverty
    • Chuck Wieland moved to approve.
    • Angela Speers seconded the motion.
      • No discussion.
    • December minutes were approved unanimously.
  3. Final Results of Open Enrollment – Olson
    • Open enrollment ended on Wednesday, November 15.
    • UI Select enrollment increased by 120 elections.
    • UI Choice decreased by 323 elections.
    • 81% elected UI Choice while 19% elected UI Select compared with 82%/18% respectively in 2023.
    • Mercy employees transitioning to the University of Iowa will continue to enroll through the end of February. These numbers will be reported at the March FRIC meeting.
  4. Investment Management Consultant Selection - Troester
    • The Retirement Fund Investment Committee (RFIC) has made its selection from two final-ists; both firms were excellent options.
    • Contract is anticipated to begin in Q2 of 2024.
  5. Update regarding Mercy Hospital transition – Troester
    • Day one of operation under UI Healthcare was January 31, 2024.
    • The facility is now a level one provider along with other affiliated clinics located outside of the Iowa City area (Williamsburg, West Liberty, Tipton, etc.).
    • WellMark has been provided with the updated information; communication to members will come later in February or early March.
    • Several independent practices continue to operate in the Market Street facility. Those will likely continue to operate independently as level two providers.
    • The addition of Mercy will bring approximately 800-900 contracts to the UI health plan. UHR is looking at the health profile of the new contracts to understand the effect this will have on future rates.
    • UHR is working with shared governance to understand how these new employees will be incorporated into UI Shared Governance and the Charter Committee system including FRIC.
    • New employees have until the end of February to enroll in a health plan and until the end of March to enroll in a retirement plan.
  6. Review/Discussion of Recommended Dental Plan Changes – Olson/Troester
    • UI dental plan is comparatively robust and the cost to the employee is low. Changes to the plan design have not been made in seven years. Going forward, the dental plan will be reviewed more frequently.
    • Proposed change is to include a $15 annual deductible per member when using Premier and non-participating providers (PPO network would maintain a $0 deductible).
    • Iowa State University’s plan includes a $50 deductible for non-PPO providers and $25 for in-network providers. UI’s plan continues to benchmark positively against geographical peers.
    • UHR will gather data on how many current providers are in and out of network prior to March vote on the recommendation.
    • Other options to eliminate the deficit include reducing coverage for periodontic maintenance therapy or high-cost services such as dentures, crowns, and bridges. The committee felt the deductible option was more equitable.
  7. Review/Discussion of Recommended OPM changes for Medical and Rx – Olson/Troester
    • Consider increasing out-of-pocket maximum (OPM) levels for medical and prescription drugs to limit increases to overall premiums.
    • Two years ago, Medical OPMs increased by $300 for single plans and $600 for family plans for level 1 & 2 providers, and by $500 and $1,000 respectively for level 3 providers (same increases for both UI Choice and UI Select plans). Proposal is for a similar increase in 2025.
    • Medical OPM increase would affect approximately 764 UI Choice members and 56 UISelect members.
    • Two options were provided for Rx plans for both UISelect and UIChoice, which would affect approximately 1,950-2,100 UIChoice members and 140-145 UISelect members.
    • More data will be provided in March regarding how these numbers break down between single and family plans.
    • UIs OPMs would continue to compare very favorably with average WellMark PPO and HMO plans.
    • Increased OPMs do not factor in cost of adding coverage for GLP-1 (weight loss drugs).
    • New Pharmacy Benefit Manager, once in place, may be able to offset some of these increases with more favorable contract, drug rebates, etc.
  8. Information/Discussion on Weight Mgt. Rx strategy and coverage – Troester 
    • Landscape around GLP-1 drugs continues to change.
    • UHR is proposing a pilot program to offer coverage to approximately 500 employee members in 2025.
    • Drug coverage for 500 employees could cost up to $7M (estimate only).
    • FRIC showed initial support for the pilot program.
    • UHR will engage with an outside vendor to determine the scope and scalability going forward.
  9. Pharmacy Benefit Manager (PBM) RFQL Update – Troester
    • 13 bids have been received and are currently under review.
    • Committee will meet in March to select finalists to proceed.
    • Candidate presentations will take place in April, followed by the selection of a top candidate.
  10. Access Metrics – Troester
    • Remained steady with a slightly positive trend in specialty care.

Meeting adjourned

  • Motion to end meeting moved by Chuck Wieland
  • Seconded by Richard Peter
  • No discussion
  • Committee agreed to adjourn unanimously at 12:57 PM

Next Meeting: March 1, 2024 via Zoom 

DRAFT FRIC Meeting Minutes

December 1, 2023

Zoom Meeting

11:30 AM – 1:00 PM

Members present: Julie Urmie*, John Laverty*, Josey Bathke, Mary Charlton, George Hospodarsky, Daniel Katz, Cormac O’Sullivan, Richard Peter+, Anya Prince, Angela Speers, Sarah Tallman, Anand Vijh, Michael Weaver, Chuck Wieland

*Co-chairs; +Minutes

Members absent: none

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Marcelo Correia, Audra Haddy, Leon Jons, Kate Klefstad, Erin Litton, Cheryl Reardon, Katie Robinson, Julie Sexton, William Silverman, Cheri Smith, Dana Stafford, Megan Threl­keld, Jessica Wade, Kara Wright

  1. Introductions – Urmie and Laverty
  2. Approval of November meeting minutes – Urmie and Laverty
    • Chuck Wieland moved a motion to approve
    • Anand Vijh seconded
    • No discussion
    • November minutes were approved unanimously
  3. Open Enrollment Update – Olson
    • Open enrollment ended on Wednesday, November 15
    • Similar participation levels as in previous years (»60%)
    • 80/20 split between UIChoice and UISelect
    • Annual year-end benefits reminder email sent out 1st week of December
  4. WellMark Plan Modernization Follow-up – Olson
    • myWellmark prompted members to update Primary Care Provider (PCP)
    • Letter mailings will be sent to members about PCP assigned by Wellmark after January 1
    • University Benefits will send a targeted email to members during first week of December for background and to clarify expectations
  5. Update regarding Mercy Hospital transition – Troester 
    • Mercy will come under the same tax ID as UIHC
    • Mercy on Market Street will be Level 1 starting Jan 31; communication after holidays
    • Billing of Mercy providers currently discussed
    • Suggestion of dedicated website to inform public about process
  6. Aon Information: Marketplace and Employer Planning: Weight Loss Rx Coverage – Troester 
    • Broad spectrum for how employers address GLP-1 coverage for obesity
    • Unrestricted (very few employers), minimal restrictions (few employers), restrictive and no coverage (many employers)
    • Dynamic environment with many employers reconsidering coverage in both directions (i.e., expanding coverage or reducing coverage)
    • Restrictive coverage requires prior authorization and evidence of behavior modifications prior to Rx refill 
    • Creates risk of rebate loss on drugs because rebate is gained when following FDA guidelines for prescription
    • Rebate loss would be absorbed by plan (rebates help keep premiums at lower rate)
    • Joni will investigate rebate loss in more detail during spring semester
    • Common to have prior authorization criteria that are stricter than FDA recommendation 
    • Weight Mgt. Rx strategy should be reassessed year-to-year
    • Considerations in the Weight Mgt. Rx strategy: formulary placement, clinical criteria for coverage, plan design & member cost share, prescriber network, member engagement, reporting, metrics for success, behavior modification 
    • Level for GLP-1 medication can be different than when used for diabetes (level can serve as lever) 
    • Weight Mgt. drug pipeline keeps expanding (CagriSema, Orforglipron, Retatrutide); FRIC will continue to monitor 
    • Current supply chain issues with Ozempic and Wegovy will be monitored by FRIC throughout 2024
  7. Weight Loss Rx Presentation – Dr. Leon Jons: UIHC Weight Management Providers (also present: Marcelo Correia, Katie Robinson)
    • Use of behavioral intervention prior to medication
      • Evaluation of causes of weight gain and barriers to weight loss 
      • Behavioral intervention as first step, followed by pharmacotherapy, followed by surgery
      • Behavioral intervention should always be used before other means and should always be part of any other approach
      • Can be required for people to be considered for pharmacotherapy; e.g., 6-month program before prescription (MOVE program at VA)
      • Documented effectiveness of behavioral intervention in prevention or delay of type 2 diabetes (article)
    • Use of medication around bariatric surgery outcomes
      • Different examples (liraglutide/semaglutide, phentermine/topiramate)
      • Use of medication around bariatric surgery has positive effects
    • New research
      • Cardiovascular outcome trial (SELECT trial, article)
      • Multicenter, double-blind, randomized, placebo-controlled trial
      • 17,600 patients, age 45 or older, preexisting cardiovascular disease, BMI of 27 or greater, no history of diabetes
      • Once-weekly subcutaneous semaglutide (2.4 mg) or placebo
      • 20% reduction in death from cardiovascular disease, non-fatal myocardial infarction or nonfatal stroke at mean follow-up of 40 months
      • Some patients discontinued trial for side effects (16% semaglutide, 8% placebo)
      • Likely different benefits of the drug
      • Surmount 1 trial (article)
      • Phase 3 double-blind, randomized, controlled trial
      • 2,539 adults, BMI of 30 or more, or 27 or more and at least one weight-related complication, excluding diabetes
      • Once-weekly subcutaneous tirzepatide (5mg, 10 mg, or 15 mg) or placebo
      • Mean weight loss at week 72 was 20.9% for 15 mg dose
      • 85% of patients receiving tirzepatide had weight loss of at least 5%
    • Narrow provider network
      • Small number of providers who are board-certified in obesity medicine
      • Limited capacity to take on patients
    • Outcomes in patients with higher BMIs
      • BMI not a good measure but often used
      • Discussed metabolic complications (e.g., diabetes, fatty liver disease), mechanical problems (e.g., hyperventilation, disability), psychological/psychosocial problems (e.g., stigma)
      • Lowering BMI typically improves other issues as well
      • Weight loss also reduces cancer risk (referrals from oncology)
    • Economic impact of obesity in Iowa estimated at $725m annually
    • Recommendations for employers
      • Offer insurance coverage and wellness programs for obesity care at parity with other chronic diseases
      • Foster a culture of support and inclusion
      • Provide education and resources
    • Landscape of obesity pharmacology
      • Insurance coverage: Federal government, VA, Tricare, Iowa City Public Schools, Waterloo Public Schools
      • Dropping insurance coverage in 2024 due to financial commitment: State of Iowa, Iowa State University
    • Models of care: MOVE program at VA, requiring behavioral interventions, narrow prescriber network, limiting access to higher BMIs and patients with comorbidities, weight loss requirements to continue medication, monitor potential future FDA approval of semaglutide for cardiovascular risk reduction
    • Discussion
      • BMI or weight-loss targets for certain types of surgeries or prevention 
      • Effect of Ozempic on A1C levels
  8. Pharmacy Benefit Manager (PBM) RFQL Update – Troester
    • Timelines are being met
    • Draft guiding principles 
      • Promote choice, flexibility, accessibility and inclusiveness for employees and their families
      • Emphasis on quality and value in plan design
      • Promote positive behaviors by employees
      • Ease of use by employees, ease of administration by University
      • Recognize and balance the role of University as employer, provider of health services and educational institution for health professionals
      • Strive to minimize disruption to plan members due to new formulary
      • Focus on a PBM relationship which is sustainable
      • Balance PBM standardization and UI customization requests
      • Ensure access to de-identified data and reporting to guide decision making
    • At least 5 year time horizon for new PBM relationship
  9. New Business: Draft Discussion Schedule for Spring 2024 Semester – Troester
    • Following proposal:
      • February: final result of open enrollment, update on Mercy, dental plan changes, OPM changes for medical and Rx, discussion on Weight Mgt. Rx strategy and coverage
      • March: finalize dental plan changes and OPM changes for Med/Rx motion and vote; continued discussion on Weight Mgt. Rx strategy
      • April: ID draft recommendations for Weight Mgt. Rx coverage, specialty Rx presentation
      • May: voluntary benefits survey results, final recommendation for Weight Mgt. Rx coverage, motion and vote
    • Possibility to schedule additional meeting and cancel if not needed
    • Will know from PBM RFQL how exactly prior authorization can be tailored when discussing Weight Mgt. Rx strategy and coverage
    • Weight Mgt. Rx strategy as pilot for initial years due to dynamic nature of weight loss drug environment; continuous reevaluation 
  10. Access Metrics – Troester

  • Meeting adjourned

  • Motion to end meeting moved by Chuck Wieland

  • Seconded by Cormac O’Sullivan

  • No discussion

  • Unanimously agreed

Next Meeting: February 2, 2024 on Zoom 

DRAFT FRIC Meeting Minutes

November 3, 2023

ZOOM Meeting

11:30 am

 

Members present: Julie Urmie*, Anya Prince, Chuck Wieland, George Hospodarsky, Richard Peter, Daniel Katz, Cormac O’Sullivan+, Sarah Tallman, Mike Weaver, Anand Vijh, Angela Speers, Mary Charlton, Josey Bathke

*Co-chairs; +Minutes

 

Members absent: John Laverty

 

Administrative staff present: Joni Troester, Rebecca Olson

 

Visitors present: Cheri Smith, Dana Stafford, Julie Sexton, Kara Wright, Jessica Wade, Cheryl Reardon, Audra Haddy, Shelly Kurtz, Erin Litton, Melissa Twait, Megan Threlkeld, Lisa Mascardo, Kayla Godfrey, William Silverman

  1. Introductions and Roll Call

 

  1. Approval of October meeting minutes
    1. Chuck Wieland moved to approve the minutes of that meeting.
    2. Richard Peters seconded.
    3. Motion was approved unanimously.

 

  1. Open Enrollment Plans
    1. Rebecca Olson presented information about open enrollment which commenced on November 1 and runs until November 15, 2023. Discussed various changes to the benefits package and communications to faculty and staff. Will continue to have the dedicated open enrollment mailbox. It was well-utilized when it was rolled out. Campus building TV slides will run an open enrollment slide. Informational handouts and videos available in English, Spanish, and French. Healthcare interpretation services available as needed and HealthEquity has interpreters available for FSA questions.
    2. Enrollment tracking with similar numbers to previous years. Reminders will be sent next week to those who have not finalized and again one day prior to the end of open enrollment.
    3. Preliminary results will be available at December meeting and final enrollment numbers will be available at February, 2024 FRIC meeting.
    4. Retiree benefits: Medicare open enrollment is slightly different timeline, so they got a letter from the benefits department last week in September to align with the Medicare open enrollment timeline running October 15 through December 7, 2023

 

  1. Wellmark Plan Modernization Follow-up
    1. Rebecca Olson gave an update to the Wellmark Plan Modernization topic.
    2. Benefits met with UIHC and both had similar questions about the Wellmark update.  UIHC sent provider specific questions to Wellmark provider relations area. They are waiting on response.
    3. Wellmark has assured UIHC and Benefits that the “assigned” primary care provider will NOT function as a gatekeeper and will not impact the ability to see the PCP of your choice. However, if a PCP is not selected by the enrollee, one will be assigned by Wellmark. There is no ability to opt-out of this PCP requirement.  
    4. Reminder: If a PCP is assigned by Wellmark, they will send a letter notification which lists the assigned PCP for contract holder and their dependents. The letter will also include information about how the contract holder may update their PCP. These letters will be sent sometime after January 1st.
    5. As more information is known, updates will be shared in the December meeting.

