Liveblogging: Peoria City Council, 4
A. HEALTH ALLIANCE MEDICAL PLANS for THIRD PARTY ADMINISTRATION (TPA) and UTILIZATION REVIEW (UR) SERVICES, in the Amount of $19.75 Per Member Per Month for the First Year and there will be a 5% Increase in the Second and Third Years;
B. METHODIST MEDICAL CENTER and PROCTOR HOSPITAL for PREFERRED PROVIDER ORGANIZATION (PPO) NETWORKS for HOSPITALS and PHYSICIANS.
Lyons: Very small savings in taking previous recommendation.
Manning: Why do we have now five options.
Mr. Lyons: Items that changed. Went back to using contract pricing. Did not have all information. Could not have apple to apple comparison. When we went back to contract pricing. Biggest change in physician discounts. We did not change our projections. None of the variables changed.
Manning: Didn’t have all the data, you said. Reminded Lyons he only gave vendors five days to provide a lot of data. Much of the date he asked for wasn’t pertinent, like dental plans.
Also, question of matrixes, more concerns. It does not seem reasonable that some people came up with these scores. “I think people knew where the wanted to go, and we’re backing our want into it.”
BVA: “Tony Ardis was the single most helpful person in helping me to understand the process.”
Nichting: Who performed the Matrix?
Answer: Done at staff level?
Based on current or previous data, or based on corrected information or not?
Lyons: Old data, not corrected.
Nichting: It’s like feeding information into a computer. Doesn’t blame people on health care committee. Disappointed in professional people on staff. Problem with lack of access to patient advocate?
Lyons: OSF later said that patient advocate would have access to information.
OSF Health Plans is up for sale. No idea who will administer these plans. Gallagher will not recommend.
Lyons insisted the Health Alliance has fixed problems with late claims.
Nichting: No first hand bad experience with OSF, right? Lyons: He has no first hand experience with OSF, still doesn’t recommend.
Lyons: OSF going to be sold, that’s a fact.
Nichting: Any company can be sold at any time, including one being recommended now.
Oliver: Only two options. Financially, OSF is less costly to the city. Significant number of the insured will be required to change primary care physicians They have assured us that there is room within system for new patients. Physician out of network charges could apply. OSF TPA will be paying claims. Potential savings is $1.18 million.
Other option: Duel TPA. Health Alliance would be TPA for Methodist and Proctor, OSF TPA for OSF network. No inter family jumping within family. Lets families test system before making change to different network. No formal vote, but police and fire supported.
Sandberg: Q for Lyons. OSF was How much time did OSF have to do repricing. Lyons: Only a week. Computerized process. Computers are often different. But, hey, it’s worked before.
Sandberg: When we all sat down with you, within five minutes with you, I felt the process was designed to just stay where you were at.
Jacob: Additonal employee costs?
Oliver and Lyons: Not a clear answer.
Jacob: Not a million over life of contract. That nearly $1.2 million is an annual cost.
Asks Mr. Parsons how to improve process. Difference between previous and last recommendation is large and he wants to void it.
Olver recomended that premiums be based on medicare rates, as they are standard for everyone.
Jacob: I am flabbergasted at the figure before us, thats a total of $3.6 million.
Ardis: I’ll add my concurrence. We had a prover in the community that came back with a very sharp pencil. Not a concern with Methodist or any other provider. Good companies lose business every day to another good company that comes along with a sharp pencil.
Ardis to Parsons: Comment by one of the providers. Were any of the providers asked to not communicate to the council members.
Answer: We asked them to send questions to our office or to the consultant.
Ardis: Providers got the impression they were not alloswed to talk to the council.
BVA: Accept recommendation to use the OSF exclusive alternative with Proctor with an annual savings of $1.18 million annual savings. This is a three year contract, so it’s a $3.64 million.
Spain: “That’s a huge savings for the city over three years.”
Oilver: $1.8 million savings is based on current charges. Net difference of $700,00 after other providers “sharpened their pencil.”
At least 75 percent of savings offered is achievable. Max achievable is $1.18 million based on current plan rates. Dual plan would generate $200,000 – $300,000 less in verifiable savings. Majority of what Labor Management Health Care Committee supported. Vote was 3-2 in favor.
Vote: Unanimously.
“It was a very difficult decision,” Ardis says.
Billy Dennis is a former reporter and editor at small daily and weekly newspapers in Illinois and Missouri. He comments on media, news and politics. He also owns and operates 
Does anyone realize the magnitude of this savings? good job City Council!!
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