HomeMy WebLinkAbout09-18-06 Admin. Com. MinutesDublin City Council
ADMINISTRATIVE COMhIITTEE MEETING
September 18, 2006
Council members present: Chai• -Vice Mayor Lecklider, Mrs. Boring, Ms. Salay, Mr. Keenan
(joined the meeting at 6:15 pm)
Staff Members present: NIs. Brautigam, Mr. Harding, Ms. Ruwette, Ms. Hamilton, Ms. Hoyle, Ms.
Warren, Mr. Ball.
Call To Order
Vice Mayor Lecklider called the meeting to order at 5:40 p.m. at Dublin Municipal Building. He
noted that the topic of tonight's discussion is the 2007 Employee NledicaUHealth Management Plan
Revisions and afollow-up to the previous discussion about possible enhancements to the dental
plan.
Mr. Harding stated that 2007 will be the second year of a three-year strategy for modifications to
the Employee MedicaUHealth Management Plan. Tonight's presentation will focus on:
• The "Healthy by Choice" initiative
• A recap of the modifications to the medical and prescription plans that will be effective
January 1, 2007
• Possible enhancements to the City dental plan per the Administrative Committee's 5/8/06
du•ection.
"HEALTHY BY CHOICE" INITIATIVE
Mr. Harding stated that he «~ould begin by re-emphasizing the philosophy behind the strategy
designed to implement modifications to the employee medical plan over a tluee-year period. The
strategy was approved by Council in July 2005. The key points of the philosophy are:
• Wellness and prevention must be inseparably linked to the plan. To achieve a sustained
reduction in the City's health care costs, an employee wellness initiative was necessary.
The premise for that initiative is that if employees adopt healthier lifestyles, the City
would experience a reduction in health care expenditures.
• To achieve a reduction, it r~~ould be necessary for the employees to be required to:
(1) pay a share ofthe costs, and
(2) take steps to adopt healthier lifestyles. Ifthey choose not to participate in that effort,
they should expect to contribute an additional amount to the costs.
Mr. Harding showed a PowerPoint presentation ofthe modifications that would be implemented
over the three-year period. In 2006 the modifications implemented were:
1. The coverage for preventative care costs «~as increased from 90% to 100%
2. Prescription drug co-pays «~ere increased as follows:
Tier 1 drugs -Employee co-pay would be 15% of the prescription cost up to a max of $25
Tier 2 dnigs -Employee co-pay r~~ould be 20% of the prescription cost up to a max of $50
Tier 3 drugs -Employee co-pay would be 20% of the prescription cost up to a max of $100
3. A premium contribution was required but waived if the employee completed an individual
health assessment survey.
4. A flexible spending program was offered through which employees could offset a portion of
their increased costs.
5. A redesigned wellness initiative was implemented.
Administrative Committee
September 18, 2006
Page 2
In 2007, entu•ely ne~u health management initiatives will be implemented.
IVIs. Hamilton presented staft~s recommendations for 2007 initiatives. She indicated that statistics
indicate that approximately '70% of chronic diseases are preventable. Therefore, the
implementation in 2007 will encourage employees to make better choices and become better health
care consumers.
Mrs. Boruig inquired the source of the statistics.
1VIs. Hamilton responded that they are compiled by the National Health Institute.
I~~Is. Hamilton stated that the City will remain an employer of choice by providing employees
options regarding their health care coverage, continuing to have a vibrant and healthy l~~orkforce,
continuing to reduce costs in the health care plan, and being fiscally responsible to the taxpayers.
Implementation Approach:
In 2007, the "Healthy by Choice" program will be linked directly to the employees' benefits. Staff
will 1~~ork «~ith the Health and Productivity Institute at Corporate College. Corporate College is a
division of Cuyahoga Community College. Tri-C Corporate College will review employee health
risk behaviors, the City's claims analysis, and employee absenteeism. They will identify the
situations that are costing the City the most money and develop a 3-5 year strategy to reduce those
costs. Everything will be focused on the goal to reduce the City's health care costs. One of the
most important goals «~ill be to keep the healthy employees healthy.
Ms. Hamilton displayed the "Healthy by Choice" logo, which «-i11 incorporate the City's logo. This
program will not be mandated or forced on employees. They will have a choice. Those employees
and spouses who choose to participate must comply with certain wellness criteria. Coaches from
Tri-C Corporate College will set up programs for them with achievable steps. The City will ease
into that program, attempting to make it inviting and welcome. In this way, the City will be
providing the tools to ensure the employees' success in meeting their goals. An outside party will
have the employee's personal information concerning thew health conditions and theiY• risk
behaviors.