 

  1. Weight Loss Rx Presentation
    1. Reminder this is an ongoing discussion throughout the year.
    2. Lisa Mascardo and Kayla Godfrey from UI Healthcare Pharmaceutical Care shared information on GLP medications being used for weight loss.
    3. They covered general information about the pharmaceutics of the various available medications, prescription patterns being seen at UIHC and statewide, availability of medications, and cost were shared with the committee. 
      1. Wegovy and Saxenda are currently approved for weight loss and being prescribed for such around the country and in Iowa.
      2. There is a significant shortage of both medications which is predicted to last through 2024.
      3. UIHC is currently limiting dispensing of these medications to diabetic patients due to the supply shortage.
      4. The shortage has created a side supply chain of a compounded salt version of the medications which is NOT approved for human use and does not appear to work as well.
      5. Lisa and Kayla indicated the medications are lifelong administration and if patients come off the medications, they may likely regain much of the weight they lost especially if strong behavior modification skills aren’t in place.
      6. In their experience, very few patients come off the medications due to potential weight gain.  
      7. A major hurdle at present is the supply chain and unavailability of the medications. Especially the starting doses needed to begin treatment which are not available at present time.
      8. Cost is also a concern per the UIHC pharmacy specialists.
      9. Providers from UI Weight management clinic will present to FRIC in December.
      10. Materials being added to FRIC shared drive as they become available.

 

  1. Survey Regarding voluntary benefits
    1. Rebecca Olson shared information on Yr 2 Strategic Plan initiative to assess UI employees desire for additional “voluntary” benefits. These include things like vision insurance, pet insurance, legal services, etc. A subcommittee will form and survey a random sample of UI staff about their wants and needs. If an external entity offers a commonly requested service, benefits office will ask for RFP and the subcommittee will determine if possible to offer to UI staff.
    2. For “voluntary” benefits, the UI Benefits acts as a payroll deduction remitter by deducting the money from the employee’s paycheck and sending it to the vendor of the service. UI does not manage voluntary benefits.
    3. Anyone wishing to be on the subcommittee on voluntary benefits can contact Rebecca. 

 

  1. PBM RFQL Update
    1. Joni Troester reported that the PBM RFQL process is on track. A key goal for the new PBM is to allow UI to tailor some pharmacy benefits to meet UI needs. PBM Committee will start reviewing top bids in February/March 2024. PBM change will be January 1, 2025.

 

  1. Investment Management Consultant for Retirement Plans
    1. Joni Troester gave an update for the investment management consultant. Presentations by the four finalists being scheduled. The new contract is anticipated to be in place in early 2024. Updates in December and February FRIC meetings.
  2. Access Metrics
    1. Joni Troester presented the access metrics for October 2023. Meeting with UIHC patient access center to discuss continued difficulty to meet access goals within specialty care and general internal medicine. Efforts are ongoing to improve these statistics.
    2. No information on Mercy, Iowa City at the time of this meeting.
  3. New Business
    1. Dental plans will be reviewed in February 2024
    2. Out-of-pocket (OPM) medical and pharmacy will be reviewed in spring 2024
    3. Continued discussion about the impact of weight loss reduction medications and other potential changes on the OPM’s and overall plan costs. Request for information about total plan costs, OPMs, other changes to be presented in total cost package for discussions.
    4. Plan design changes will need to be voted on by the May FRIC meeting in order to process through the UI administrative system to President Wilson for submission to the Board of Regents in time for implementation in 2025.

 

Motion to adjourn: Weiland; Seconded Speers; approved unanimously.

DRAFT FRIC Meeting Minutes

October 6, 2023

ZOOM Meeting

11:30 am

 

Members present: Julie Urmie*, John Laverty*, Anya Prince+, Chuck Wieland, George Hospodarsky, Richard Peter, Daniel Katz, Cormac O’Sullivan, Sarah Tallman, Mike Weaver, Angela Speers, Mary Charlton

*Co-chairs; +Minutes

Members absent: Josey Bathke, Anand Vijh

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, Dana Stafford, Julie Sexton, Cheryl Reardon, Audra Haddy, Shelly Kurtz, Erin Litton, Jessica Wade, Melissa Twait, Megan Threlkeld, Kate Klefstad

  1. Introductions and Roll Call
  2. Approval of September meeting minutes
    1. Chuck Wieland moved a proposal to approve the minutes of that meeting.
    2. Mike Weaver seconded.
    3. Motion was approved unanimously.
  3. Open Enrollment Plans
    1. Rebecca Olson presented information about open enrollment which runs November 1 until November 15th. Discussed FSA dollar amount increase and communications to faculty and staff. Will continue to have the dedicated open enrollment mailbox. It was well-utilized when it was rolled out. Campus building TV slides will be shown around campus.
    2. Retirees: Medicare open enrollment is slightly different timeline, so they got a letter from the benefits department last week to align with the Medicare open enrollment timeline.
    3. Interpretation: Written materials available in English, Spanish, and French. Benefits office utilizes healthcare interpretation services if needed and HealthEquity has interpreters available for FSA questions.
  4. HealthEquity Six Month Update
    1. Rebecca Olson shared 6 month stats with HealthEquity as well as feedback heard from employees, which is overwhelmingly positive.
    2. Will share similar statistics in the February 2024 FRIC meeting.
  5. Wellmark Plan Modernization Follow-up
    1. Rebecca Olson gave an update to the Wellmark Plan Modernization. This was discussed in the September Meeting, where the new platform would have a designated primary care provider listed. As discussed last month, this does not impact the ability to see the PCP or your choice or obtain plan benefits.
    2. The new information for October: A letter will be sent to enrollees that lists their PCP for themselves and their dependents. It gives information about updating the PCP listed. These letters will be sent after January.
    3. There will be more information available in November.
    4. Rebecca Olson discussed how Wellmark requires this new field designation, so it can’t be left blank and there is no ability to opt-out.
    5. Discussion:
      1. There were questions about how the Wellmark system will designate a PCP when there isn’t one. If Wellmark designates a PCP, then will the PCP know that they have a new patient? Will that PCP have capacity to actually take that person? The current understanding is that there is no communication between the Wellmark payment system and the healthcare side.
        1. There are ongoing talks with UIHC providers and Wellmark to discuss these concerns.
      2. There was a question about whether Iowa should also send a letter to clarify what the Wellmark letter means for them. (i.e. that they don’t have to have a PCP to see a provider). Iowa is planning to send out communication prior to Wellmark’s letter.
  6. Weight Loss Rx Discussion
    1. Reminder that this is an ongoing discussion throughout the year.
    2. Joni Troester presented updates on this ongoing discussion. Joni Troester met in September with physicians who presented to FRIC in the Spring explaining the decision to not cover weight loss rx for 1/1/24, but continuing to discuss and research this area.
    3. Updates on peer benchmarks: Iowa State University was covering the medication through ExpressScripts, but as of 9/1/23 they are no longer covering this. There is not yet clarity on the reasoning for these changes.
    4. Materials in shared drive: Joni Troester discussed a variety of new resources that have been uploaded to the FRIC Shared Drive of materials.
    5. Questions for the committee over the year will be what some restrictions on any coverage would be: i.e. who prescribes, what behavioral interventions may need to be paired, what BMI level, etc. We can’t put these restrictions with our current PBM, but we can put that in the request in the PBM RFQL in the spring to be able to tailor the prior authorization.
    6. Please send helpful articles and resources to Joni and Rebecca and they will put in the shared drive.
    7. Joni Troester shared the presentation schedule:
      1. November 2023 – Lisa Mascardo from UIHC Pharmacy will present on observations on prescribing weight loss  rx patterns and supply
      2. December 2023 – Weight Management Clinic Physicians will discuss possibilities for narrow eligibility criteria, as well as how these prescriptions interact with bariatric surgery.
        1. Member requested information on how a referral system might work. Or the steps in a step program. The referral system could potentially be included in a discussion in February 2024. Joni will request the physicians to cover the step program in December.
  7. PBM RFQL Update
    1. Joni Troester presented the timeline for the PBM RFQL process. Purchasing will post in November. PBM Committee will start reviewing top bids in February, 2024. PBM change will be January 1, 2025.
  8. Investment Management Consultant for Retirement Plans
    1. Joni Troester gave an update for the investment management consultant. Nine firms responded to RFQL and four have been chosen for finalist presentations. The new contract is anticipated to be in place in early 2024.
  9. Access Metrics
    1. Joni Troester presented the access metrics for August 2023. Continued difficulty to meet access goals within specialty care. Efforts are ongoing to improve these statistics.
    2. Discussion about how the potential Mercy purchase could impact access and people’s perceptions over which providers will now be Level I providers.

Motion to adjourn: Chuck Wieland; Seconded Cormac O’Sullivan; approved unanimously.

DRAFT FRIC Meeting Minutes

September 1, 2023

ZOOM Meeting

11:30 am

Members present: Julie Urmie*, John Laverty*, Anya Prince, Angela Speers, Sarah Tallman, Chuck Wieland, Richard Peter, Mary Charlton, Cormac O’Sullivan, Mike Weaver, George Hospodarsky, Anand Vijh+, Daniel Katz

*Co-chairs; +Minutes

Members absent: Josey Bathke

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, Dana Stafford, Julie Sexton, Cheryl Reardon, Audra Haddy, Shelly Kurtz,  Erin Litton, Megan Threlkeld, Melissa Twait, Kate Klefstad

  1. Introductions and Roll Call
  2. Approval of August meeting minutes
    1. Chuck Wieland moved a proposal to approve the minutes of that meeting. 
    2. Richard Peter seconded.
    3. Motion was approved unanimously.
  3. FRIC OneDrive
    1. Rebecca Olson informed the members that she started a FRIC OneDrive to share reading materials. She said that she would share the OneDrive address with FRIC members after the FRIC meeting. 
  4. Update on CY2024 Insurance Premiums
    1. Joni Troester informed the members that President Barbara Wilson had approved the 2024 health insurance premiums proposed by FRIC and they were now pending approval by the Board of Regents during their forthcoming meeting on September 27-28, 2023. The new rates information will be shared with all university employees in early October, prior to the open enrollment period.
  5. Retirement Plan Updates
    1. Rebecca Olson informed the members about the following. 
      1. The Retirement Fund Investment Committee (RFIC) is looking for an investment fund management specialist to consult with RFIC on the future TIAA lifecycle fund line-up. Bids currently being examined. Expect the consultant will be chosen by the end of the year. 
      2. Fund changes announced in May were implemented in July. Froze the following two funds. 
        1. T. Rowe Price Growth Stock fund  - new contributions mapped to TIAA Large Cap Growth Index fund. 
        2. Western Core Asset fund – new contributions mapped to Vanguard Total Bond Market Index fund. 
  6. Secure Act 2.0 requires that employees over 50 years of age who want to make catch-up retirement contributions will be limited to Roth contributions (i.e., with post-tax earnings). However, the implementation date of this requirement has been shifted from January 2024 to January 2026.
  7. Wellmark Plan Modernization
    1. Rebecca Olson informed the members that Wellmark plans to modernize their system by phasing out the existing platforms (Blue Access and Blue Choice) and replacing with two new ones (Wellmark Blue HMO and Wellmark Blue POS.) With the new platforms, there will be a required Primary Care Provider (PCP) field that must be populated for every member. There may be some confusion with our plan members since University of Iowa does not require a PCP.  More specific information will be provided by Wellmark in the upcoming weeks.  Updates will be shared in the October FRIC meeting. 
  8. Weight Loss Rx Update and Discussion
    1. The committee continued the exploration of future plan coverage which started earlier this year.
      1. Joni Troester reviewed the Wellmark white paper and WSJ article.
        1. Committee members discussed the articles. Although Ozempic was originally intended for diabetic care, these drugs are increasingly being taken for weight loss by many people. The drugs are expensive, on average $13,000 per year per patient. Further, weight loss requires their continued use over the long term. The drugs may increase health-care premiums for everybody by 6% to 7% if made easily available. At present, the university plans do not cover these drugs for weight loss purpose, although these are covered for diabetic care. This issue was actively discussed by members, and the discussion will continue to future meetings. Several points were raised as follows:
        2. If the only criterion for coverage is that a person be obese, generally defined as body mass index (BMI) of greater than 30, then 40% to 45% of Iowans lie in that category. That means the cost implications to healthcare plans will be huge. Thus, at a minimum there should be stiffer eligibility criteria.
        3. Continued from above, members would like a presentation from an expert in the obesity clinic on who really needs the drugs and benefits the most from them.
      2. Joni shared the updated peer benchmarking which was first presented earlier this year. Among our peer groups, Iowa State, Illinois, Michigan, Northwestern, Ohio State, Penn State, and Purdue provide some coverage of weight loss drugs. The extent of their coverage is not known. On the other hand, Maryland, Nebraska, Wisconsin, and University of Northern Iowa do not provide any coverage. 
        1. We need the specifics of plans that do cover them.
        2. These drugs work, but their effect is not permanent. So, will the health plan be required to cover them forever?
        3. What is the overall cost-benefit analysis of these drugs in view of their short-lived effect? How does the effectiveness of this drug treatment differ from that of other treatments like bariatric surgery?
        4. Several other points came up for discussion and that will continue. If the committee does approve coverage in some acute cases, the earliest that coverage will start will be in 2025.
  9. Access Metrics
    1. Joni Troester presented July 2023 access reporting from UIHC. Specialty access has improved from the prior month.
  10. PBM RFQL Update
    1. Joni Troester provided an update on the progress with the PBM RFQL. Expect the bid to be released in November. 

