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State of Nevada Public Employees' Benefits Program

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Company: State of Nevada Public Employees' Benefits Program
Company Description: The Public Employees’ Benefits Program administers a group health and life insurance program which offers comprehensive medical, prescription drug, dental, vision, life, and long-term disability insurance. Our organization is responsible for designing and managing a quality health care program for approximately 43,000 primary participants and 27,000 covered dependents, totaling over 70,000 lives.
Nomination Category: Company / Organization Categories
Nomination Sub Category: Organization of the Year - Non-Profit or Government - Large

Nomination Title: State of Nevada Public Employees' Benefits Program

Tell the story about what this nominated organization has achieved since January 1 2017 (up to 650 words). Focus on specific accomplishments, and relate these accomplishments to past performance or industry norms.

The Public Employees’ Benefits Program (PEBP) administers a group health and life insurance program which offers comprehensive medical, prescription drug, dental, vision, life, and long-term disability insurance. Our organizationis responsible for designingand managing a quality health care program for approximately 43,000 primary participants and 27,000 covered dependents, totaling over 70,000 lives.

In August, 2017 PEBP developed a strategic plan centered on three goals, access, quality, and affordability. PEBP is a member centric entity with the mission to provide employees, retirees, and their families with access to high quality benefits at affordable prices. PEBP has been able to save the program substantially while lowering costs and restoring benefits to members through innovative solutions. In March and May, 2017 PEBP was able to successfully renegotiate and extend contracts with its third party administrator saving the program approximately $225,000 a year. Included in the contract negotiations PEBP’s Diabetes Care Management program was transferred under the third party administrator saving an additional $990,000. In May PEBP was able to renegotiate and extend the contract with PEBP’s Preferred Provider Organization Network saving the program $455,000 over the next three years.

PEBP continued with contract negotiations and extensions in July, 2017 with PEBP’s Pharmacy Benefits Manager and Basic Life and Long Term Disability Services vendor. PEBP successfully negotiated higher rebates including a contract extension with the Pharmacy Benefits Manager saving the program $1,800,000 in 2017 with a projected savings of $8,100,000 through 2022. PEBP also successfully renegotiated life insurance rates saving the plan $500,000 in 2017 with an expected savings of $2,000,000 over four years.

In an attempt to offset premiums for members, the PEBP board in November, 2017 approved replacing the current HMO plan that has a proposed rate increase of 13%-15% for members, with a PEBP managed plan to go effect July 1, 2018. This change resulted in a 10% decrease for members on that plan instead of the proposed increase.

To promote high quality, lower cost facilities, PEBP implemented a new process to steer members to high quality, lower cost facilities for hip and knee replacement surgeries effective July 1, 2017. This referenced based pricing program created an exclusive network of high quality, lower cost facilities and providers located in Northern and Southern Nevada. PEBP gathered data from the Centers of Medicare and Medicaid (CMS) and did a claims analysis based on hip and knee replacement surgeries from the facilities in Nevada to create the exclusive provider list for these procedures.

Based on excellent decision making, PEBP has pursued and achieved national recognition. PEBP is a member of the national State and Local Government Benefits Association (SALGBA) and regularly attends and speaks at their conferences.Every year SALGBA challenges benefit programs to submit successes to be recognized, acknowledged, and utilized as a best practice by other public sector entities. In 2017, PEBP implemented a new program to help members with chronic disease receive critical drug infusions from high quality, low cost providers throughout Nevada. In Partnership with PEBP’s third party administrators, over $800,000 was saved for the program while honoring each member’s right to choose where they received their care. In January 2017 PEBP applied, along with 32 other entities, for the award with SALGBA. In May, 2017 PEBP received the SALGBA Challenge Award.

In September 2017 PEBP started accreditation with URAC, one of two entities that insurance companies are required to be accredited to sell Qualified Health Plans in accordance with the Affordable Care Act (ACA). In the government sector, public health plans have no requirement as public health plans do not participate on ACA exchanges. PEBP, leading the nation in government health plans was awarded full Core accreditation on April 1, 2018 and is recognized as the only accredited governmental health plan nationally.

PEBP is excited to apply for Organization of the Year.

In bullet-list form, briefly summarize up to ten (10) of the chief accomplishments of this organization since the beginning of 2017 (up to 150 words).

-PEBP is a SALGBA Challenge Award Winner in May, 2017
-PEBP is the first, and currently only accredited governmental health plan in the nation.
-PEBP through successful contract negotiations and extensions was able to save the program $3,665,000 in 2017 with an expected savings of $4,780,000 in 2018.
-PEBP has achieved a negative medical trend the last two years when it was expected to be a positive, resulting in lower rates for all members.
-PEBP successfully implementing a referenced based pricing system creating an exclusive network of high quality, lower cost providers and facilities for hip and knee replacement surgeries.

Of the following measures of success, which ONE do you want the judges to most appreciate about your organization's story of achievement since the beginning of 2017? Public Service