Health Coaching Model:
To implement individual employee programs, employees and spouses will be encouraged to take
advantage of a new health coaching program. The health coaches will work as an encouragement/
empowerment tool for the employees. The employee will be asked to contact their designated
coach. The coach will: (1} reviet~-• their health risk assessment; (2) discuss l~~ith them their
priorities and motivations; and (3} interactively help the employee to set goals to be met by the
following year. The coaches will then be available for ongoing advice and direction during the fu•st
6 months of the year.
Vice Mayor Lecklider inquired if the coaches will be Tri-C Corporate College employees.
Ms. Hamilton responded that the coaches will be provided by Achieva, an outside company that
specializes in health coaching.
Administrative Committee
September 18, 2006
Page 3
I~~Is. Salay inquired how the Achieva coaches would be provided the personal information about
individual employees.
IVIs. Hamilton responded that they would have the results of the employees' health risk assessments.
The health assessments this year will be more comprehensive than last year, and those results will
be automatically forwarded to them.
Mrs. Boring inquired how many other employers are using this health coaching model.
Nis. Hamilton responded that many companies are beginning to use it, but very few municipalities
are using it.
Mrs. Boring requested that a list of employers who are using Achieva be provided to Council.
Ms. Hamilton agreed to obtain that information and foi-~~ard it to Council.
Ms. Salay inquu-ed how situations would be handled where the employees cannot respond to some
questions in the health assessment questionnaire because they had not been tested recently.
I~~Is. Hamilton responded that the employees will be required to have those screenings. Tlu•ee
opportunities will be provided on site for blood screening, cholesterol screening and height/weight
check. The results will be provided to the employee, not to the Human Resources division. The
employee will be able to provide those numbers on theri• health risk assessment. If the employee
prefers, they can have the screenings through their physician.
For 2009, the employees will also be required to ~~•ork through their physician to have additional
preventive screenings that are age specific. These adult health maintenance screenings are
recommended by medical literature from the American Academy of Family Physicians and the
Center for Disease Control. For instance, if the employee is 50, they should have a colonoscopy
and should repeat it every 10 years. It is also recommended that women from 18-65 have an annual
cervical smear and pelvic exam. Regular blood pressure checks are reconunended.
In 2008, employees will also be required to participate in an education program that the City will
define based on the aggregate data from the health risk assessment results.
Ms. Salay requested an example of type of education.
Nis. Hamilton provided examples of stress management, nutrition, exercise or working with aging
parents' education.
I~~Irs. Borilzg inquu-ed if time would Ue made available for the employees to have these physician
appointments and health assessments.
14Ir. Harduzg responded that time from work for this purpose has not been built in the program.
However, employees will be able to use their sick hours for this purpose.
I~~Is. Brautigam noted that the Health Fair in November will provide an opportunity for the
employees to have the blood pressure and cholesterol screenings on City time. In the City where
she worked previously, education teas provided «~ith brot~~n bag lunches; that could also be
incorporated into Dublin's program.
Ivirs. Boring expressed that requiring time to be spent on education can sometimes hinder the
employees' ability to meet their job obligations.
Administrative Committee
September 18, 2006
Page 4
I~~Is. Brautigam stated that brown bag lunches would not impact employees' jobs, as the education
would occur at a time in which they would normally be at lunch.
Ms. Hamilton stated that in 2007, if the employee complies with the requirements they will earn a
«--~aiver of the charge for insurance premium. That objective will be kept in mind for the employees.
Open Enrollment:
Ms. Ruwette stated that with the City's program, there will always be two steps with the open
enrollment: (1) health risk appraisals and (2) screenings -- blood pressure, finger sticks,
height/weight.
Three testing dates have been set up for City employees to have these screenings done on site -- on
t«~o days, the appointments will begin at 7 a.m. If preferred, the employees can also have the
screenings done through their private physicians. Employees must comply with the open enrollment
requu-ements to earn their insurance premium waiver in 2007.
However, 2006 is a transition year, easing the employee into the program. Going forward, in 2007,
employees will immediately begin to follow steps to earn their premium waiver for 2008.