Recorder: Anand Vijh

Draft FRIC Meeting Minutes
August 1, 2023
ZOOM Meeting
11:30am

Members present: Julie Urmie*, John Laverty*, Josey Bathke, Anya Prince, Angela Speers+, Sarah Tallman, Chuck Wieland, Richard Peter, Mary Charlton, Cormac O’Sullivan, Mike Weaver, George Hospodarsky, Anand Vijh, Daniel Katz

*Co-chairs; +Minutes

Members absent: none

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, Dana Stafford, Jessica Wade, Kara Wright, Julie Sexton, Cheryl Reardon, Audra Haddy, Britt Marcussen, Erin Litton, Jessica Wade, Bernard Sorofman, David Fitzgerald

  1. Introductions– Urmie and Laverty
    • John Laverty is the new staff co-chair for the FRIC committee
  2. Welcome New Staff Members
  3. Approval of May meeting minutes – Urmie and Laverty
    • Motion to approve:  Chuck Wieland
    • Seconded:  Mary Charlton
    • No discussion
    • Unanimously agreed
    • Opposed: None
  4. CY2024 Retiree Health Rates – Information Only
    • Industry Trends
      • Aon 7.4% Medical; 11.0% Rx
      • Wellmark 6.75% Medical; 13.0% Rx
    • Monthly premiums
      • UIChoice Single $1018 (increase 1%)
      • UISelect Single $916 (1% increase)
      • Note: $288 per month subsidy for eligible retiree continues for CY2024
  5. CY2024 Dental Rates – Discussion
    • Recommended 3% increase across all family status for 2024
    • Reminder- no rate increases 2018-2022: 3% increase for 2023
    • Approval
      • Motion to approve:  Chuck Wieland
      • Seconded:  Josie Bathke
      • No discussion
      • Approval: unanimous
      • Opposed: none
  6. CY2024 Health Rates – Discussion
    • Plan Change Adjustment: Change in relative value due to changes in plan design per Aon Modeling
    • PPO Cost Factor: used in setting the rate ratio between the two plans
    • Tier Ratio: The ratio between the Employee Only premium and the other Family Status assuming the Employee only premium is 1
    • Industry Trends
      • Aon 7.4% Medical; 11.0% Rx
      • Wellmark 6.75% Medical; 13.0% Rx
    • Projected Trends:
      • Use 7.4% for Medical; 11.0% for Rx (majority due to specialty Rx)
    • % Change in Premiums for 2024
      • UIChoice 5.75%
      • UISelect 1.7%
        • Approval
        • Motion to approve:  John Laverty
        • Seconded:  Sarah Tallman
        • No discussion
        • Approval: unanimous
        • Opposed: none
  7. Tentative Timeline – Troester
    • August 1- FRIC Discussion and Recommendation
    • August 9- Meeting with President Wilson to Review Recommendations
    • By August 28- Information provided by September Board Meeting Docket
    • By August 28- benefits website updated with CY2024 information with header “Pending Board of Regents Approval”
    • September 27, 28- Board of Regents
  8. Meeting Adjourned
  • Motion to end meeting moved by Chuck Wieland
  • Seconded by Richard Peter
  • No discussion
  • Unanimously agreed
  • Opposed: None

Next Meeting

September 1st from 11:30 a.m. – 1:00 p.m. via Zoom

FY23 Meeting Minutes

Draft FRIC Meeting Minutes

May 5, 2023

ZOOM Meeting

11:30am

Members present: Michael Schueller*, Julie Urmie*, Josey Bathke, Daniel Katz, Anya Prince, Angela Speers, Sarah Tallman, Chuck Wieland, Richard Peter, Mary Charlton, John Laverty, Cormac O’Sullivan

*Co-chairs; +Minutes

Members absent: Anand Vijh

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, Dana Stafford+, Jessica Wade, Kara Wright, Julie Sexton, Cheryl Reardon, Audra Haddy, Britt Marcussen

  1. Introductions – Urmie and Schueller
  2. Approval of April meeting minutes – Urmie and Schueller
  • Motion to approve:  Chuck Wieland 
  • Seconded:  Angela Speers
  • No discussion
  • Approved; no dissent
  1. Announcement
    1. Joni Troester informed the committee there’s a review of the UHR website taking place.  Please watch for a short survey of 15 questions concerning your use of the website.  Justin Fraase, UHR Communications, will send the survey nest week.
  2. Recognition of Members
    1.  Mike Schueller has been on FRIC since 2014 and Staff Co-chair for the past two years.  Thanks for Mike’s service and commitment.
  3. Retirement Fund Line-Update – Joni Troester
    1. Reviewed the July 1st fund line-up changes with the committee:
      1. Freeze TRowe Price Growth Stock - map new contributions to TIAA Large Cap Growth Index
      2. Freeze Western Asset Core - map new contributions to Vanguard Total Bond Market
  4. Pharmacy Benefit Manager Update – Troester
    1. Joni Troester provided an update on the RFQL process. The committee is building the question set for the RFQL. Working with Aon to establish template language. Will continue to update FRIC with updates at each meeting.
  5. Review of Plan Design – Mental Health Coverage for UIChoice and UISelect
    1. Doc on Demand mental health coverage effective July 1, 2023 for both UIChoice and UISelect. Members will pay $0 for services.
    2. Committee members reviewed projected plan costs if UISelect mental health copays were $0. Members discussed pros and cons. Dan Katz motioned to approve changing the UISelect mental health copay to $0 for Level 1&2 effective January 1, 2024.  Josey Bathke seconded.  Motion approved. Chuck Wieland abstained.
  6.  Additional Weight Management Medication Information and Discussion – Troester/Olson
    1. Two questions for discussion
      1. Should UI self-funded plans cover Rx for weight loss only?
        1. Committee discussed.  Chuck Wieland motioned to explore weight management Rx coverage in the upcoming year.  John Laverty seconded. 
          1. Committee voted.
          2. Twelve members voted aye.
          3.  O’Sullivan opposed.
          4. Motion passed.
      2. If covered, what is the plan design specifics regarding coverage?
        1. Committee reviewed peer benchmark data and Wellmark’s potential Rx plan design and prior authorization of weight management Rx. Estimated financial impact analysis was reviewed based on Wellmark, Aon, Mercer, and Segal projections.  Joni Troester shared if average utilization, this could add a little over 1% to plan Rx cost or approximately $3.5M. More information will be shared in the Sept meeting.
  7. Access Reports
    1. Challenges continue in specialty care (neuor, derm, digestive disease). UIHC is trying a number of different things to remedy.
  8. Quarterly Metrics
    1. Pharmacy costs continue to increase due to specialty and new drugs.  Concern about upcoming gene therapies which have amazing potential but $2-3M per use.
    2. UIChoice PMPM continues to run high compared to UISelect.
  9. FRIC Membership Changes for AY23-24
    1. Two openings due to Mike Schueller and Nancy Davin not returning.  Mike Weaver and George Hospodarsky will join the committee on August 1st.
  10. Meeting Adjourned
  • Motion to end meeting moved by Chuck Wieland
  • Seconded by Josey Bathke
  • No discussion
  • Unanimously agreed

Next Meeting

Special Aug 1, 2023

Zoom Meeting

Draft FRIC Meeting Minutes
April 7, 2023
ZOOM meeting
11:30am

Members present: Michael Schueller*, Julie Urmie*, Josey Bathke+, Daniel Katz, Anya Prince, Angela Speers, Sarah Tallman, Chuck Wieland, Richard Peter, Cormac O’Sullivan, Mary Charlton

*Co-chairs; +Minutes

Members absent: Anand Vijh, John Laverty

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, Dana Stafford, Jessica Wade, Cheryl Reardon, Bernard Sorofman, Audra Haddy, Britt Marcussen, Teresa Marshall, Justin Fraase, Michael Brownlee, Lisa Mascardo, Alex Mersch, Young Fried, Shanda Harclerode

  1. Introductions– Urmie and Schueller
  2. Approval of March meeting minutes – Urmie and Schueller
    1. Motion to approve:  Chuck Wieland 
    2. Seconded:  Angela Speers
    3. No discussion
    4. Approved; no dissent
    5. Abstained:  Cormac O’Sullivan
  3. Specialty Rx Annual Report Presentation – Mike Brownlee, Lisa Mascardo, Alex Mersch, UIHC Pharmaceutical Care
    1. UIHC specialty partnership began in 2019
      1. Data shows superior turnaround compared to other commercial pharmacies
      2. Reviewed high adherence rates and other significant data
      3. Advocate on behalf of members and provide superior customer service
      4. Recent re-accreditation
    2. National Trends
      1. FDA approval of new specialty meds is slowing
      2. Anticipate novel/specialty meds to continue to be the drugs seeking FDA approval
      3. More patients utilizing more specialty meds
      4. Specialty drugs will continue to grow in use which is a cost driver but brand conversion with biosimilars/generics may be cost mitigators
    3. 2023 Observations
      1. Pharmacy Benefit:
        1. Humira biosimilar will be potentially disruptive
        2. Other autoinflammatory has potential
        3. Pulmonary therapy transitions have potential
        4. Hematoloty/Oncology medication will transition to generic and increased access should follow
      2. Medical Benefit:
        1. Recently approved Type 1 Diabetes treatment may be impactful
        2. Several hemophilia treatments coming to market
        3. Various Alzheimer treatments may have new treatments coming
    4. Wins in UI Partnership
      1. Response to the tri-demic/RSV outbreak
      2. UIHC response when communities were struggling with access to appropriate prescriptions (some were waiting over a month for a prescription through HYVEE); UIHC was able to move providing of the prescription to just several DAYS!
    5. Specialty Pharmacy Implications for UI Health Plan discussed
      1. Top 5 drugs in spend – Humira, Stelara, Trifactor, Enbrel, Dupixent
      2. Reviewed spend per category of Autoinflammatory, Pulmonary, Hematology/Oncology, Neurology, Endocrinology, and Other
    6. UIHC Specialty Pharmacy Services
      1. Discussed the exemplary member and provider experiences
      2. Providers confirm exemplary perceived outcomes
      3. Licensed in 10 states
      4. Now the only 24/7 pharmacy in Iowa City area!
  4. Coverage of Medication Therapy for Weight Loss by Wellmark – Shanda Harclerode Director, Pharmacy Solutions and Young Fried, VP of Pharmacy
    1. Three main archetypes that can drive pharmaceutical spend up or down
      1. Blockbuster brands, specialty brands and generics from the past; now we’re moving towards obesity drugs, gene therapy and biosimilars
    2. Less than 1/5 of employers cover drugs for weight loss management
    3. Nationally – employers are asking for more information and not asking for coverage changes yet; very little plan data available at this time
    4. Reviewed National GLP-1 cost and growth/utilization trends for both anti-diabetes and weight loss
    5. Wellmark’s management options
      1. Add GLP-1 medication therapy for weight loss as a covered benefit
        1. Only 10 groups in Wellmark’s entire book of business have chosen this option
        2. Weight loss drug covered only with prior authorization
      2. Maintain GLP-1 medication therapy for anti-diabetes, but weight loss therapy as an excluded benefit
        1. Most of Wellmark’s self-funded accounts and all of their fully-insured book of business have stayed with this option
        2. If medication is submitted for Type 2 diabetes treatment (or if claim look back shows history of Type 2 diabetes treatment) then it is covered; if for submitted for obesity treatment then it is excluded and rejected at POS
      3. Discussed plan cost impacts
        1. Estimate 36.4% of Iowans are obese; assume all eligible utilize GLP-1 for weight loss then net pharmacy plan cost would increase $51.28PMPM; increase Pharmacy PMPM overall by 43%
        2. If 18.2% utilize GLP-1 for weight loss then plan cost would increase $25.64PMPM; increase pharmacy PMPM overall by 23%
  5. Weight Management Medication – Troester/Olson
    1. Peer Benchmark presentation shared
      1. Weight loss drugs covered by 8 peers including ISU and State of Iowa/DAS
        1. Each requires prior authorization
      2. Weight loss drugs not covered by 4 peers including UNI
    2. Committee Discussion and Information request for May Meeting
      1. Send any data requests to Rebecca by Monday, April 10th COB
  6. UI Choice and UI Select Mental Health Plan Coverage – Olson/Troester
    1. Additional WellMark data
    2. Discussion regarding the different copays in the UIChoice and UISelect
    3. July 1 Doc on Demand at no cost for mental health for both UICHoice and UISelect
    4. Tabled for more discussion/motion in May
  7. COVID 19 Required Health Plan Coverages – Olson
    1. As of May 12 (day after federal disaster ends) coverage for COVID-19 tests and testing related services in Dr office, OTC  At Home COVID-19 Tests, and COVID-19 Vaccines will revert to prior coverage. For vaccines, they will be covered as preventative with a $0 member copay
    2. Benefits will update its website to share this change
    3. Benefits will work with Office of Strategic Communications to have IOWANOW announcement about this change before effective date
  8. Premium Rate Setting Process for CY2024 – Troester
    1. BOR will review our premiums prior to any release to employees
    2. To meet required timeline for the September BOR meeting we need to move FRIC meeting up as a special meeting on 7/31 or 8/1
    3. FRIC members to review personal calendars and share availability with Benefits for those two dates
    4. Then FRIC won’t need the second Sept meeting
  9. Quarterly Metrics – Olson – tabled until May
  10. Access Report – Troester – tabled until May
  11. New Business (AY 2022 - 2023)
    1. Medically Necessary Laser Hair Removal (UIHC) – May 2023 – moved to Fall 2023
  12. Meeting Adjourned
  • Motion to end meeting moved by Chuck Weiland
  • Seconded by Sarah Tallman
  • No discussion
  • Unanimously agreed

Next Meeting

May 5, 2023

Zoom Meeting

Draft FRIC Meeting Minutes
March 3, 2023
Zoom Meeting
11:30 AM

Members present: Michael Schueller*, Julie Urmie*, Josey Bathke, Daniel Katz, John Laverty, Nancy Davin, Anya Prince, Angela Speers, Sarah Tallman, Chuck Wieland

*Co-chairs; +Minutes

Members absent: Richard Peter, Cormac O’Sullivan, Anand Vijh, Mary Charlton

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, Dana Stafford, Julie Sexton, Jessica Wade, Kara Wright, Cheryl Reardon, Megan Hammes, Bernard Sorofman, Audra Haddy, David Fitgerald, Britt Marcussen, Kari Vrban, Leon Jons, Amanda Pitts, Kathleen Robinson, Marcelo Correin, Ayotunde Dokun.

  1. Introductions– Urmie and Schueller
  2. Approval of February meeting minutes – Urmie and Schueller
    1. Motion to approve: Chuck Wieland; Dan Katz seconded
    2. No discussion
    3. Unanimously approved
  3. Medically Necessary Weight Management – Presentation by Drs. Ayotunde Dokun, Leon Jons, and Katie Robinson
    1. Doctors from the Weight Management Division of Endocrinology provided an overview of anti-obesity medications.
    2. Obesity rates are rising nation-wide as well as in Iowa with 36.5% of Iowans considered obese.
    3. With increases in obesity, there are increases in the health care needs of the obese.
    4. To address weight issue, change the person’s behaviors; if additional help is needed, add pharmacotherapy; last resort is surgery.
    5. Reviewed different weight loss medicines which are FDA approved.
    6. Potential positive impact of weight loss drug includes likelihood of changing obesity classification, improved biometric screenings (BP, glucose, lipids), and reduced cost of total health care.
    7. Costs of new GLP-1 weight loss drugs (such as Wegovy) are close to $20,000 yr and must be taken in perpetuity to maintain weight loss. There are several lower cost drugs available.
    8. Questions from FRIC members followed.
    9. In closing, the doctors asked that the FRIC committee recommend covering prescription weight loss drugs on the university health plans.
    10. Committee will discuss in April.
  4. UIChoice and UISelect Plan Provision Review – Olson/Troester
    1. Joni Troester shared that as of July 1, 2023, behavioral health services will be added to Doctor on Demand (telehealth) coverage for both UIChoice and UISelect plans. Doctor on Demand services are at $0 cost for the member.
    2. Dr. Dan Katz provided an overview of mental health which covered UIChoice and UISelect plan provisions for mental health visits and potential financial barriers to MH treatment. Questions from committee members followed.
    3. Rebecca Olson shared Wellmark plan modeling of potential changes to UISelect copays for mental health visits.  Questions from committee members followed, including additional information request on mental health utilization for younger populations.
    4. Committee will continue discussion in April.
  5. New Business (AY 2022-2023)
    1. Specialty Drug Presentation (UIHC Pharmaceutical Care) – April 2023
    2. Weight Management Medication (Young Fried; VP of Pharmacy Services @ WellMark) – April 2023
    3. Medically Necessary Laser Hair Removal (UIHC) – May 2023

Meeting adjourned.

