City of Holyoke Health Benefit Trust Committee Meeting April 7, 2025
Apr 7 2025
5:00 pm Holyoke Fire Department
600 High St, Holyoke 01040
City of Holyoke Health Benefit Meeting
April 7, 2025
City Hall, Fire Headquarters
The meeting was called to order by Quentin Donohue at 5:04 PM
In attendance:
PEC Representatives: Joe O’Connor- Retirees, Chris Butler-Fire Dept
City Representatives: Sean Mangano- HPS CFO, Dazhana Argueta-Personnel Specialist
Others: Quentin Donohue – chairman, Steve Corbin – Dowd Insurance, Kelly Curran – HR Director, Rebecca Sutter – Dowd, Heidi Fountain, Jessica Chaput, Steve Fay and Steve Dion- BCBS, William Alicea-Fire Dept
Receive minutes from 3/24/25 meeting
MOTION: Joe made a motion to approve minutes. Sean seconded. Motion carried Unanimously
- Quentin- all those in favor to receive minutes. Vote carried unanimously
Pharmacy Carve Out Discussion – Heidi Fountain from Blue Cross/Blue Shield
- Heidi introduced folks from BCBS to review BCBS’s Pharmacy carve out option.
- Jessica stated that we get all reimbursement for RX. Steve-90% of profit goes back into claims. Heidi clarified that all goes back into our claims as we are self funded with the exception of Admin fees.
- Jessica- reward providers for how they provide outcomes for their patients. Ex. Lower cost Rx. Also if the drug does not perform as expected= money back. (Outcome based)
- Quentin requested real world evidence. How does the drug work in the clinical trial vs real world? How does it compare to outcomes compared to other drugs?
- Steve- the important thing is when you talk about carving out the RX what they are not taking into consideration is the integration between medical and Rx.
- Dazhana mentioned that currently most issues have been with diabetics getting coverage for medication
- Heidi- there have been 17 calls regarding RX and most were for GLP1 regarding cost and coverage. This is tiny
- Quentin-Maybe for you but not for employees. Rory mentioned previously that employees had the GLP1 authorized and then not with BCBS and had to spend hours on the phone to get their Rx covered.
- Joe- Why did he not reach out to Steve or Rebecca?
- Heidi- Their concern is not coming to me or Member services.
- Joe- Did he bring it to Steve
- Steve-No
- Steve- Only carrier where Heidi and Steve work together and look at trends but this is also the first he is hearing of this situation so that they may address concerns. Please trust us.
- Quentin-I get no benefit, I am a teacher but I hear stories and I am here for one reason, someone has to be in this chair and make sure that if there are problems please reach out to BCBS.
- Dazhana- we do have members go to Member services first and Heidi and Candis have been great with additional questions and support. This just happens to be an issue with a specific group of employees with Diabetes. Candis recommended that we meet to discuss and see what is happening behind the scenes.
- Steve- definitely reach out to Steve but also they should go to Member services first.
- Jessica- not to say we are not going to run into problems but that is there to make sure those that should be receiving the medication are.
- Ex. Rescue inhaler refilled 5x and BCBS reached out to Provider who was not concerned but still reached out to the family and it turns out they were using the rescue in place of preventative which could cause severe lung damage.
- Benefits of integrated care
- Simple, improved health outcomes, lower medical cost, increased control, lower admin cost and time spent and contract oversight and management
- Quentin-why would there be a difference in cost?
- Jessice- where they are getting the prescription
- Quentin- BCBS providers providing their own?
- Jessica- most expensive. Ex. DR giving injectable in office vs cheaper out of office option
- Groups that carve in save about 6%. Medical spend increases
- Heidi- 6% is a lot. Currently around 11 million and could cost 660,000 dollars.
- Jessica- additional fees that follow suit
- Joe- dollar amount
- Jessica- about 10% increase
- Sean- just to confirm, cost per contract increases and if we take Rx out the contract goes up
- Steve- Yes
- Jessica-plus annual fee
- Quentin-6% increase not just associated with management fee and medical claims due to lack of integration?