Employees will have three choices:
(1) To participate in open enrollment, complete the health screenings, and participate in the
"Healthy by Choice" program. To do this, they «~ill need to:
(a) discuss their assessment with a health coach and set a health goal to pursue
tlu•oughout 2007;
(b) work on that goal throughout 2007
(c) do the pre~•°entive screenings
I~~Irs. Boring stated that, occasionally, goals cannot be reached. For instance, she recently folio«~ed
the steps outlined by her physician to reduce her cholesterol level. The result -her cholesterol level
increased by two points.
Ms. Hamilton stated that for the first couple of years, personal health goals would be very
achievable. It won't be something such as reducing cholesterol by a specific number of points. It
might be, for example, to exercise three times a week for 20 minutes, or to eat more fruits and
vegetables weekly -very achievable goals.
Ms. Ru«~ette continued:
(2) To participate in open enrollment, complete the health screenings, and NOT pursue a personal
health goal. Employees would not pay an insurance premium in 2007, but they would be
requu•ed to pay a premium in 2008 because they did not pursue and achieve a health goal.
(3) To NOT participate in open enrollment, health screenings, or personal health goal. Employees
r~~ill pay an insurance premium in 2007. Open enrollment will occur annually, so the employee
may choose differently from year to year.
If employees choose not to participate, the cost in 2007 will remain ~% ofthe projected claims cost
-- $25.00/individual and $50.00/family per month. In 2008, the premium will increase to 10% of
the projected claims cost.
Administrative Committee
September 18, 2006
Page 5
In 2008, compliance with the educational component of the program will Ue required to earn the
insurance premium waiver for 2009.
Target Outcomes:
• Minimize utilization
• Increase preventive screenings
• Increase personal accountability
Vice Nlayor Lecklider inquired how the educational component would be uzcorporated.
NIs. Ruwette responded they may be brown bag lunches, as mentioned by the City Manager, or
before or after work sessions to accommodate spouses.
Mrs. Boring inquu•ed how the spouse who works a significant distance away and unable to attend
any of the offered sessions would be accommodated.
NIs. Ruwette responded that the City will offer other options, such as online education.
lUleasurements of the Program:
Health RiskAppf°aisal:
1~~Is. Hamilton stated that a City welhzess survey was completed. The results indicated that there is
strong leadership support for this initiative, and employees recognize that maintaining good health
is a shared responsibility. This appears to indicate that employees are ready to listen to different
ideas; share in then own health and insurance costs; and recognize they play a role in maintaining
those costs.
Aggregate Data:
Corporate College is well knot~~n for analyzing data through clusters of risk. Traditional «~ellness
programs have employees take health risk appraisals and identify their risk factors. Typically,
people rho have one high risk factor have other high risk factors. Corporate College will
categorize the risks to help in creation of programs to address them.
Aggregate Claims Data:
Ms. Hoyle stated that the effect of the program should be seen in the City's claims data.
Return of Investment Model:
This model has been developed by Corporate College. In 2006, the data from 2005 and the first 6
months of 2006 was entered to provide a baseline of information. That data included claims,
different types of claims, prescriptions, and usage of sick leave. In mid 2007, they will begin to
look for changes, if any, and whether they are positive or negative. They will evaluate the return in
relationship to the benefits offset against the cost invested u1 the plan design and implementation
1VIrs. Boring inquired if evaluations will occur per a prescribed timeline.
Ms. Hoyle responded that per a 6-month timeline, updated data will be entered and results measured
again. Realistically, a return may not be realized for 3-~ years.
Nlrs. Boruig inquired how the reports will be shared with Council.
Administrative Committee
September 18, 2006
Page 6
I~fls. Hoyle responded that annual reports could be made to Council, similar to the report tonight.
Mrs. Boriig stated that the report would not need to be accompanied with a presentation.
14Is. Hoyle agreed. A report t~~•ith a full 12 months of data would be beneficial.
City Investment:
In 2007, the Tri-C health assessments will be completed. The cost of each assessment to the City is
$31.50iper person. If all eligible employees participate, the annual cost will be $12,000. There will
be a miiimum requirement per employee and per spouse oftwo coaching sessions - a cost of
$56/per participant, $112/per family. There will be an opportunity for 6 months of unlimited
coaching sessions, if desired. Tri-C has indicated that, typically, one-third of a company's
employees will elect for the maximum coaching. For budgeting purposes, the City is assuming one-
half of its employees and spouses will opt for the more extensive coaching program. The 2007
budget will contain $12,000 for the health risk appraisals and $41,000 for health coaching, a total of
$53,000.