  • Motion to end meeting moved by Mike Schueller
  • Seconded by Chuck Wieland
  • No discussion
  • Unanimously agreed

​​​​​​​Next Meeting

April 7, 2023

Zoom Meeting

FRIC
FEBRUARY 3, 2023
ZOOM MEETING
1130 AM

Members present: Michael Schueller*, Julie Urmie*, Josey Bathke, Daniel Katz, John Laverty, Mary Charlton, Cormac O’Sullivan, Angela Speers, Sarah Tallman+, Chuck Wieland

*Co-chairs; +Minutes

Members absent: Nancy Davin, Anand Vijh, Anya Prince, Richard Peter

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: David Fitzgerald, Audra Haddy, Britt Marcussen, Julie Sexton, Cheri Smith, Dana Stafford, Jessica Wade, Kara Wright, Teresa Marshall

  1. Introductions – Urmie and Schueller
  2. Welcome New Faculty Member: Mary Charlton, College of Public Health
  3. Approval of December meeting minutes - Urmie and Schueller
    1. Chuck Wieland motioned to approve; seconded by Cormac O’Sullivan
    2. No discussion
    3. December minutes were approved unanimously
  4. Open Enrollment:  Outcome for CY2023 – Olson
    • Reviewed 2023 outcomes and compared to 2022
    • UISelect contracts increased in 2023 - 18% in 2023, 16% last year
    • UIChoice contracts dropped in 2023 - 82% in 2023, 84% last year
    • Most enrollments into UISelect occur with new hires
    • Movement also occurs during open enrollment or with a qualifying event
    • Do we track why people change between plans?  We would need to be very thoughtful as this is sensitive information
    • No benefits satisfaction survey recently.  Last one was in 2018 during Health Benefit Review. May consider during  open enrollment next year
    • Data shows large difference in plan participation by family status
    • What are the UI goals when you review this data? 
      • Want to provide a choice in plans to our employees
      • Family status & ages/stages in life are different
      • Long term – employee engagement & experience is important
      • Want to make sure employees understand the benefits & make decisions based on their situation.
      • Inclusivity – with other languages included in the forms
      • Very successful benefits enrollment this year
  5. Pharmacy Benefit Manager – Troester
    • Joni Troester provided an update on the RFQL committee created
    • Sarah Tallman & Julie Urmie are FRIC members on the committee
    • The process will likely last 18-20 months
    • Non-disclosure agreement has been signed between outside entities involved. Data meeting with Wellmark, AON, UI, etc.
    • Committee will establish guiding principles for this process

  6. Review of Plan Design - Troester and Olson

    *Reviewed guiding principles for the annual review of plans*

    FRIC members support these.  Any feedback from campus concerning changes made effective Jan 1st?  Not many questions, no negative feedback. Employees thankful we have robust health plan.  Committee will revisit guiding principles each year during the annual review of the plans.  We’ll target incremental changes every year so people expect it.

    • Dental Plan – will review the dental plan this year
      1. Three tiers in current plan
      2. Plan will pay more & employee pays less in the Tier One. Tier two provides good benefits
      3. Coinsurance varies by Tier and service received
      4. Do we get feedback on the quality of the Provider? Consumers can google ratings for health care providers.  We have freedom to choose our provider
      5. Unique relationship with the College of Dentistry – UI will pay up to $2000 for services for dental plan members.  Great thing about this arrangement is that it gives UI students practice.  You can use both COD students & outside provider
      6. No annual deductible with our plan
      7. $2000 max annual benefit
      8. Each member has $2000 max annual benefit.  Remaining balance at year end will roll over to the next year with a max $4000 available in year two.  See plan details for specifics on how this works
      9. Over the past year, University Benefits has received one request from an employee asking that the annual maximum benefit of $2000 be increased
      10. UIHR recommendation would be to make no changes to the Delta Dental Plan.  Quite generous/robust plan & good coverage
      11. FRIC members agree
    • UIChoice and UISelect  
      1. Rebecca Olson went through REVIEW of changes effective Jan 1, 2023
      2. UIHR doesn’t suggest any changes this year
      3. Fastest rising trend is Pharmacy with increasing costs of pharmacy/specialty drugs
      4. Committee wishes to look at Mental Health Coverage this year, as we didn’t make a change for 2023
      5. Dan Katz would like to see the impact of $0 dollar copay in UISelect Plan since UIChoice covers mental health with $0 copay
      6. What are you trying to accomplish with $0 mental health copay in UISelect?  Remove any obstacle for those who need mental health care if they choose the UISelect. There’s a greater proportion of young people who need mental health care.  Mental health care is something that people are more likely to defer due to cost
      7. We will get more data so we can continue this discussion
  7. Access Report - Troester
    • Reviewed monthly report
    • ED Director will come to FRIC this fall to report on an annual basis
    • Opening the Urgent Care has impacted the ED by decreasing the demand
    • Video – Right level of care
  8. March Agenda
    • UIHC weight management services will present
    • North Liberty facility will open in 2025 – moving presentation to fall

We have four staff member terms that are ending this spring.  You need to reapply to stay on FRIC.  Mike Schueller is finishing his term after nine years on FRIC. He will not reapply.  Staff co-chair will be open.

Membership discussion – new FRIC members & existing ones with term ending

New Business (AY 2022 - 2023)

  1. Medically Necessary Weight Management (UIHC) - March 2023
  2. Specialty Drug Presentation (UIHC Pharmaceutical Care) – April 2023
  3. Medically Necessary Laser Hair Removal (UIHC) – May 2023

John Laverty moved to adjourn the meeting. Cormac O’Sullivan seconded.

Next meeting
March 3, 2023 via Zoom

FRIC draft meeting minutes
December 2, 2022

Zoom Meeting

11:30 AM

Members present: Michael Schueller*, Julie Urmie*, Josey Bathke, Daniel Katz, John Laverty, Nicole Nisly, Cormac O’Sullivan, Richard Peter+, Anya PrinceK, Angela Speers, Sarah Tallman, Anand Vijh, Chuck Wieland

*Co-chairs; +Minutes

Members absent: Nancy Davin

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cody Ching, David Fitzergerald, Audra Haddy, Megan Hammes, Rachel Kirchner, Kate Klefstad, Britt Marcussen, Cheryl Reardon, Julie Sexton, Nathan Shaw, Siroos Shirazi, Sonia Slevinski, Cheri Smith, Dana Stafford, Bronwyn Threlkeld-Wiegand, Jessica Wade, Kara Wright

  1. Introductions – Urmie and Schueller
  2. Approval of November meeting minutes – Urmie and Schueller
    • Chuck Wieland moved a motion to approve; Cormac O’Sullivan seconded
    • No discussion
    • November minutes were approved unanimously
  3. Recognition of Nicole Nisly
    Dr. Nisly’s service on FRIC was recognized. Dr. Nisly was a member on FRIC since 2013 and lent her expertise in many different areas. She received a round of applause and best wishes for her upcoming retirement.
     
  4. Continuum of Care/UIHC Acute Care – Rachel Kirchner, Cody Ching and Dr. Nate Shaw
    • UI QuickCare: Patients can schedule online or on MyChart to reduce waiting time; patients can check wait times online. Average waiting room time: 8 min, average door-to-door time: 47 min. Common conditions: ear pain, eye infection, sprains, UTI, rash & skin infection, cold flu, sore throat, minor wounds. Some limited possibilities to draw blood for diagnostic testing. Telemedicine option: avg. 1,643 visits/month; conditions: COVID-19, cough, rash and skin infections, allergies, diarrhea, vomiting, fever, sinus problems. If patient needs to come in, only one charge. High patient satisfaction ratings
    • UI QuickCare & Telemedicine patients: 41% UI plans, 59% other for FY19 through FY23 Q1, variability of numbers across years mainly driven by how Covid-19 was handled. Marketing of UI QuickCare via social media pushes (FaceBook, Instagram, Twitter), UI Health Fair, and seasonal messaging
    • UI QuickCare and UI UrgentCare can use e-consult; e-consult recently added also for orthopedics
    • UI UrgentCare: common conditions include broken bones, lacerations, dehydration, migraines, nausea/vomiting, abdominal pain, chest pain. Similar waiting times as UI QuickCare. Capacity to do IVs at UI UrgentCare. Means of transportation to ED is 911. Some discussion regarding the workflow for chest pain and how it is consistent across different levels of care at UIHC. UI UrgentCare patients: 41% UI plans, 59% other for FY19 through FY23 Q1. No age restriction at UI UrgentCare, capability to do full fever evaluation for fevers in patients less than 2-3 months old; UI QuickCare often limits age to 6 months and older
    • UI Emergency Department: avg. 9 min wait time (registration to triage), 297 min door-to-door time. Conditions: head injury, stroke, severe bleeding, chest pain, abdominal pain, difficulty breathing, severe pain, newborn fever, major trauma, suicidal thoughts. Level of acuity always considered, waves of activity over time. Discussion of trends in average door-to-door times; boarding hours have increased, challenges with capacity of inpatient beds, can cause backup and bottleneck; heat maps used for staffing
    • UI QuickCare and UI UrgentCare have lowered ED volumes over time; statistics of patient visit per month across walk-in clinics
    • Avg. transfer rate from UI QuickCare and UrgentCare to ED: 2%; high of 6% in some months; avg. transfer rate from UI UrgentCare to ED: 3 to 5% not including Mercy and Cedar Rapids; national avg. at 5%
    • Strategic placement of marketing materials for patients to identify appropriate level of care; at ED visible prior to check-in; concept of “right care at the right place”. Messaging targeted to UI employees: UI Health Fair, LiveWell newsletters, UI HR (new hires, grad students, etc.)
    • Suggestion: include messaging in Iowa Now and see it a couple of times a year; share with Staff Council and Faculty Senate to promote among their constituents; Suggestion: Incorporate “right care at right place” in benefits information, possibly with a video; Suggestion: For small kids with asthma capability of suction kiddos would be helpful at UI QuickCare and/or UrgentCare; not available at pediatric clinics; Suggestion: Would be helpful to see online when there is X-ray capability at particular UI UrgentCare that day (tech working)
  5. Overview of the Employee Assistance Program (EAP) Presentation - Bronwyn Threlkeld-Wiegand, Director
    • Goal: provide employees and their family with most effective tools, resources and support for achieving personal health and overall well-being while respecting privacy and confidentially of personal information. EAP partners with LiveWell and Family Services
    • EAP Team: four clinicians (two alcohol and drug counselors) plus admin support
    • Services: Counseling and referral; management supervisory consultation, behavioral and drug-free workplace consultation, critical incident response and campus support, population health, prevention and educational services. Access confidential and free for up to 6 sessions per year per member. Sessions last about 1 hour, clients see same clinician each time
    • Scheduling by email or phone, same-week availability, continuity of care/referrals, in person/zoom/phone, multiple locations, lunch and after work appointments (no weekends)
    • Utilization (visits): 1,770 (2018), 1,911 (2019), 1,984 (2020), 2,036 (2021), 2,051 (2022); high satisfaction and recommendation rates
    • Top 3 reasons: depression/anxiety, job stress, marital/relationship; Other reasons: sleep resources, anger management, health/medical concern, elder care concern, financial/legal concern, parent/child concern, substance abuse (self), substance abuse (other)
    • Programming: suicide prevention, hardship fund, resilience, happiness, purpose, sleep, burnout
    • Kognito suicide prevention app: tool to learn skills for difficult conversations (suicide prevention page, takes 30-45 minutes)
      • Suggestion: Kognito training could be added to performance review; consider making mandatory for anybody in supervisory or teaching role
    • UI emergency hardship fund: supports costs up to $1,000 related to unforeseen emergency event or crisis which created financial hardship; 52 recipients in 2021-22.
    • Completion of online form, documentation in app. Referrals from campaigns or people’s supervisors; awareness of UI emergency hardship fund could be further expanded
    • EAP great supplement to other counseling services; individual records are not connected to EPIC
    • Discussion about demographics; EAP sees typically more women than men, a fair number of children, and a fair number of couples
    • Referrals to ED or medication management consultation possible; emergent needs do not happen very often
  6. Open Enrollment: Initial Results - Olson
    • Ran very smoothly
    • Opened Nov 1 and closed Nov 15
    • Stronger participation with 11,500 active choices, increase by 500 employees compared to last year
    • For employees without active choice: last year’s choices rolled over
    • Preliminary results: 83% UI Choice, 17% UI Select
    • Final data will be sent to Wellmark and Delta Dental; new Wellmark ID cards will be issued for everyone in Dec
    • UI Benefits team assisted over 3,000 individuals who called or emailed
  7. Flexible Spending Account Program Vendor – Olson
    • ​​​​​​​Communications planned with targeted email in week of Dec 5. Content: expectations for 2023 FSA plan participants, communications from HealthEquity coming, updated UI Benefits FSA website
    • HealthEquity will send welcome mailing mid-December which includes information to help individuals understand how to manage their account, file a claim, how to download the mobile app, how to use the app, and contact info for HealthEquity (24/7 customer service)
      • FSA VISA cards will be mailed to FSA participants by Dec 31
      • Kudos to Jessica Wade, Kara Wright and Mike Kaplan for their work on the new FSA program vendor implementation
  8. Pharmacy Benefit Manager (PBM) - Troester
    • Timeline for the selection of the PBM
    • Agreement on scope of work with AON Consulting
    • Kick-off with RFQL committee in January, kickoff with AON in February, selection of PBM in Spring of 2024, implementation in the summer/fall of 2024, launch on Jan 1, 2025
  9. Secure Act 2.0 - Olson
    • University Benefits is closely monitoring the situation in Washington DC; Rebecca Olson will continue to provide further updates. Legislation builds on changes to retirement plans in Secure Act of 2019: increase catch-up of contributions amounts, require catch-up of contributions to be Roth (after-tax), increase age when RMD must begin, provide easier access to funds if personal or family emergency. Could be passed this month by Congress; otherwise legislative process starts over next year