- Jessisca- Yes. Also think of the care management team reaching out when claims are high to review. The minute Rx is carved out we don’t have the claim data so less members go down.
- Quentin- how much of that information is accessible by our broker?
- Steve Corbin- I do a lot of things but not medical management
- Quentin- Could the data from BCBS and Carve out be analyzed by the Trust if we had the power to do so? Who owns the data?
- Steve- BCBS data that you have access to
- Quentin- we should have all of the data
- Jessica- recommend speaking to a HIPAA attorney to be aware of legal guardrails
- Heidi- caution a self insured trust to have that confidential data.
- Steve- to put this in dummy terms, that is why you pay us
- Sean-the number we see for savings is significant and totally understands the service piece. Why does BCBS not have a middle plan that has the drug savings? Is BCBS exploring those plans?
- Jessica- Yes, great question. We want people to use generic and low cost. I think what you’re thinking of Hollywood drugs losing patents. Bio-similars are usually for less concentration which are not suitable for certain people. Removing Humara from our formulary but seeing 2 others that are a lot less costly. Members pay 0 dollars for it. 2 They are interchangeable.
- Quentin- are they of concentration?
- Jessica- Yes
- Quentin-I have no idea what it is used for
- Jessica- it is used for everything
- Jessica- needs disruption analysis to see how members with be affected
- Sean- Humera will result in lower cost to city
- Jessica- Yes, Humera now on cost share as well as being lower cost
- Quentin- by acknowledging that, 10 most expensive drugs. What is on schedule for drug saving and cost?
- Jessica-Will see spending decrease once that comes off. Takes time to see
- Quentin- we are generic mandate in MA
- Jessica-Different for speciality dugs
- Heidi- if COH wanted to do an independent study without all claims, its not really a fair and full comparison.
- Jessica- group carved out and ended up spending more money because they did not think they were covering GLP1 drugs.
- Joe- Steve did we have a disruption report?
- Steve- yes top 50 drugs
- Jessica- you need a full data to compare, not the top 50 which are probably most expensive
- Heidi- Pharmacy who has no skin in the game.
- Steve- savings is going to decrease at the cost to members and calls to HR
- Quentin-how much does Caremark make
- JessicaThey negotiate but we create our own formulary and rebates are dependent on that formulary. 80% goes through CVS but we are not CVS we are just leveraging them because they can get us the aggregate due to their size.
Sean Mangano left meeting at 6:03pm
- Joe- How many rebates collected
- Jessica- there is a lag since you are still newer. Rebates paid 120 days after the close of the quarter.
- Steve- $373,240 last one received. IDealy not getting high rebates because that means you are spending a lot on drugs.
- Heidi- never going to avoid HCD.
- Quentin- asked Dazhana what the process is when someone has an issue
- Dazhana- did they contact Member services, if not, then I reach out to Heidi or Candis
- Chris Butler- had a situation with the transition and directed to MS and it was taking too long and so he reached out to Steve and it was resolved on the same day.
- Quentin- Thanked BCBS for coming and for their support
Broker Update
- Quentin- asked for any questions and how folks are feeling
- Dazhana’s concern is the member experience
- Steve Corbin- submitted 36 months of claim data although they kept saying no data
- Quentin- since we are only in year one, maybe after year 2 would be a good time to take a look at it
- Steve Corbin- only leverage is Admin Fee
- Chris Butler- Can appreciate that their number is their number. Agree that this is maybe a next year thing
- Joe- would you come back with more options
- Steve Corbin- There are others, just comfortable to SmithRx
- Joe- They don’t have a municipality
- Steve Corbin- non in MA
- Chris Butler- worried about same people having the issues again
Quentin- The newly Health Benefit Trust is doing its due diligence to better provide better care for the employees of the City of Holyoke
Dazhana- brought up section 19 request to be presented to the Mayor
Chris Butler- 1% shift in splits for just HMO not PPO.Asked that Kelly Curran talk with Mayor regarding the pitch. It is a 179 thousand dollar shift. Maybe try to shift people to HMO plan.
MOTION: Joe O’Connor made a motion to adjourn . Chris Butler seconded. Motion carried unanimously
The meeting adjourned at 6:24 PM