Vice Mayor Lecklider stated there is a need to justify the cost ofthis program to the public.
Therefore, should the City realize within the first year or two a savings of $53,000 or greater per
year?
Ivls. Hoyle responded that she is not certain that it would be seen that quickly. Tri-C's return of
investment program predicts that by the end of year three, the City should see a 14% reduction in
health care costs.
Vice Mayor Lecklider inquired if there are other expenses ofthe program incurred by the City to the
University of Michigan and Achieva in addition to the individual cost of the health appraisals and
the coaching.
1VIs. Hoyle responded that it is an annual cost.
I~~Ir. Keenan inquied the City's current health care costs.
Ms. Hoyle responded it is approximately $4M per year. In the early years, an increase in costs will
be seen.
Mr. Keenan noted that a recent Duhlin "Health~~4'ise" newsletter provided information on the
amazing benefits of virtual body scans -heart, lung, vascular, colonoscopies, and bone density
scans. Evidently, a heart scan ~i~ill do a detailed readout providing information of plaque build-up,
etc. Could this type of screening/assessment be implemented?
IVIr. Harding responded that, traditionally, those screenings haven't been covered by the City's
health insurance. Ho«Tever, this type oftechnology is very impressi~•=e and moving for-~~~ard, perhaps
it can he incorporated. At this point in time, the cost is high -approximately $800 foi• a fiill
vascular scan. These scans can predict the beginnings of heart disease 8 years in advance of any
other screening technology.
Ivlr. Keenan stated the ability to have visual evidence of plaque in one's heart would provide an
incentive for a change in lifestyle when it would matter most.
Administrative Committee
September 18, 2006
Page 7
Ivlr. Harding stated that the technology is 98% accurate, while a stress test is only 50% accurate.
Mrs. Boring inquired if the cost of the scan would be covered if it is ordered by the physician.
Mr. Harding responded that a fe«~ health plans are beginning to cover it, but at this time, health
insurance companies typically do not cover it.
Ms. Salay stated that when the insurance companies see evidence that an $800 vascular scan today
will save $50,000 in 8 years, they will begin to cover it.
Mr. Harding stated that the virtual scans are based on prevention, while the whole medical system is
based on treating disease, which is counterproductive. He can envision the City adding this to its
program in the future.
Vice Mayor Lecklider inquired if Council received some information or a presentation on this
recently.
I~~Ir. Harding responded that a couple of representatives attended the Administrative Committee in
May. He and the City Manager have been provided information on this type of preventive health
screening and are at~~are of its benefits. Strategically, they t~~ould like to add it, but it is fairly costly
and not covered by the City's insurance plan. They were reluctant to budget $750/employee for 400
employees, or even 50% of that for a more limited number of employees for this type of screening.
Vice Mayor Lecklider stated that health insurance companies will hopefully recognize the value of
this type of screening in the near future.
I~~Irs. Borilzg stated that the City is self-insured and designs its o«~n plan. Mr. Keenan has made a
good point. ~?Vhy have all the brown bag session efforts to educate employees on the value of
changing behaviors, when a scan will do it more effectively?
Mr. Keenan agreed. This t~~pe of screening would probably bring a much larger return of
investment than 14% of $4M.
Vice Mayor Lecklider stated that when the screenings become more commonplace, that would drive
the price down.
I~~Ir. Keenan stated that the City can structure the plan as it wishes and has. Colonoscopies are not
typically covered by other health plans either, but the City elected to add that to its coi•=erage.
Vice Mayor Lecklider stated that even if employees were to receive results from the scan that
indicated dire consequences of a particular nature, they would still need the other aspects of this
program to get them ultimately «~here they need to be.
14Irs. Boring stated that there «~ould be immeasurable value in "pinpointing" a serious concern.
IVIr. Keenan stated that the current program would only provide the basic information -- blood
pressure, cholesterol and glucose levels -nothing like a vascular scan.
Administrative Committee
September 18, 2006
Page 8
I~~Ir. Harding suggested that it would Ue preferable to have those basic screenings established before
going to the nett level. However, he does not disagree with Mr. Keenan's point.