 

  1. Access Report - Troester
    • Access statistics for primary care, specialty care and tertiary care over the last month, the last six months and the last 13 months. Goals met for primary care and tertiary care; challenges continue in specialty care. Expansion and recruitment considered in specialty care; FRIC continues to monitor situation. Comment: access to tertiary care has decreased; plotting downtrend in access against case load would require more granular data

Mike Schueller points out New Business (AY 2022 - 2023)

  1. Mental Health
  2. Well-being and Mental Health Collaborative - TBD
  3. Medically Necessary Weight Management - March 2023
  4. Specialty Drug Presentation - April 2023
  5. Medically Necessary Laser Hair Removal - May 2023

Meeting adjourned

  • Motion to end meeting moved by Chuck Wieland
  • Seconded by Nicole Nisly
  • No discussion
  • Unanimously agreed

Next Meeting

February 3, 2023

Zoom Meeting

DRAFT FRIC Meeting Minutes
November 4, 2022

Zoom Meeting

1130 AM

Members present:  Michael Schueller*, Julie Urmie*, John Laverty+, Nancy Davin, Dan Katz, Nicole Nisly, Angela Speers, Chuck Wieland, Sarah Tallman, Anand Vijh, Cormac O’Sullivan, Josey Bathke

*Co-chairs; +Minutes

Members absent: Richard Peter, Anya Prince

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheryl Reardon, Cheri Smith, Dana Stafford, Jessica Wade, Kara Wright, Julie Sexton, Bernard Sorofman, Audra Hadley 

  1. Introductions– Urmie and Schueller
  2. Approval of October meeting minutes – Urmie and Schueller
    1. Chuck Wieland moved to approve
    2. Nancy Davin seconded
    3. No discussion
    4. October minutes approved unanimously
  3.  Open Enrollment Update – Olson
    1. First day – Tuesday, Nov. 1
    2. An announcement email was sent to eligible faculty and staff highlighting the plan and rate changes for 2023. It included information about the new FSA claim administrator – HealthEquity and the adoption assistance pilot program.
    3. Many options to get questions answered by UI Benefits staff, including “You Ask, We Answer” option M-F from 8 AM – 5 PM.
    4. Resource information includes English and Spanish options this year.
    5. It appears we’re tracking higher response than last year; preliminary stats will be shared at the Dec. FRIC meeting
    6. Several reminders about open enrollment will be sent with the final reminder on Nov. 14.
  4. Pharmacy Benefit Manager – Troester
    1. RFQL Committee will include
      • Julie Urmie – FRIC Faculty Co-Chair
      • Sarah Tallman – FRIC Staff Member
      • Lisa Mascardo – UIHC Pharmaceutical Care
      • Britt Marcussen – Campus Health Officer/Family Medicine
      • Mike Kaplan – IMHR
      • Rebecca Olson – University Benefits
      • Joni Troester – UHR
  5. Draft Plan and Timeline
    • Identify RFQL committee (by Jan. 2023)
    • Finalize Scope of Work (SOW) with Aon for RFQL consulting (by Jan. 2023)
    • Kick-off of RFQL process with Aon (Feb. 2023)
    • Selection of PBM (April 2024)
    • Implementation (Summer/Fall 2024)
    • Launch (Jan. 1, 2025)
  6. FRIC will receive updates on the progress in Feb. – May 2023 meetings and ongoing.
  7. Flexible Spending Account Program Vendor – Olson
    1. HealthEquity is our new Flexible Spending Accounts (FSA) Vendor who will manage claim review, approval, and payment.
    2. University Benefits will identify 2023 FSA participants and send an enrollment file to HealthEquity in early December. University Benefits will continue to identify and manage eligible faculty and staff for FSA participation and update HealthEquity ongoing.
    3. A targeted email from University Benefits will go out to identified faculty and staff about what to expect with the new FSA process and vendor.
    4. HealthEquity “welcome” communication will go out mid-December and explain FSA claim management.
    5. Healthcare FSA participants will receive in the mail a debit card by the end of December.
    6. Implementation of changes to FSA claims management to HealthEquity will start of Jan. 1, 2023. They will review, approve, and pay FSA claims at that point. A reminder email will be sent to participating staff around Jan. 1.
    7. Any remaining 2022 claims will still be reviewed, approved, and paid by University Benefits.
    8. Discussion by committee members about FSA debit card use, ability to have more than one card, how claims will be adjudicated when using the debit card option, etc.
    9. FRIC will be provided the FSA communications at our December meeting.
  8. FSA Limits for 2023
    1. Health Care FSA limit will go from $2750 in 2022 to $2850 in 2023.
    2. Dependent Care FSA will remain at $5000 per household.
  9. Access Report – Troester
    1. Continue to struggle a bit with access in Specialty Care areas (i.e. Dermatology, G.I., and OBGyn). 
    2. University Benefits is continuously working with the UI Patient Access Center to make improvements for UI faculty and staff access.
    3. UIHC partners will present at our December FRIC meeting.
    4. The UI Employee Assistance Program (EAP) has expanded free “in-house” mental health appointments from 4 to 6 per year for UI faculty and staff. More information about this will be shared at an upcoming meeting along with other EAP programs.
    5. Discussion by committee members about various coverage scenarios, access to primary care clinics, specific concerns about wait times at UIHC Emergency and alternative options, new “No Surprises” federal legislation, new North Liberty hospital alternative, and how University Benefits works with Wellmark to help alleviate individual coverage issues.
    6. Joni will ask UIHC representatives to be prepared at our December meeting to help address some of these topics. 
  10. Quarterly Metrics – Olson
    1. Report about the 3rd Quarter 2022 UI Health Plans
    2. UI Choice avg. enrollment of 15,600; UI Select avg. about 3,200 – slightly ahead of last year.
    3. Overall UI faculty/staff population is growing, primarily in the health care enterprise.
    4. Discussion by committee members about how the two options are working compared to the original intent, how new employees to UI view the UI Select option (high quality, lower out-of-pocket up-front option -- favorable).
    5. Will look at age-range data if available for who is choosing which option.
  11. New Business (AY 2022 - 2023)
    1. Continuum of Care Presentation – December 2022
    2. Mental Health
      1. EAP Presentation – December 2022
      2. Well-being and Mental Health Collaborative - TBD
    3. Medically Necessary Weight Management - March 2023
    4. Specialty Drug Presentation – April 2023
    5. Medically Necessary Laser Hair Removal – May 2023

Adjournment

Motion to end meeting by Chuck Wieland; seconded by Nancy Davin. Unanimously agreed. 

FRIC

Draft meeting minutes
October 7, 2022

Zoom Meeting

1130 AM

Members present:  Michael Schueller*, Julie Urmie*, John Laverty, Nancy Davin, Dan Katz, Nicole Nisly, Angela Speers, Chuck Wieland, Anya Prince+, Sarah Tallman, Richard Peter, Anand Vijh

*Co-chairs; +Minutes

Members absent: Cormac O’Sullivan, Josey Bathke

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, David Fitzgerald, Jessica Wade, Dana Stafford, Cheryl Reardon, Audra Haddy, Britt Marcussen, Kara Wright, Kate Klefstad, Bernard Sorofman

  1. Introductions– Urmie and Schueller
  2. Approval of September meeting minutes – Urmie and Schueller
    1. Chuck Wieland moved to approve
    2. Nicole Nisly seconded
    3. No discussion
    4. September minutes approved unanimously
  3. Digital Evaluation & Management Pilot – Troester
    1. Presented information about pilot program and incurred costs for 2022
    2. Recommendation to continue for another year: CY2023
    3. Discussion about uptake by providers and patients
    4. Nicole Nisly moved to approve
    5. John Laverty seconded
    6. Discussion of pros and cons for continuing as pilot versus adopting permanently now
    7. Recommendation for extended pilot approved unanimously
  4. Retirement Plan Fund Line-up – Troester
    1. Report out about advantages to a change in retirement lifecycle fund line-up at TIAA including timeline for implementation  
    2. Future plans: discuss the change and timeline with shared governance
    3. Discussion about impacts of plan on members
  5. Pharmacy Benefit Manager – Troester
    1. Report out about request for qualifications for PBM to occur during 2023-2024
    2. Will be a standing agenda item for future FRIC meetings
  6. Flexible Spending Account Program Vendor Overview – Olson
    1. Report out about new FSA Vendor beginning in January and planned communication in Nov-Dec.
    2. Discussion about provider letter of medical necessity process and impacts on members/details of the plan
  7. Adoption Assistance Pilot Program Overview – Olson
    1. Report out on new Adoption Assistance Pilot Program beginning in January and communication roll-out plan
    2. Discussion about plan details and communications rollout
  8. Open Enrollment Communication Plans – Olson
    1. Report out on open enrollment, website, & resources
  9. Access Report – Troester
    1. Report out on access within UI healthcare system
    2. Discussed areas of concern
  10. New Business (AY 2022 - 2023)
    1. Continuum of Care Presentation – December 2022
    2. Specialty Drug Presentation – April 2023
    3. Mental Health Coverage

Meeting adjourned

  • Motion to end meeting by Chuck Wieland
  • Seconded by Nancy Devin
  • Unanimously agreed

Next Meeting

November 4, 2022

Zoom Meeting

FRIC
Meeting Minutes
September 2, 2022
Zoom Meeting
11:30 AM

Members present:  Michael Schueller*, Julie Urmie*, John Laverty, Nancy Davin, Dan Katz, Nicole Nisly, Cormac O’Sullivan, Angela Speers+, Chuck Wieland, Anya Prince, Sarah Tallman, Richard Peter, Anand Vijh, Josey Bathke

*Co-chairs; +Minutes

Members absent: none

Administrative staff present: Joni Troester, Rebecca Olson, Cheri Smith

Visitors present: Cheri Smith, Jessica Wade, Dana Stafford, Cheryl Reardon, Audra Haddy, Britt Marcussen, Jill Valde, David Fitzgerald, Julie Sexton, Kate Klefstad, Theresa Marshall, Kara Wright, Megan Hammes, Kate Klefstad

  1. Introductions– Urmie and Schueller
  2. Approval of May meeting minutes – Urmie and Schueller
    1. Chuck Wieland moved to approve
    2. Nancy Davin second
    3. May minutes approved unanimously
  3. Rate Setting for CY2023
    1. Dental- 3% increase across all family status
      1. John Laverty moved to approve
      2. Chuck Wieland second
      3. Approved unanimously
    2. UI Choice and UI Select – increase of 6% across both plans/all family status
      1. AON trend 6.3% Medical 8.0% Rx
      2. Wellmark trend 8.5% Medical 12.0% Rx
      3. UI used 6.3% Medical 8.0% Rx
      4. Chuck Wieland moved to approve; Nancy Davin second; Approved unanimously
  4. Retiree Association Update – Troester
    1. 9.7% increase in health insurance rate for CY2023
  5. COVID Updates – Troester/Olson
    1. Members have no cost share for COVID-19 testing and related services to diagnose or detect COVID-19 during national public health emergency
    2. OTC COVID-19 testing kits covered by health plan during national public health emergency
  6. Other Updates
    1. Adoption Assistance Program
      1. Approved and implementing January 1, 2023
      2. Working with outside legal on final plan document
      3. Announce new benefit during Open Enrollment in November
    2. Flex Spending – Vendor
      1. FSA Administrator: Health Equity
      2. Will offer:
        1.  
          1. Debit Card for eligible health care expenses
          2. 2 business day claim processing; 5 business day payment
          3. 24/7 customer service
      3. UHR will continue to manage enrollments: Health Equity will manage claim processing and payment
      4. Announce during Open Enrollment in November
      5. Targeted communications to FSA participants begins in December
    3. Campus Influenza Vaccinations
      1. Mid-September through Mid-November
      2. Available at campus and community locations
      3. Covered at no cost through UI Health Plans
    4. Access Report
      1. Provider issues and drivers
    5. Other Voluntary Benefits
      1. Researching other benefits (pet insurance one example) where employees would incur the full cost of cost sharing, but UI would act as payroll deduction remitter
  7. New Business (AY 2022 - 2023)
    1. Rx Discussions – October 2022
    2. Continuum of Care Presentation – December 2022
    3. Specialty Drug Presentation – April 2023
    4. Mental Health Coverage

Adjournment:

Cancel September 9th meeting/ Motion to adjourn 

  1. moved by Chuck Wieland
  2. Second by Nancy Davin
  3. approved unanimously

Meeting adjourned

Next Meeting

October 7, 2022

Zoom Meeting

FY22 Meeting Minutes

FRIC Meeting Minutes
May 6, 2022
Zoom Meeting
1130 AM

Members present:  Michael Schueller*, Julie Urmie*, John Laverty, Nancy Davin, Cathy Koebrick, Dan Katz+, Nicole Nisly, Cormac O’Sullivan, Angela Speers, Chuck Wieland, Anya Prince, Sarah Tallman, Richard Peter

*Co-chairs; +Minutes

Members absent: Anand Vijh

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Kevin Zihlman, Jessica Wade, Dana Stafford, Cheryl Reardon, Audra Haddy, Britt Marcussen, Jill Valde

  1. Introductions – Schueller and Urmie

  1. Approval of April meeting minutes – Urmie and Schueller
    1. Chuck Wieland moved to approve
    2. Nicole Nisly second
    3. April minutes approved unanimously

  1. Plan Design Review: Co-Pay/Co-Insurance/OPM rate increase proposals

The plan elements were reviewed, discussed and voted upon individually with discussion and consideration for total and percentage increases relative to current copay levels and between group comparisons for UIChoice and UISelect. Several recurring comments or themes emerged through the discussions. These included:

      1. The need to address changes to co-pay and OPM rates on a more regular basis to avoid large absolute or percentage changes in one year.
      2. For multiple line items the possibility of introducing predetermined incremental changes was considered, but in the end the committee decided to make its best judgment for the necessary increase for this year alone and readdress possible changes in subsequent meetings/years.
  2. Proposal: Increase Quick Care copay from $5 to $10

Discussion involved consideration of deterring Quick Care utilization due to a copay increase. Following discussion motion was made to accept the proposal as written (increase from $5 to $10).

Motion: By Nisly, to accept proposed changes as written

Second: Tallman

Vote: Unanimous

  1. Proposal: Increase ER copay from $100 to $150

Discussion: Three main concerns about raising ER copay were raised. The first was that patients do not totally control where they are directed for care. Therefore, a patient may desire a visit with outpatient services and have intentions of utilizing healthcare resources in the most responsible way; however, their medical issue may be too serious for primary or outpatient care. Therefore, the copay cannot impact their decision-making in the way it was intended. Second, it was raised that the copay increase may affect families with children who require frequent emergency care. The group had sympathy for this point as it would affect young families, possibly already with heavy medical expenses, where the employee is toward the entry level of the pay scale. The third concern involved a possible unfairness in that for patients who are admitted the copay is waived. However, some patients may complete an “inpatient stay” entirely in the ER if the hospital is too full and therefore be subject to the copay. A final consideration was raised that it was difficult to have ER fees increase when there has not been an improvement in ER services over time. It was countered that the copay increase may, by design, divert unneeded ER visits to more appropriate venues, thereby improving ER access.   

