Bookmark & ShareFor Immediate Release: 05/11/2009
Contact: Dave Wasser 360-923-2711
On May 8, 2009, the Health Care Authority signed a contract with Aetna Life Insurance Company (Aetna) to provide Third Party Administrator (TPA) Services for the Uniform Medical Plan beginning January 1, 2010. Aetna will provide all of the services being provided by UMP’s current TPA, Harrington Health, as well as additional services, including offering a provider network within Washington state and throughout the country.
Background
UMP contracts with private vendors to provide most of the administrative services needed to run a health plan. UMP’s largest contract with its current third party administrator (TPA), Harrington Health, expires December 31, 2009. Harrington currently provides claims processing, customer service, medical review and other services for UMP members.
HCA began the re-bidding process in December 2008 to select the UMP TPA for the 2010-2013 contract period. The TPA Request for Proposals included an expanded scope of services that consolidates a portion of the administrative and operational work currently being performed by other contracted vendors and HCA employees. This providing the UMP provider network – both in Washington and across the country. The HCA received bids from five qualified bidders.
Why did the Health Care Authority choose Aetna?
Aetna offers the following advantages to UMP members in 2010:
- Aetna has a larger provider network than the current UMP, with more than 30,000 providers in its Washington state network and over 700,000 in its national network. Most UMP providers are already in the Aetna network. Currently, 84% of doctors in UMP’s Washington network are also in Aetna’s Network – accounting for 96% of claims dollars UMP spent on doctors in 2008.
- Aetna has more robust online tools to help members manage their care including cost estimator tools, hospital compare tool, customized heath information, secure customer service (chat), and online claims information.
- Aetna offers seamless coordination between customer service staff and programs offered to members including case management, disease management, and UMP’s wellness program. Aetna also owns ActiveHealth, which is UMP’s vendor for disease management
- Aetna participates in local and national initiatives to improve the quality of health care, and has the resources and expertise to provide state of the art tools and services to UMP members.
- Aetna’s Washington PPO network is fully accredited by the National Committee for Quality Assurance accreditation, receiving the organization’s highest ratings for access to care and provider quality. See “Report Cards” on ncqa.org for details.
Can I Still See My Same UMP Providers in 2010?
Most providers in UMP’s Washington state network are already in the Aetna network so most members will not notice any change. Aetna will also make every effort to contract with UMP network providers that are not in their network.
You can check to see if your providers currently contract with Aetna by asking your providers or by checking Aetna’s online provider directory at www.aetna.com. From Aetna’s home page, select “Find a doctor.” The easiest way to search is by provider name and city. You can also search by specialty and plan. When searching by plan, choose the “Open Choice PPO” network under “Aetna Standard Plans” in the drop down menu.
Providers who want to contract with Aetna can begin by visiting www.aetna.com, clicking on “Health Care Professionals” and then click on “Join Aetna’s Network” for information on how to join the network.
Aetna will develop a custom website and have dedicated customer service members available for UMP members by October 1, 2009 to answer specific questions.
Will My Monthly Premiums or Out-of-Pocket Costs Go Up?
Monthly premium rates for 2010 are currently being developed by the HCA. We do not anticipate that changing the TPA will directly affect premiums.
Medical inflation is estimated to be between 7-8% in 2010. This will likely cause premiums to increase. Because of the state budget shortfall, the percent increase the State Legislature allotted toward paying the State’s portion of employee premiums will not keep up with this medical inflation. As a result, the amount members will pay out-of-pocket for services (coinsurance, copays and deductible amounts) are likely to increase.
Final rates and member cost sharing are scheduled to come before the Public Employees Benefits Board for review in June. This information will be made public after the Board has approved the benefits package for 2010, tentatively scheduled for July 22.
Will My Benefits Change in 2010?
There may be slight changes to what services are covered by the plan, but that won’t be related to the change in the third party administrator (TPA). HCA’s goal is to minimize changes for UMP enrollees.
The HCA has to follow state and federal laws that mandate changes in what is covered (or what cannot be covered) that could have an effect on cost. One example is the mental health parity law that requires health plans to remove any limits on coverage for substance abuse or mental health services in 2010.
Why is UMP Changing TPAs? It’s a Good Plan; Why Change It?
UMP is a well managed plan. It is the most popular plan offered to PEBB members, insuring more than half of all state employees, retirees and their dependents. The HCA intends to continue to manage it well and to continuously improve the plan into the future.
The contract for the current third party administrator is expiring at the end of 2009. Issuing a Request for Proposal for a new contract and holding a competitive process to select a vendor is standard operating procedure.
More than 95% of premium funds go toward paying providers for medical and pharmaceutical claims. The remaining 5% is spent on health plan services including claims processing, customer service, medical review, etc.
Of the remaining 5%, HCA has always contracted out the majority (about 90%) of these services to private vendors. What’s different about the scope of work for this contract is the HCA decided to consolidate a broader array of services under one contract in order to better manage the plan. These expanded services include the TPA providing a state network of healthcare providers, (currently managed by HCA directly), as well as a national provider network, case management, subrogation and other services that are currently being provided through subcontractors to the current TPA.
HCA had a team approach to reviewing the proposals and selecting a vendor. Aetna was selected as the best of the bidders. We look forward to working with Aetna to meet UMP members’ health care needs in 2010.
Is UMP being privatized in 2010?
No. The Uniform Medical Plan is a self-insured plan designed by the Public Employees Benefits Board and administered by the Health Care Authority. That will continue in 2010. Decisions regarding what services will be covered, what members will pay, and which provider network the plan uses, continue to be made by the Health Care Authority, with approval from the PEB Board.
Will State Employees Lose Their Jobs because this Change?
No. Those state employees who currently manage the UMP network will not lose their jobs as a result of this change. HCA will re-focus their activities to managing the full benefits package administered by the HCA.