IVIr. Keenan inquired if the vu-tual scan screening could be phased in. Perhaps, in the fu•st year, the
City plan ~~~ould only cover 25%, the second year ~0°,'0, etc.
I~~Ir. Harding responded that the City can do whatever Council directs in this regard. It would
require budgeting the funds to cover that percent of coverage.
l~Is. Hoyle noted that currently, employees aren't required to have any screenings. Perhaps it would
be advisable to get them "on board" for the most basic preventive screenings fu•st before providing
opportunities for alternative preventive health screenings. She agrees, however, with the value of
the opportunity for that type of screening.
l~Is. Salay inquired if the virtual scan would replace the other preventive screenings. For instance,
would a colon screen be as good as the traditional colonoscopy and therefore replace it? Would a
carotid screen be as good as the physician's traditional test by stethoscope?
lU1r. Harding stated that the virtual scans are more accurate than the common screening tools widely
used today. He visited one ofthese facilities and observed a virtual colon screen. It was amazing
the degree of detail that can be seen in that screen, and it's entirely noninvasive.
Ms. Salay responded that she does not need convincing; she believes it would be a great thing to
hate.
I~~Irs. Borilzg suggested that perhaps the City could initially make the viY-tual scans possible by
applying the cost of the traditional screen towards the cost of the vu-tual scan.
1VIr. Harding responded that the City could do whatever Council directs - it is just a matter of
funding.
Mrs. Boring stated that she is in favor of offering this option to the employees - if they choose that
type of preventive screening, the UCR equivalent portion would be covered by City insurance.
Ms. Hoyle noted that the City couldn't cover both. If the employee's physician also orders the
traditional screening, that would present a problem.
lU1rs. Boring responded that there are times now when a physician will ask for a test to be repeated
within a couple of months -that would be the same thing. The employee's second test is covered.
I~~Is. Hoyle responded that it then moves from being a preventive screening to a diagnostic tool, so it
«°ould be covered.
Mrs. Boring responded that this type of preventive screening would not be a problem «-~ith
physicians - it could be a matter of discretion between the employee and their doctor. If the
screening revealed problems, and the physician ordered additional tests, that should be covered.
Administrative Committee
September 18, 2006
Page 9
I~~Is. Hoyle suggested that staff learn more about the alternative screening first and then bring a
proposal to Council for the 2008 plan modifications. They would have better information on the
costs.
h2rs. Boring responded that in her estimation, people overcome the educational fear factor quickly.
Visual proof of a health issue would be much more convincing, and more people would alter their
behaviors. This preventive care type of employee health program will be a radical change for the
City, and there will be objections. However, if the preventive screening program is made attractive
and appealing to the employees, that would bring the employees "on board.'' It would be perceived
as Council indicating they truly are concerned about the employees' health by offering a new
preventive screening tool with real merit.
1VIs. Hoyle requested that staff conduct more research and come back with a proposal. She and Mr.
Harding have discussed this before, and now, with Council's direction, they will compile the
information.
Mr. Keenan stated that he has seen some rates and numbers that indicates the cost is very
negotiable.
hTr. Harding agreed. The company has already provided him with a proposal for a carotid artery,
cardiovascular and stomach scans. There could be protocols in place -not every employee would
necessarily be a candidate for the scans.
1VIs. Salay stated that she is interested in looking at initiating those screenings in 2008. This is
September 2006, and it would probably be mid-2007 before the program could be ready. Initiating
it in January 2008 «~ould provide the opportunity for better knowledge.
IVIr. Harding noted that there are full-body scans that are inferior in technology to that of the facility
staff visited. His understanding is that there is only one other facility in the state with the equivalent
technology. It would be necessary to be particular in the facility used.
Ms. Salay stated that due to her family history, she has learned that is wise to be cautious about
"new" technology. Her physician has said that when technology is f°u-st introduced, it is 3-5 or even
10 years in advance of widespread use of the technology for preventive or diagnostic uses.
I~~Is. Hoyle suggested that a preliminary pilot program could be useful.
Mrs. Boring responded that the screening Mr. Keenan has referred to has been tested for some time
now.
IVIr. Keenan responded that these screenings are not brand-new technology.
IVIr. Harding stated that the Chief Medical Officer of HealthWise, Dr. Rumberger, is on the Board
of the AMA, and according to him, there is no question about the effectiveness of this tecluzology.
It is simply a cost factor.