It was proposed that the Medical and Pharmacy Out of Pocket Maximum discussion would further inform the conversation about the ER copay decision, and it was proposed and subsequently entertained by the Chairs that further discussion on the ER copay be considered later in the meeting. For the purpose of organizing the minutes, this note taker has taken the liberty of including below the results of the conclusion of the ER discussion when it occurred later in the meeting after the Medical and Rx OPMs were considered.

It was further discussed that it would be consistent with plan design to have differentiation in the plans as reflected by differences in ER copay amounts.

Motion: Nisly, that the Choice ER copay increase to $125 and Select copay increase to $150.

Second: Speers

Vote: 8 in favor, 4 against, 1 abstention

  1. Proposal: Increase Urgent Care copay as follows:
      1. UIChoice increase from $10/$25 to $15/$30, s/f respectively
      2. UISelect increase from $10/$35 to $15/$40, and $20/$50 to $25/$55; levels I and II, s/f, respectively

Motion: By Nisly, to accept proposal as written

Second: Laverty

Vote: Unanimously in favor of the motion

  1. Proposal: Increase Inpatient Deductibles for UIChoice and UISelect per the table below.

Plan

Level 1

Level 2

Level 3

Proposed Level 1 (change)

Proposed Level 2 (change)

Proposed Level 3 (change)

UI Select

In-patient Deductible

Note that UISelect has a global deductible, that also includes in-patient care

Deductible

Single

$400

$800

n/a

$500 ($100/25%)

$1000

($200/25%)

n/a

Family

$800

$1600

n/a

$950 ($150/18.75%)

$1900 ($300/18.75%))

n/a

UI Choice

In-patient Deductible

No Family Status

$400

$600

$800

$500

($100/25%)

$750

($150/25%)

$1000 ($200/25%)

Note the UIChoice plan in-patient deductible is followed by a coinsurance that was not affected as part of this discussion.

Discussion: Concern was raised over the larger dollar amount increase in deductible particularly in the Select family status. It was further discussed that as a percent increase it was the same or lower across statuses compared with the proposed Choice increases and that it was important to plan design to maintain a distinction in the plans.

Motion: By Laverty, to accept proposal as written

Second: Tallman

Vote: Unanimously in favor of the motion

  1. The Committee had previously requested data about peer benchmarking in order to frame the Medical and Pharmacy Out of Pocket Maximum Discussion. This was then presented in a table comparing the 2022 single and family plans of 14 peer institutions. A comparison of the 2022 family plans shows a range of the combined medical and prescription OPMs from $5500 to $17,400. For comparison, as of 2022, the University of Iowa combined (medical + Rx) family OPMs was $5600 (for both Choice and Select plans). The proposed changes continue to position the combined medical plus prescription OPMs for Select ($8000) and Choice ($7200) plans at the lower end of the 2022 range.

  1. Medical and Pharmacy Out of Pocket Maximum

Proposed changes are summarized in the table below. The percentages and cost increase comparison, although not supplied in the table presented at the meeting, were added by this note taker as they factored in some aspects of the discussion. At the prior meeting an analysis of projected members affected by the cost increases was requested and this is provided to the group and is included in the tables below.

Discussion: It was decided to discuss and vote upon the medical and pharmacy OPMs separately.

  1. Medical OPMs. There was a discussion about the impact of the cost increases, and particularly about the relative impact to UISelect members. Proposals about lower percent increases and phased increases were made and followed by debate. It was ultimately decided that as the percent increases were similar between the plans, and as there had not been an increase to the OPM since the plan inception in 2008, that with acknowledged rises in health care costs, and to maintain a distinction between the plans, to accept the changes as proposed.

Motion: by Laverty, to approve changes as proposed.

Second: Wieland

Vote: Unanimously in favor of the motion

Plan

Level 1

Level 2

Level 3

Proposed Level 1 (change)

Proposed Level 2 (change)

Proposed Level 3 (change)

Impacted Members

UI Select

Medical OPM

Single

$2000

$3000

n/a

$2300

($300/15%)

$3500

($500/16.67%)

n/a

39

Family

$3400

$6000

n/a

$4000

($600/17.65%)

$7000 ($1000/16.67%))

n/a

UI Choice

Medical

OPM

Single

$1700

$1700

$2000

$2000

($300/17.65%)

$2000

($300/17.65%)

$2500

($500/25%)

829

Family

$3400

$3400

$4000

$4000

($600/17.65%)

$4000

($600/17.65%)

$5000

($1000/25%)

*Note: 42,000 members across both plans

  1. Pharmacy OPMs. Debate on the pharmacy OPM proposal centered on the potential impact of the relatively large cost increases in the Select plan (see below table). It was pointed out that the current plan does not reflect a plan differentiation between the Select and Choice plans. It was suggested that it would be best to phase in the Select cost increases to allow members to plan and blunt the effect of a large single year increase. After more discussion, a consensus emerged that phased plans would be problematic as it is difficult to predict the needs in future years and, that as the committee has a rotation membership, the knowledge of the intent to raise rates at a certain point might be lost. After more discussion of several straw recommendations, it was proposed to increase the UI Select single and family prescription OPMs to $1800 and $3600, respectively ($200 and $400 less than the proposed changes, respectively).

Motion: By Nisly, to accept UIChoice Rx OPMs as written and increase UISelect single and family Rx OPMs to $1800 and $3600.

Second: O’Sullivan

Vote: 5 in favor, 8 opposed

Further discussion ensued and was followed by a motion to accept the proposed changes as written.

Motion: By Wieland, to accept proposed pharmacy OPM increases as written

Second: Tallman

Vote: 11 in favor, 2 opposed

Plan

Current

Proposed (change)

Impacted Members

UI Select

Rx

OPM

Single

$1100

$2000

($900/82%)

371

Family

$2200

$4000

($1800/82%)

UI Choice

Rx

OPM

Single

$1100

$1600

($500/45%)

6289

Family

$2200

$3200

($1000/45%)

  1. Aon/PBM Review

An update will be provided at the September meeting.

  1. FSA Vendor Report

A vendor has been selected. The vendor’s website and cellphone app are user friendly and are anticipated to be an improvement over the existing process.

  1. Adoption Assistance Pilot Program

The Board of Regents approved an adoption assistance pilot program. The University of Iowa will sponsor the program which will assist employees with adoption expenses incurred while finalizing an adoption. The eligible employee will have the opportunity to request reimbursement for qualified adoption expenses.  There will be limitations concerning what is considered an eligible expense, as well as the maximum benefit (reimbursement) available. 

Adjournment

Motion to adjourn by Nisly; second by Laverty. Meeting adjourned.

FRIC Meeting Minutes

April 1, 2022

Zoom Meeting

1130 AM

Members present:  Michael Schueller*, Julie Urmie*, John Laverty, Nancy Davin, Cathy Koebrick+, Dan Katz, Nicole Nisly, Cormac O’Sullivan, Angela Speers, Chuck Wieland, Anand Vijh

*Co-chairs; +Minutes

Members absent: Anya Prince, Sarah Tallman, Richard Peter

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Jessica Wade, Kara Wright, Dana Stafford, Cheryl Reardon, Audra Haddy, Britt Marcussen, Megan Hammes, Jill Valde, Siroos Shirazi, Michael Brownlee, Alex Mersch, Megan Threlkeld

  1. Introductions – Schueller and Urmie
    1. Roll call taken
  2. Approval of March meeting minutes – Schueller and Urmie
    1. Chuck Wieland moved to approve
    2. Nancy Davin second
    3. March minutes approved unanimously
  3. UIHC Specialty Pharmacy

Mike Brownlee and Alex Mersch from UIHC Specialty Pharmacy Services presented an overview, data and other information regarding our specialty pharmacy program.  The program began in 2019 and is the required specialty pharmacy for our employee and retiree health plans.

A number of trends related to specialty pharmacy were shared, such as a shift of more meds to specialty which drives an increase in drug spend while potentially reducing the overall cost of total care due to increased quality of care.  Some factors that drive or mitigate drug spend were noted as well.

Specialty Pharmacy implications for our health plan include increase in specialty claims and members on therapy, rather large increase in claims for non-UI pharmacies, and total allowed amount also going up.  A review of data for UIChoice and UISelect shows an increase in dispenses of autoinflammatory therapeutic group from 2020 to 2021, and a very slight decrease in neurology claims.

Brownlee highlighted a number of service differentiators of UIHC Specialty Pharmacy Services:

  • Pharmacist physically in the clinic and available to meet with patient (in person education).
  • More streamlined and collaboration with other providers due to that physical presence.
  • High touch member experience. Live person answers within 10 seconds typically.
  • Identifying issues to Wellmark that disrupt patient care.
  • Continuing to advocate for member access

Some data and metrics were shared.  Recently Trellis, a consulting company, released benchmark data on pharmacy performance. UIHC outperformed the benchmark (90) with a score of 93.  It was noted UIHC’s score also improved from last year (92). Other data shared included the average turnround time for a new Rx fill – 1.5 days for UIHC compared to other pharmacies at >5 days.   UIHC’s Specialty Pharmacy is currently licensed in 10 states.

Looking ahead, goals and plans include continuation of exemplary service / member experience, financial copay assistance access, evolving and expanding services, advocacy in the specialty market, and remaining a vested partner with the UI and Wellmark.  Also noted they are watching for and anticipate a shift of oncology meds going from specialty to generic.

Discussion and questions in response to the presentation included clarification that the UIHC discharge pharmacy provides 24/7/365 service.   It was noted that 20-30% of UI members get copay assistance related to specialty pharmacy. Also noted that members traveling or living in areas not currently licensed are covered via partnerships and collaborations with external pharmacies in those areas to ensure continuity of care.

  1. Updates
    1. Troester provided an update on pharmacy benefit manager exploration for which AON has been engaged. Currently in phase 1 to see if it would be advantageous – nondisclosure agreement was just signed. Anticipate May meeting will have initial report from AON to share.
    2. Olson provided update on flexible spending account vendor search.  Interviews are now complete with the top 3 candidates.  Selection committee includes Laverty from FRIC plus key HR staff.  Selection committee will be meeting in April to review/rank candidates and provide an overall recommendation to leadership. Hope to choose by end of April so can present to FRIC at May meeting.
  1. Health Plan Design Review

This was a continuation of March discussion, led by Olson.  Troester noted if there are changes for 2023, those will need to happen at May meeting to be in place for 2023.  Since last meeting, data has been collected related to employee/member cost share.

Overall trend information was shared.  UIChoice employee cost share dropped from 6.8% to 5.8% over the last 4 calendar years.  UISelect cost share dropped from 12.6% to 11.7% over the 2 years since the plan was implemented.

The Plan Provision modeling was updated to include total estimated plan savings if all proposed changes were made. 

The itemized dollar and percentage changes for UI Choice and UI Select plan modeling were reviewed:

  • Quick care copay change from $5 to $10 for both plans (100% change); reminder that doc on Demand is available at no charge. Some discussion about whether this small financial impact is worth making the change.
  • ER copays increase from $100 to $150 for both plans (50% change). Reminder that if member is admitted, ER copay is waived.  Also reminder that urgent care option is available. Some discussion around what is the cost (or other element) break point that causes someone to choose urgent care vs ER since a reason for this proposed change is to change behavior and encourage people to use urgent care vs ER. Also some discussion on waiver of copay due to admission vs appropriate use of ER services.  Comments regarding the importance of educating employees/members.
  • Other copays increase by $5 (these copay differ by plan in some cases currently and will continue to.
  • Inpatient deductible (UIChoice only) increase by 25%. Note this is a nonstandard benefit.
  • Deductible (UISelect only) increase 25% or 18.75% depending on coverage.
  • Medical OPM increases (vary by plan, individual/family, and provider tier – min 15%; max 25%);  Question about ISU OPM which is the same as what is proposed ($2000/$4000).  Some concerns that the significance of the increase for an employee’s OPM is too much.
  • Pharmacy OPM increase 45.5% for UIChoice and 81.8% for UISelect.  

Troester provided a reminder that the intent of this benefit plan design review was no change to methodology of UIChoice – higher premium with lower out of pocket; UISelect lower premium with higher OOP.  It was noted that some organizations have a cost share design based on employee salary for premiums. 

The following were requests for additional data at May meeting

  • How many members meet OPM on medical/Rx/both (understanding who is impacted the most). 
  • Benchmark OPMs from BigTen.  
  • Benchmarks from BigTen and any institutions that are doing salary-based cost share.

Adjournment

Motion to adjourn by Wieland; second by Davin. Meeting adjourned 1:03pm

Funded Retirement and Insurance Committee (FRIC) Meeting Minutes
March 4, 2022
via Zoom at 11:30 AM

Members present: Michael Schueller*, Julie Urmie*, John Laverty, Nancy Davin, Cathy Koebrick, Dan Katz, Anya Prince, Cormac O’Sullivan+, Sarah Tallman, Angela Speers, Chuck Wieland, Anand Vijh, Richard Peter

*Co-chairs; +Minutes

Members absent: Nicole Nisly

Administrative staff present: Joni Troester, Rebecca Olson 

Visitors present: Cheri Smith, Jessica Wade, Dana Stafford, Julie Sexton, Cheryl Reardon, Audra Haddy, Britt Marcussen

  1. Roll Call/Introductions: Joni Troester completed roll call.
  2. Approval of February Meeting Minutes: A motion to approve the minutes was made by Chuck Wieland, seconded by John Laverty, approved unanimously

  3. Updates:

    1. Aon/Pharmacy Benefit Manager (PBM) exploration – Joni Troester

      1. Continuing to gather data for presentation on feasibility of creating direct PBM program. On track for report at May FRIC meeting. 

      2. Flexible Spending Account (FSA) Vendor Selection – Rebecca Olson

        • A committee of key UHR staff members, a data systems expert, and a FRIC member have reviewed FSA vendor proposals.  Three vendors have been selected for further interviews. Planning for selection of final vendor Spring 2022. 

      3. UIHC Access Reports – Joni Troester

        • UIHC is reaching targets for access by university plan beneficiaries in primary, specialty, and tertiary care.

