Feeling up for a challenge? How’s this:
Take charge of providing and maintaining affordable and appropriate medical and dental coverage for a group of nearly 25,000 men, women and children, where the stakes are both incredibly high and incredibly personal. Accomplish this while working in the most difficult economic conditions since the Great Depression, in a region where challenges to health include a fast-food outlet at nearly every corner and where the air is usually far less than clean. Work across several language barriers while balancing the wants and needs of several diverse labor unions and management, and do this in an environment where the costs of what you provide go up by staggering amounts every single year.
Do all of this while ensuring that time is invested in answering the concerns of each individual within the plan. Do this without incurring exorbitant costs. And then, just when your results show you have this down to a science, have the rulebook for the services you provide rewritten completely.
Now we’re not saying any of this like it’s a bad thing, mind you. It’s simply a description of the challenges met daily by the Fresno Unified School District’s Joint Health Management Board (JHMB), an organization comprised of school district management and representatives of its component labor unions, created to provide and manage appropriate and affordable health and dental benefits for the District’s active employees and retirees.
One of the greatest challenges in health care today is cost control, the concept of providing benefits that meet the needs and expectations of our plan participants and their covered dependents, while ensuring those benefits remain affordable.
Meeting the challenges
“Cost control is a challenge we take very seriously,” said Ruthie Quinto, JHMB Co-Chair and Management representative. “Since our inception in 2005, the JHMB has made a number of cost-control adjustments to our employee health benefit program, all designed to continue to provide quality health care benefits at affordable rates.” Ruthie cited a number of actions as instrumental in containing cost, including:
- Changing prescription-drug benefit providers, to provide the best possible coverage at the lower costs;
- Instituting case management services, generic substitutions and ‘step therapy’ programs within our prescription-drug program;
- Auditing enrolled plan participants and their dependents for eligibility, to ensure our members are not paying for the care of people who are ineligible;
- Evaluating the JHMB’s business partners, to ensure efficient delivery and affordability.
“We’ve realized these savings through competition and cooperation,” Ruthie added. “Competition between vendors in the marketplace has allowed the JHMB to choose providers based on performance and cost, ensuring that our plan participants get the most for their dollar.” According to district projections, these and other measures have saved nearly $200 million dollars since 2005. That means money saved by every covered employee and retiree.
All in it together
“None of these savings would have been possible without the cooperation of labor and management representatives working together with our plan participants,” said John Stallsmith, JHMB Co-Chair and CSEA 143 Representative. “The bottom line is we’ve been able to meet the needs of our employees while saving them money. And with inflation in health care running at double-digit rates, delivering benefits while saving costs is quite an accomplishment.”
“And while cost savings are important, let’s not lose sight of the most important factor,” added Brenda Emerson, JHMB Alternate Co-Chair and FTA Representative. “For many across the country, health care benefits have simply become unaffordable, and many have lost their health care coverage completely. Meanwhile, we’ve continued to provide the quality and level of health care benefits expected by our plan participants and their families during one of the most challenging economic times in memory.”
Despite all of these efforts, there appears to be no end in sight to the challenges involved in providing affordable health care benefits. Inflation in health care is still running at double-digit rates, medical care and prescriptions are still getting more expensive, and the challenging economy seems to be providing no respite.
“We’re proud of how the JHMB has steered through tough situations so far, but we’re continuing to see serious challenges on the horizon,” Ruthie said. Among the coming challenges:
- The JHMB is experiencing a drop in the number of its active participants, which means a drop in the funds available for health care benefits.
- Continuing poor economic conditions mean declining revenue for the State of California, which passes along those shortages as budget cuts.
- Increases in health care costs show no signs of abating anytime soon.
- National health care reform legislation will require benefit providers like the JHMB to provide new kinds of coverage to new groups of constituents, adding additional pressure to the battle for cost control.
So what do these challenges mean for the future? “It means – once again — that the JHMB’s benefit plans will need to adapt to challenging conditions,” said Brenda Emerson. “We’ve performed admirably in providing benefits and controlling costs so far, but what we’re about to experience really is a ‘perfect storm.’”
“It will require that we do what we must to adapt, so we can continue to accomplish our mission of providing our constituents with the best possible coverage at the most affordable rates,” added John Stallsmith. “With the changes required, we’re going to work together – management, unions and employees – just like we have in the past to meet challenges. And we’ll keep our plan participants and their families in the loop every step of the way.”