Ms. Salay inquired if it would be helpful to do an employee survey to determine interest in this
screening if it were offered with a certain level of discount. Would employees be excited about it?
Would it be perceived as a huge benefit? If so, there would be a benefit to the City's health plan
and a perceived benefit from the employees' perspective.
Administrative Committee
September 18, 2006
Page 10
Ivlrs. Boring stated that she does not believe there is a need for an employee survey. If Council
were to ask the audience tonight if there is anyone who wouldn't prefer the virtual colon scan over
the traditional colonoscopy, the scan t~~ould be the screening of choice.
(Audience affirmation.)
Ms. Salay responded that she ~~~ould «~ant to ask her physician's opinion.
Mrs. Boring stated the vi-tual scan ~-ould not be required; it would be an option for employees,
subject to their physicians' choice. Offering this option would convince the employees of Council's
real interest in a preventive health program for them. She believes it could be offered sooner than
2008. Many changes have been implemented recently that have affected City employees -
reclassifications, salaries, health benefits. It would be good to provide them something really
positive.
IVIr. Harding stated that staff is very supportive of the concept. He would suggest that early in 2007,
research be completed on the protocol, possible triggers for employee option to have the scan, and
an estimated cost impact.
Mrs. Boring inqui•ed if it ti~~ould be possible to survey the City's list of approved providers (family
physicians).
Mr. Keenan noted that even if some providers question the colon scan, there should be no dissenters
to the heart and cardiovascular scan.
I~~Irs. Boring responded this is probably true, but it would still be profitable to Council to actually
see how the City's providers view the screening.
Vice Mayor Lecklider stated that there is clearly a need to change the program. An article he read
this past weekend stated that U. S. health care plans are not achieving what European health care
plans do primarily because European plans focus on prevention, while the U.S. still focuses on
treatment. Clearly, a change is past due.
Recap of Health Plan Cost Changes in 2007
• Co-insurance -Cost will increase to 85%/15% in-net~~~ork; 50%-50%out-of-network
• Hospital inpatient stay - Co-pay will remain 85°%,-`15% in-net~~ork; 50%-50% out-of-
network
• Emergency room - Co-pay will increase to $100 and 85%-15% in-network; $500 and 50%-
50% out-of-network
• Annual out-of-pocket maximum -Single Coverage from $1,000 to $1,250 in-network;
$5,000 to $6,000 out-of-network; Family Coverage from $2,000 to $2,500.00 in-network
and $10,000 to $12,000 out-of-network.
• Prescription Drugs -Tier 1 (generic) no increase; Tier 2 (drugs on formulary) 20% with cap
of $50 increased to 20% per prescription with cap of $75; Tier 3 (drugs NCT on formulary)
20% per prescription with cap of $100 increased to 20% with cap of $150; annual
prescription out-of-pocket -single coverage $1,000 to $1,250 and Family Coverage $2,000
to $2.500.
Administrative Committee
September 18, 2006
Page 11
Premium Equivalent and Employee Contribution -Those employees who choose not to
participate in the Healthy by Choice Program -Single - $25!00 month and Family -
$~0.00%month (J% of coverage). In 2008, that cost will increase to 10% of the projected
cost of the coverage.
11~Is. Hoyle noted that the current cost of Family Coverage is estimated at $1,000Imonth.
I~~Irs. Borilzg inquired about the type of employee feedback there has been following the plan design
changes in January of 2006.
Mr. Harding responded that initially there were objections, but over time, there has been
acceptance. The City's health plan is still rich in comparison to many other plans.
Mrs. Boring induu•ed the percent of employees «~ho participated.
141s. Hoyle responded that employee participation ~~~as 100%.
Estimated vs. Actual Health Care Costs in 2006
Ms. Hoyle stated that the City did not have a good claim year. However, any self-insured plan will
be cyclical. The plan design changes in 2006 u1 Medical were not very radical. The employee co-
payment remained at 90%-10%, plus 100% preventive screening was added. However, there were
radical changes in the plan design in employee co-pay of prescription costs, and the City saw a
greater reduction in pharmaceutical costs than was projected.
Communication of 2007 Changes to Employ
l~Is. Ruwette distributed a copy of the communication that will be forwarded to employees on
September 27. She thanked 1~1r. Ball for developing the communication piece for staff. He has
contributed significantly to the tearn initiative. Large group meetings and staff meetings will be
held in October to explain the plan changes. There will be articles in the Mulligan Stew, and copies
of all the corrununication pieces will be posted at the DubNet. As last year, a special link will be
created so that spouses can view this information on DubNet fiom their home computers. In 2007,
an ongoing communication plan will be implemented to remind employees of different options.