      4. Quarterly Metrics – Rebecca Olson

        • Four quarters of plan metrics reviewed for both UI Choice and UI Select health plans

        • Roughly 85% of UI employees are enrolled in UI Choice and 15% in UI Select with enrollment in UI Select increasing over the previous year

        • UI Select began enrolling UI employees in calendar year 2020

        • Per-member-per-month costs for UI Choice members are roughly twice the cost for UI Select members for a variety of reasons

  4.  Health Insurance Plan Design Review: Co-Pay, Co-Insurance, OPM – Joni Troester & Rebecca Olson

    1. Reviewed the Updated draft Guiding Principles:

      • Maintain quality health plan

      • Review annually, as an industry best practice

      • Drive utilization to cost-effective, quality solution

      • Standardize plan provisions, as much as possible

      • Provide ongoing communication and education to plan members

      • Prioritize plan member accessibility to quality health care

      • Balance employer and employee cost sharing arrangements

      • A plan review has not been conducted since the Health Benefit Review was conducted in 2018/2019. Several plan provisions within UIChoice have not been changed since 2008. 

      • Projected 2022 health claim costs by AON and Wellmark were presented to the committee

        • AON predicting a 5% medical, 7% pharmacy increase over 2021

        • Wellmark predicting a 7.25% medical and 11% pharmacy increase over 2021

    2. ​​​​​​​Summary of committee discussion: Lengthy discussion about guiding principles for the review of the health plans including overall plan design, inclusivity, quality, services offered, accessibility, cost-sharing, out-of-pocket payments, co-pays, and overall cost to beneficiaries and the institution. 

  5. Rate setting is completed across the entire population, not by plan or by family status.

  6. Discussion on whether to increase cost share for individual aspects of health plan and cost impact on plan members

  7. Impact of Co-pays versus Co-insurance

  8. Review of ER co-pay.   Other options available for care like Telehealth, Doc-on-Demand, QuickCare, UrgentCare vs. Emergency Room

    • Educate and incentivize use of best and most cost-effective care options given specific situations

  9. Other various co-pays

    1. Mental health co-pays (no changes)

  10. Inpatient versus Outpatient deductibles (differences between UIChoice and UISelect)

  11. Differences in cost structures of UIChoice versus UISelect

    1. UIChoice is more expensive premium cost on a monthly basis but has lower co-pays and co-insurance requirements for some services when accessed

    2. UISelect is less expensive premium cost on a monthly basis but has slightly higher co-pays and co-insurance requirements for some services when accessed

    3. How to balance the differential cost structure versus employee choice for plans

    4. Discussion on out-of-pocket maximums (OPM) for individual plans and differences between OPM for medical care and OPM for pharmaceutical care.

    5. Should there be separate OPM for Medical and Pharmaceutical or one “global health care” OPM?

    6. Further discussion, informed by additional data, will happen at our April meeting.

  • Final Points for future discussion:
    • Need for market corrective increases to both health plans. Distributing the increases over 1-2 years or more versus a large cost increase in a single year.
    • Maintaining the cost differential structure between the UIChoice and UISelect plans
    • Need for an annual review to prevent large increases in the future

Adjournment: The meeting adjourned at 1:00 PM after a motion by Chuck Wieland and seconded by Cathy Koebrick, and approved unanimously.

Recorder: Cormac O’Sullivan

College of Nursing and UIHC Dept. Of Anesthesia

Funded Retirement and Insurance Committee (FRIC) Meeting Minutes
February 4, 2022
via Zoom at 11:30 AM         

Members present: Michael Schueller*, Julie Urmie*, John Laverty+, Nancy Davin, Cathy Koebrick, Dan Katz, Nicole Nisly, Anya Prince, Cormac O’Sullivan, Sarah Tallman, Angela Speers, Chuck Wieland, Anand Vijh, Richard Peter

*Co-chairs; +Minutes

Members absent: none

Administrative staff present: Joni Troester, Rebecca Olson 

Visitors present: Cheri Smith, Kara Wright, Jessica Wade, Dana Stafford, Julie Sexton, Megan Hammes, Cheryl Reardon, Audra Haddy, Teresa Marshall, Britt Marcussen, Jill Valde, Kevin Zihlman, Brian Cassady, Keri Semrau, Phil Roudabush, Melissa Twait, Megan Threlkeld

 

  1. Roll Call/Introductions: Joni Troester completed roll call. Michael Schueller introduced new FRIC member Richard Peter from Tippie College of Business who is replacing Jon Garfinkel on the committee.

  2. Approval of December Meeting Minutes: A motion to approve the minutes was made by Chuck Wieland, seconded by Nancy Davin, approved unanimously.

  3. MyChart Presentation:  Brian Cassady, lead application developer for MyChart, began the presentation showing the variety of “community connection” sites across Iowa maintained by his team along with the main UIHC MyChart site. Patient engagement is key and MyChart makes it easy. Engaged patients are more likely to have healthier behaviors and use preventative health care options. Volumes of users of the platform have increased dramatically over the past two years, from 269,131 total users in October 2019 to 421,062 total users in October 2021. Much of this can be attributed to the pandemic. The Institutional Activation Rate in 2017 was 39.5%; in 2021 that number jumped to 66.6% with some age demographics up to 80%. Two new methods of activation include “Auto-Instant Activation” and “Instant Activation” triggered from messages sent to patients for new appointments who are not already using MyChart. Keri Semrau, Director of the UIHC Patient Access Center, then explained all the functions available to patients in MyChart, including: scheduling, reminders, Fast Pass Wait List offers, eCheck-in, video visits, visit information, provider messaging, and bill pay. Direct scheduling is available for known patients in many clinics as wells as “Open scheduling” to some clinics/sites for those who have not been seen before. Automated reminder messages have a Spanish translation option along with 20 other languages. Keri confirmed that patients with one of the UI health care plans (UIChoice & UISelect) are offered priority in Fast Pass Wait List and for scheduling appointments. Philip Roudabush discussed the MyChart Bill Pay feature and explained this has greatly increased paperless statements and payments. FRIC members asked questions related to “preferred name” in communication to patients, how accounts for children and “parent proxy” works, and several other questions answered in the presentation.

  4. Updates

    1. COVID – Joni Troester

    2. Fee Leveling – Joni Troester

      • Fee leveling across all UI retirement plans went into effect January 2022

      • Same administrative fees charged across all retirement plans now

      • No questions or concerns raised by participants so far; notices went out in November 2021

    3. Fund Line-up Change – Retirement Plans – Joni Troester

      • Upon recommendation of the UI Retirement Fund Investment Committee (RFIC), the Royce Premier fund will be frozen; new contributions will be mapped to Vanguard Small Cap fund effective 3/31/2022

    4. Savi – Student Loan Assistance – Rebecca Olson

      • Upon request at the last FRIC meeting, Rebecca Olson discussed resources offered by Savi [https://www.bysavi.com/] with UI General Counsel and the UI Office of Student Financial Aid. She confirmed that neither have any concerns about offering the availability of Savi resources to UI employees

      • College student loan borrowers may be able to reduce their overall loan fees, identify the best loan repayment options, and in some cases identify loan forgiveness programs

      • UNI and ISU offer Savi resources to their employees

      • An announcement will be made to UI employees in an upcoming Iowa Now this spring

    5. Aon/Pharmacy Benefit Manager (PBM) exploration – Joni Troester

      • Aon is completing a market check review of our pharmacy plan including current contract terms.

      • Currently Aon is in the “data gathering phase” which will include looking at costs vs. benefits

      • A report-out is anticipated at the May FRIC meeting if all goes as expected

    6. Flexible Spending Account (FSA) Vendor Selection – Rebecca Olson

      • University HR staff currently manage FSA claims and reimbursements

      • A committee of key UHR staff members, a data systems expert, and a FRIC member was created to review FSA vendor proposals

      • 12 proposals were received; the committee is narrowing the list down and is planning to do vendor interviews of the finalists in late February and March with a goal to have the new FSA vended service begin on January 1, 2023

      • Three primary criteria include: 1) the employee/customer experience, 2) data/systems/reporting, and 3) plan administration and compliance, including data privacy

      • A question was asked about cost savings. Joni reiterated  that cost savings was not the only driver (although it should be cost-neutral at minimum), but also to improve our employee experience, and the efficiency of the process. Another question asked about security of personal data; Rebecca said data privacy and security is of primary concern and specific questions about this have been asked of the vendors

      • The new FSA service should greatly improve turnaround times for reimbursement (most vendors indicate 2–4 day typical turnaround), provide a user-friendly interface and dashboards, have multiple options for how to submit claims, and likely offer an FSA Debit Card feature for point-of-sale direct payment from the FSA account for covered items and services

  

  1. Open Enrollment—Final Results: Rebecca Olson shared a table indicating continued movement towards the UISelect plan (440 more enrolled in 2022; 2,883 total) vs. UIChoice (695 fewer enrolled in 2022; 15,216 total).  The increase in UISelect was especially noticeable in the “Employee Only” and “Double Spouse Family” categories because of the zero employee premium cost, although there was increased movement across all employee classifications and family statuses.

  2. Health Insurance Plan Design Review: Co-Pay, Co-Insurance, OPM – Joni Troester & Rebecca Olson

    • This is an introductory conversation to get input from FRIC about considerations and guiding principles to consider during such a targeted review

    • We have not reviewed our plan design since 2018; aomw of the UIChoice plan provisions have been in place since 2008. Best practice is to review every year

    • Both UIChoice and UISelect will be reviewed. Joni shared a copy of the UIChoice-UISelect plan comparison as of Jan 1, 2022

    • DRAFT Guiding Principles were shared for consideration, including:

      • Maintain quality health plan

      • Review annually, as an industry best practice

      • Drive utilization to cost-effective, quality solution

      • Standardize plan provisions, as much as possible

      • Balance employer and employee cost sharing arrangements

    • Continuum of Care – where to go for care, i.e. Doctor-on-Demand/Telehealth, Quick Care, Urgent Care, Primary/Specialty Care, Emergency Room

      • Need to consider educating and incentivizing use of best and most cost-effective care options given specific situations

    • FRIC committee members had several suggestions and comments about guiding principles for consideration in this review. These included:

      • Survey employees about their views of our health care plans; Joni indicated that may not be feasible yet this spring but could consider in the future

      • Continue to educate and communicate about health care resources and coverage to ensure employees better understand and comprehend their options

      • Employee access to quality health care is key

    • Rebecca previewed a potential scenario for UI Choice for discussion. This would include “smaller changes” and standardize to the Wellmark book of business more closely

    • Joni reminded the committee that rate setting is across the entire population, not by plan or by family status.

    • Under “Projected Financial Impact” the question was asked if it could show % of change?

    • It was confirmed the Rx OOP max. and Medical OOP max. are separate, so the two maximums would be added together to see what an employee could potentially pay in total OOP

    • Rationale for looking at increased efficiencies is that increased efficiencies are used to keep premium increases at a minimum year over year.

    • Further discussion by committee members asked about how these potential increases are related to what UI employees are seeing in their salary increases? Also, the importance of health insurance and other UI benefits as part of employee recruitment and retention efforts.

    • Further discussion about this, including review of additional options, will be brought to our March meeting.

  3. Note of Thanks: Before adjourning, Mike Schueller wanted to take a moment to thank Jon Garfinkel for his service on FRIC over the years and encouraged other committee members to thank Jon as well. Jon’s insight and leadership on the committee will be missed.

  4. Adjournment: The meeting adjourned at 1:04 PM after a motion by Chuck Wieland and seconded by Nancy Davin, was approved unanimously.

Recorder: John Laverty

Enrollment Management

FRIC Meeting Minutes
December 3, 2021
Zoom Meeting
1130 AM

Members present:  Jon Garfinkel*, Michael Schueller*, John Laverty, Nancy Davin, Cathy Koebrick, Dan Katz, Nicole Nisly, Cormac O’Sullivan, Sarah Tallman+, Angela Speers, Julie Urmie, Chuck Wieland, Anand Vijh

*Co-chairs; +Minutes

Members absent: Anya Prince

Administrative staff present: Joni Troester, Rebecca Olson

Visitors present: Cheri Smith, Kara Wright, Jessica Wade, Dana Stafford, Cheryl Reardon, Teresa Marshall, Britt Marcussen, Jill Valde, Kevin Zihlman

  1. Introductions– Garfinkel and Schueller
    1. Roll call taken
  2. Approval of November meeting minutes – Garfinkel and Schueller
    1. Minor typo to be corrected
    2. Chuck Wieland moved to approve; John Laverty second
    3. November minutes approved unanimously
  3. Announcement that FRIC meetings will continue with virtual format through spring semester
  4. Benefits Updates
    1. COVID – Troester
  • Boosters approved for all ages; available in the community & UIHC
  • Pharmaceuticals to treat COVID not yet approved by FDA
  • Vaccine mandate being reviewed by UI. Will be managed by departments/orgs with federal contract requirement.  On hold until mid-January due to court injunction
  • Special health plan provision for COVID inpatient coverage with no member cost will sunset on December 31. Health plan coverage will revert back to standard plan coverage on January 1.

 ​Open Enrollment – Olson

  • Ran very smoothly this year; No negative feedback from employees regarding health premium increase
  • Overall, our plans are viewed very favorably by our new employees
  • During the 2 week open enrollment (Nov 1 to Nov 15), 11k employees completed enrollment and all other employees’ 2021 elections were rolled over to 2022, except FSA where employees must re-enroll each year
  • Preliminary results indicate 14% enrolled in UI Select for 2022; last year it was 12%
  • New hires (upwards to 40%) are selecting UI Select option when choosing single or double spouse ($0 premium cost to employee)
  • Final open enrollment stats will be shared in the February FRIC meeting
    1. Student Loan Program – Olson
  • UHR to roll-out availability of the SAVI student loan program in 2022
  • Program provides access to resources where employees find options for new repayment plans or qualify for loan forgiveness over time
  • To be eligible, employee must work at least 30 hrs/week and earning W2 wages, plus their (undergrad and grad) loans must be through the Federal Direct Loan program; dependents of UI employees not eligible
  • No cost to employees to use the SAVI website (do it yourself method) or employee may pay $60 annual fee and documentation handled by SAVI
  • UNI & ISU implemented SAVI in 2021
  • Follow-up questions for Benefits to research before implementation and communication occurs
    1. ACO 2020 Results – Troester
  • Accountable Care Organization (ACO) and Shared Savings Agreement with UIHC has been in place since 2016
  • Approximately 26,000 UI health plan members are attributed to UIHC
  • 2020 very abnormal year due to COVID and the delay of care & decrease in services provided; no shared savings for 2020
  1. Discussion on Pharmacy Benefits – Troester/Olson
  • Continued discussion from November meeting with review of pharmacy plan modeling, including focus on insulin coverage and costs for our members
  • Reviewed projections to move from coinsurance to copays
  • Projected range of additional costs if we move to copay approach would be $9 to $28/month over approximately 11,000 members
  • Olson notified the committee that the Wellmark Pharmacy Committee completed annual review of the formulary. The committee approved several formulary changes for 2022, including some of the insulins on our plans. Given the formulary changes, our review and analysis from this year is impacted.  
  • Troester re-introduced Pharmacy Benefit topic discussed in February/March of 2020; this project was placed on hold due to COVID
  • UI will reengage with AON consulting to complete market check review of pharmacy plan arrangement
  • Expect project will be completed spring of 2022 with results before the last FRIC meeting of the year
  • Update will be provided in February meeting 
  1. Preview of Plan Design Review: Co-Pay/Co-Insurance/OPM – Olson
  • We have not reviewed plan design since 2018; reviews should be completed every year (best practice)
  • UI Choice started 1/1/2008; UI Select started 1/1/2020
  • Minor changes to UIChoice Quick Care & Office Copays in 2018; no changes to out of pocket max since plan inception in 2008
  • For February meeting, model three different plan design scenarios; with each approach, obtain the projected financial impact to members
  • Projections will look at small and moderate changes, plus Wellmark book of business
  • During the review, committee will consider impact on recruitment/retention
  1. Other Updates – Troester/Olson
    1. Metrics – UIChoice and UISelect plan results
  • Reviewed first three quarters of 2021
  • Average 16k employees in UIChoice; 2700 in UISelect
  • Closer to end of year, more members obtain services
  • UISelect has lower cost per member; UIChoice is twice as much
    1. Access Reports - not available yet

Meeting adjourned – Nicole Nisly moved that the meeting close & Mike Schueller seconded motion

  1. New Business (AY 2021 - 2022)
    1. MyChart Presentation – February 2022
    2. UIHC – North Liberty Facility - TBD
    3. Mental Health Coverage

Next Meeting

February 4, 2022

Zoom Meeting

FRIC Meeting Minutes
November 5, 2021
Zoom Meeting
1130 AM

Members present: Jon Garfinkel*, Michael Schueller*, John Laverty, Nancy Davin, Anya Prince, Cathy Koebrick, Dan Katz, Cormac O’Sullivan, Sarah Tallman, Angela Speers, Julie Urmie, Chuck Wieland+, Anand Vijh, Nicole Nisly

*Co-chairs; +Minutes

Administrative staff present: Joni Troester, Rebecca Olson 

Visitors present: Cheri Smith, Kara Wright, Jessica Wade, Dana Stafford, Megan Hammes, Audra Haddy, Cheryl Reardon, Siroos Shirazi, Teresa Marshall, Britt Marcussen

  1. Introductions– Garfinkel and Schueller
    1. Roll call taken
  2. Approval of October meeting minutes – Garfinkel and Schueller
    1. Nancy Davin moved to approve
    2. John Laverty second
    3. October minutes approved unanimously
  3. COVID Updates – Troester
    1. All vaccine boosters are available to eligible employees along with newly approved children ages 5-11.
    2. Executive Order mandates COVID vaccine for federal employee contractors.   Regents reviewing and will be coming out with future guidance in the coming weeks.
  4. Open Enrollment Update – Olson
    1. Open enrollment is from Nov 1st – 15th. 
    2. Reminders will be emailed on 9th and 12th. 
    3. Benefits website has helpful resources to guide employees how to complete their forms.
    4. For the new open enrollment feature “You Ask, We Answer” contact form, Benefits will have personnel dedicated to answer questions from 8am-5pm M-F.
    5. Confirmation statements will be sent after the enrollment period has ended.
  5. Regulatory Update - Olson
    1. Transparency in Coverage Rule and Consolidated Appropriations Act effective January 1, 2022
      1. Transparency in ID Cards
        1. ID cards will include in and out of network deductibles, out-of-pocket maximums, and how to find network providers.
      2. Provider Directory
        1. Requires online directory update every 90 days.
      3. Continuity of Care
        1. For certain patients, opportunity to continue care if their provider is no longer in the network.
      4. No Surprise Billings
        1. Establishes new claim payment requirements for patient liability/balance billing if ER services obtained from OON provider.
      5.  Information will be sent to policy holders by end of year.
  6. Farmland Update from 10/27 Meeting – Troester/Garfinkel/Schueller
    1. Meeting with Sustainability Committee and Selected Faculty along with shared governance and FRIC representatives with TIAA and its Nuveen Executive Leaders
    2. TIAA has updated website to provide more transparent information about the concerning issues.
    3. Updates will be provided to the FRIC committee annually in the future.
  7. Discussion on Pharmacy Benefits – Troester/Olson
    1. Continued discussion from October meeting.
    2. Assume change would be cost neutral to the plan.
    3. Proposed changes to Copays (Tier 2 & 3 only)
      1. 71.5% would see no change due to $0 generic co pay.
      2. 7.3% members would pay less.
      3. 21.1% members would pay more.
      4. Fewer individuals would reach their out-of-pocket maximum.
    4. Under the Wellmark book of business, there would be a copay for generic drugs.
      1. 91.4% would pay more in pharmaceuticals.
      2. This approach would be a huge dissatisfier for members.
    5. Discussion will continue as more requested information is provided.
  8. Other Updates – Troester/Olson
    1. Access Reports
      1. Access Dashboard shared with committee on performance of assess for UI beneficiaries.
  9. New Business (AY 2021 - 2022)
    1. My Chart Presentation – December meeting
    2. UIHC – North Liberty Facility - TBD
    3. Mental Health Coverage.
  10. Meeting adjourned

Next Meeting

December 3, 2021

Zoom Meeting

Funded Retirement and Insurance Committee (FRIC) Meeting
October 1, 2021
via zoom

Members present:

Jon Garfinkel, Michael Schueller, John Laverty, Nancy Davin, Cathy Koebrick, Dan Katz, Nicole Nisly, Angela Speers, Julie Urmie, Sarah Tallman, Anand Vijh

Members absent:

Anaya Prince, Cormac O’Sullivan, Chuck Wieland

Administrative staff present:

Joni Troester, Rebecca Olson

Visitors present:

Cheri Smith, Kara Wright, Jessica Wade, Dana Stafford, Julie Sexton, Cheryl Reardon, Britt Marcussen, Audra Haddy, Teresa Marshall, Kevin Zihlman, Siroos Shirazi

  1. Preliminaries: Meeting started on time. Joni Troester did the roll call. Committee reviewed the September meeting minutes.  Cathy Koebrick motioned to approve the minutes, Nancy Davin seconded, and the rest of the committee approved the minutes with a unanimous vote.
  2. Rate approval: Joni Troester informed the committee that President Wilson approved the new health-care plan rates for 2022.  There is no increase in dental plan rates for 2022.
  3. COVID updates: Rebecca Olson and Joni Troester (the administrators) provided updates on COVID-19 cases and coverage. Several points came up as follows:
    1. Following CDC approval, UEHC (University Employee Health Clinic) will soon be giving booster shots to employees meeting certain criteria (such as those over 65 years of age, or those having certain underlying health conditions). UEHC will be sending emails to eligible employees.
    2. The booster shot is approved for those who received the Pfizer vaccine in the first place. As of now, there is no similar approval for those who received Moderna or Johnson and Johnson vaccination.
    3. Recently President Biden released an executive order which mandates COVID vaccinations for employees who work for federal contractors employing more than one hundred employees. The university is working with the Board of Regents to determine next steps.
    4. Among approximately 44,000 employees and dependents on our health plans, there were 39 admissions to UIHC hospital for COVID in 2020. There were 11 admissions to UIHC hospital during first eight months this year. These statistics compare favorably with national averages.
    5. There continues to be no copay for COVID tests during the national public health emergency.  Members also have no cost share for inpatient, in-network treatment of COVID.  Starting 2022, coverage will revert back to standard plan coverage for inpatient, in-network treatment of COVID.  
  4. Fee leveling: The Retirement Fund Investment Committee approved a change to the administrative fee structure for UI retirement plans at TIAA. The intent of the change is to provide a consistent or “level” fee across all fund investments.  Currently, administrative fees vary among fund investments. As of January 1, 2022, an annual fee of 2.3 basis points will be charged to all fund investments. All plan participants will receive a letter in November 2021 informing them of this change.
  5. Open enrollment for 2022 benefits: Following a long-time practice from before the COVID pandemic, the open enrollment period will be November 1 to 15. This is the once-a-year opportunity for employees to make changes to their insurance benefits, outside of a qualifying life event (such as marriage or birth).  The administrators are making a strong effort to educate employees about the available benefits package at the university.  There will be YouTube videos of an overview of 2022 benefits and how to complete your enrollment in Employee Self Service. There will be both English and Spanish versions of the open enrollment benefits guide. There will also be a new online resource where employees can ask open enrollment questions that will be answered by a dedicated benefits staff member in the University Benefits Office.
  6. Pharmacy benefits: In May 2021, the committee had voted to investigate the pros and cons of moving to a copay approach of sharing the cost of prescription medicines as an alternative to the current coinsurance approach. The committee requested financial modeling of a change to copays. Under copay system, members pay a fixed dollar cost per prescription rather than a percentage of the total prescription cost.
    1. Wellmark modeled the financial impact of a change from coinsurance to copays, keeping the plan as financially neutral as possible. Another criterion was to keep Tier 1 copay to be zero as under the current plan design.
    2. Under the proposal, the copay would range from $0 for Tier 1 which includes many generics, to $150 for Tier 5 which includes non-preferred specialty drugs. Some members would pay the same cost as under the existing coinsurance plan, some 11,000 members will pay more, and some 4,000 members would pay less. Our plans have a $1,100 out-of-pocket maximum for drugs, which means that the likely financial impact on employees will be limited.
    3. The committee asked that the modeling be re-run to keep both preferred and non-preferred specialty tiers charging a coinsurance and also look at tier copay/co-insurance for Wellmark book of business. For November, the committee will continue debating the pros and cons of copay and coinsurance.
  7. Access report: The administrators shared statistics on health plan member access to primary care, specialty care, tertiary care, etc., at UIHC hospital. As usual, these statistics provided by UIHC look good. Data shows that 98%, 82%, and 70% of members looking for primary, secondary, and tertiary care are seen within 10 days.
  8. Adjournment: Nicole Nisly made a motion to adjourn. Nancy Davin seconded. Committee approved unanimously.

Recorder: Anand M. Vijh

Tippie College of Business

Funded Retirement and Insurance Committee (FRIC) Minutes
September 3, 2021
Zoom
11:30 – 1:00 pm

Members Present:

Nancy Davin, Jon Garfinkel, Co-Chair, Dan Katz, Cathy Koebrick, John Laverty, Nicole Nisly, Cormac O’Sullivan, Anya Prince, Sarah Tallman, Mike Schueller, Co-Chair, Angela Speers, Minute Taker, Julie Urmie, Anand Vijh, Chuck Wieland

Admin. Liaisons:

Rebecca Olson, Joni Troester

Guests:

Audra Haddy, Megan Hammes, Cheryl Reardon, Dana Stafford, Jessica Wade, Kara Wright, Brit Marcussen, Jill Valde, Cheri Smith, Teresa Marshall

  1. Introductions/Role call – Garfinkel and Schueller
    1. Sarah Tallman has joined the FRIC committee this year.
  2. Approval of May meeting minutes – Garfinkel and Schueller
    1. Corrections to spelling and date were noted. A motion to approve was made by Chuck Wieland, seconded by Nicole Nisly, approved unanimously.
  3. Quarterly Report – Olson
    1. Rebecca Olson presented UIChoice and UISelect dashboard metrics which included costs and utilizations for 1st and 2nd quarter 2021.
  4. Rate Setting for CY2022 – Troester
    1. Dental - Proposed 0% increase in dental premiums based on cost and utilization across all family statuses.
    2. UIChoice and UISelect - No change to premium cost share for UIChoice and UISelect.
      1. UIChoice EE and Dual Spouse Family premium cost share remain at 10% for 2022.  UIChoice all other family status premium cost share remain at 20% for 2022.
      2. UISelect EE and Dual Spouse Family premium cost share remain at 0% for 2022.  UISelect all other family status premium cost share remain at 20% for 2022.
    3. Rate setting process discussed. Assumptions and data used in rate setting shared.  Given COVID and the unique past year of plan utilization, University Benefits worked with AON to model projections.  To account for irregular utilization during the pandemic, AON used two years of claims data and adjusted claims using COVID factors to account for suppressed claims during 2020 and future COVID related costs.  Projections also include increased Wellmark administrative fees for CY2022.
    4. UIChoice will be increasing 7.1% for CY22 and UISelect will be increasing 2.9% for CY22
    5. The CY22 Open Enrollment guide will be available in Spanish for employees during this fall
    6. A motion to approve the CY2022 dental and health rates was made by Chuck Wieland, seconded by Nicole Nisly, approved unanimously.
    7. A motion to cancel the September 10th FRIC meeting was made by Chuck Wieland, seconded by Nicole Nisly, approved unanimously.
    8. For the Medicare carve-out retiree health plans, CY2022 rates are:
      1. UIChoice Single increasing by 6.6%
      2. UISelect Single increasing by 6.5%
  5. Farmland Update – Troester
    1. Joni Troester shared an update on Farmland.  Faculty Senate approved a resolution in April 2021 and Staff Council approved a resolution July 2021 urging FRIC and RFIC to ask TIAA to address transparency and sustainability issues.  Next steps are a campus meeting with TIAA Nuveen Leadership of Responsible Investing on October 27, 2021. TIAA will meet with Sustainability Charter Committee, Shared Governance Leadership, and RFIC. Joni Troester will provide a follow-up at our November FRIC meeting.
  6. COVID Updates – Troester/Olson
    1. Joni Troester provided an update on vaccination planning.  There will be a 3rd dose for select populations, currently by appointment at UEHC.  Also, a booster is approved for 8 months out from second dose beginning September 20th, 2021.
    2. Rebecca Olson provided an update on COVID related health plan provisions.
      1. Plan members currently have no cost sharing for COVID testing and related services during the national public health emergency. Members also have no-cost share for inpatient, in-network treatment of COVID-19 through December 31, 2021. Coverage will revert back to standard plan coverage for inpatient, in-network treatment of COVID-19 starting January 1st, 2022.
  7. WellMark Changes for CY2022 – Olson
    1. Rebecca Olson shared the following health plan changes. Bereavement and family counseling will be covered as of January 1st, 2022. Family counseling includes marriage counseling, but group counseling is excluded. Dental treatment for accidental injury needing repair increased to 24 months as of January 1st, 2022.  Surgical Removal of Impacted Teeth is covered only with concurrent medical needs as of January 1st, 2022.
  8. Announcement
    1. Flexible Spending Account (FSA) will be transitioned to a FSA administrator for 2023.  Numerous advantages to having a FSA administrator process claims versus in-house, manual claim processing: Debit card, Faster claim processing, Ability to quickly respond to any federal changes to FSA rules.  This will result in an improved employee experience and greater efficiency to the plan. Timeline for transition: Recommended- Fall 2021; Vendor Selected- Spring 2022; Implemented- January 1, 2023.
  9. Other Updates – Troester/Olson
    1. Access Reports
    2. Board of Regent Review

Chuck Wieland made motion to adjourn. Cathy Koebrick seconded. Unanimous approval.

Next Meeting
October 1, 2021
Zoom Meeting