Dental Plan Design -Coverage Enhancements
• 1~Jajor Dental Coverage
Ms. Ruwette stated that this is a follow-up to the May 8 Administrative Committee direction for
staff to review increasing the dental service coverage. The current plan annual maximum for Major
Dental Services is $1,500 paid at 50%,`50%. Major Dental Services covers procedures such as caps
and bridge work. Staff looked at the impact of keeping the annual maximum at $1,00 but paying a
greater share ofthe costs - 60%, 70%, or 80%. They also looked at the results of increasing the
annual cap for Dental -Major Services from $1,00 to $1,70 or $2,000.
Nlrs. Boring inquired about the Committee's request for an estimate ofthe number of employees
who eclipsed the $1,500 max and the number of employees who postpone or do not have dental
work because they could not afford it.
Administrative Committee
September 18, 2006
Page 12
I~fls. Hoyle responded that 2005 claims data indicated only the number of employees who exceeded
$3,000 in 2006 -- with reimbursement capped at $1,500, they obviously met the max. Only 20
employees met the maximum. With that minimal number of employees, an increased maximum
t~-•ould not have a significant impact. Therefore, information has been provided about increasing the
maximum to different levels -- $1,750, $2,000 and $2,500.
Mrs. Boring stated that the chart indicates an insignificant cost impact, even if the maximum were
to be increased from $1,500 to $2,500. Therefore, she advocates increasing the annual cap to that
amount. That would be a very positive message to the employees, which wouldn't be costly to the
City.
Ms. Hoyle agreed. Increasing the maximum to $2,500 and keeping the present reimbursement
percentage at 50%-50% would only be an increase of $1,000 per employee. Last year, that cost
would have been $20,000. The cost ofthe extra coverage would not be expensive.
• Orthodontia Coverage
Ms. Hoyle stated that per the Committee's request, information has also been provided on
increasing the coverage for lifetime orthodontia. A comparison with other cities revealed that
Dublin's lifetime orthodontia coverage of $1,000~`person is lower than other cities. Based on the
last three years of claim data, estimated costs of increasing the lifetime orthodontia to $1,250,
$1,500, and $2,000 has been provided. As sho«-•n, increasing the maximum for orthodontia would
also not be expensive. Council has several options: in Major Dental Sei-~~ices, the annual
reimbursement percentage could be increased or the annual maximum could be increased; the
lifetime maximum for Orthodontia could be increased; or any combination of the above. If Council
would like to propose increases in those maximums, however, staff should be advised quickly so
that the appropriate amounts can be budgeted for 2007.
Vice Mayor Lecklider stated that at the May 8~' Committee meeting, a consensus was reached in
one or two areas, such as orthodontia. Does staff have those meeting minutes?
NIr. Harding responded that the Committee did reach a consensus on increasing the lifetime
Orthodontia maximum. In the survey of 13 other cities, 7 other cities provided a greater maximum.
The City's 50%-50% level of reimbursement for Mayor Dental is also lo«~, and Committee
consensus was to increase that level. The survey indicated 6 other cities that provide a higher
reimbursement level than Dublin -two at 80%. He would recommend increasing the
reimbursement percentage to 75%. In the combined aggregate (Preventive/Diagnostic, Basic
Services, and Maximum Annual), two cities provide a combine annual maximum of $2,000.
Dublin's plan provides an annual maximum of $1,500.
Mrs. Boring stated that those cities are Grandview and Upper Arlington, both of which have less tax
revenues than Dublin. Dublin should certainly be able to provide a similar level. In addition to the
reimbursement percentage increase, she l~~ould support an increase in both the Major Dental annual
maximum and the Orthodontia lifetime maximum.
Vice I~'Iayor Lecklider requested staff's recommendation for an appropriate Major Services
maximum that would dovetail with a 75% reimbursement.
Administrative Committee
September 18, 2006
Page 13
Ivlr. Harding recommended increasing the percentage of reimbursement for Major Services to 75%
and increasing the Annual Aggregate from $1,500 to $1,75().
Ms. Hoyle recommended increasing the Orthodontia lifetime maximum to $1,500. An increase
from 50% to 75% reimbursement with an aggregate maximum increase fi•orn $1,500 to $1,750 --
this is only an additional $250 and reached very quickly; it is not expensive to add. It would not put
Dublin at the top, but it would make the City more competitive. In view of the other changes being
made, this would also be a positive gesture.
I~~Is. Salay stated that it has become more evident how innportant oral health is to the overall health.
Perhaps this «~•ill encourage an employee to have some needed dental work done.
Vice Mayor Lecklider stated that he would concur with the increases recommended by staff.
I~~Irs. Boring asked if fellow committee members would consider the following: As I~~Is. Hoyle
pointed out, increasing the City's reimbursement from 50% to 75% is not that beneficial, as the
maximum reimbursement is reached more quickly. She «~ould recotnrnend also raising the
maximum to $2,000. That is only $250 more and would be a more comprehensive change.
Vice Mayor Lecklider stated that he would be willing to consider that. He is not deferring entirely
to Mr. Harding and Mrs. Hoyle. Ho~~-ever, he did ask them earlier what their recommendation was.
They indicated they had discussed the issue and that was their recommendation. He «~ould be
~~~illing to revisit this a year or two in the future in order that that t~vo years' claims experience could
be seen. Ho«~ever, the Committee will be recornmending increases in different categories where the
City's coverage has been low to make the City more competitive.
lU1r. Harding noted that he and Ms. Hoyle were actually conservative in their initial
recommendation, as staff al«-~ays exercises caution in adding costs. Increasing the maximum to
$2,000 would be acceptable.
IVIs. Hoyle noted that the chart of potential increase comparisons provided to the committee lists
$2,500 at the top. However, $2,000 is the top provided by other municipalities, according to the
survey.
Mrs. Boring responded that «~ould be more appropriate for ho«~ Dublin identifies itself as a top
community. Dublin has said it wants to have an innovative health program -something other
municipalities are not yet doing. It would be more consistent with the iltent to be at the top and
innovative to also provide the top maximum. Staff stated that this type of increase would have
minimal impact on the City's budget.
1VIs. Hoyle responded that is correct. However, she would suggest that the Committee stay with the
$1,750 reconnnnendation for 2007, analyze it again next year at this time, and make another
reconmendation at that time.
Administrative Committee
September 18, 2006
Page 14
I~~Is. Salay responded that would be her preference. The Committee can hold that consideration until
next year, look at the actual experience in 2007, and perhaps next year at this time, make a
recommendation.
Ms. Hoyle stated that in the meantime, staff ~~-ill track and review the data and have that analysis
ready.
Mrs. Borng stated therein lies her other argument. The data indicates that in the last year, only 20
employees reached the maximum. What a great opportunity to give something to the employees,
-•ith a minimal cost impact to the City.
Ms. Hoyle responded that was the actual numbers for 2005, but anything could happen in a year's
time.
Vice Mayor Lecklider stated that Council does have a responsibility to its shareholders, and those
shareholders are the citizens of the community. While this community probably would want to see
Dublin employees enjoy higher than average compensation and higher than average benefits, there
are probably some of those citizens who do not enjoy this level of benefits. There is the potential
for this type of feedback from citizens. although that probably doesn't significantly influence
Council's ultimate decision, Council represents the citizens and are accountable to them.
Mrs. Boring stated that the citizens she represents are very interested in the customer service they
receive from City employees. Council often receives the credit for the quality services that City
employees provide. Therefore, she would defend increasing the maximum for employees and
would explain to her constituents that it is due to the value of the City's employees. There is a
balance of factors. ~?Vhile Council must always be accountable to the taxpayers, this would be a
minimal cost and would provide a boost to the employees.
Vice Mayor moved to recommend for Council approval the following modifications to the
Employee Dental Health Plan:
{1) the percentage of reimbursement for Major Services be increased from 50% to 75%;
(2) the Combined Annual Maximum be increased from $1,500 to $1,750; and
(3) the C?rthodontia Services lifetime maximum be increased from $1,000 to $1,500.
Ms. Salay seconded the motion.
Vote on the motion: Vice Mayor Lecklider, yes; Ms. Salay, yes; Mrs. Borng, yes.
Vice Mayor Lecklider indicated that the recommendation would be made at the Council meeting,
which immediately follows this Committee meeting.
The meeting was adjourned at 7:05 p.m.
Deputy Clerk of Council