Flipchart Notes from November 21, 2002 Conference

Community involvement in decision on what health care services are available instead of competition

Competition doesn’t work

Keeping necessary services and quality care

How do we keep our local doctors

How to change our designation from rural to urban

Knowing our local data and who is it available to

How do we cooperate on common goals

How do we educate consumers of health care to be smart consumers

How do we invest in prevention and wellness systems

How to expand access to what already exists on wellness

How to keep overhead down

How d we keep rates reasonable

Provider choice

Maintaining or improving quality or care

Dealing with the number of people who are uninsured

Eliminate unnecessary procedures unnecessary drugs

Identify patterns of utilization and analyze data

Improve access to specialists where are the gaps

When aren’t all school systems united pre K-16

Why is S.C. considered rural and reimbursred at lower rural rates

1st time we’ve heard this data

Why brokers haven’t shared this data

It looks like we have bargaining power

Trust? More info? Numbers to be more effective than RESIG.

What is the incentive for providers to share information

Can information be compelled as a condition of contract

Does there have to be only three choices for RESIG in S.C.

Trust health providers

The system seems to be set up to have non-convergent interests

Goal should be best health care at the lowest cost

We have told the health industry that we will pay high costs for lower level care

The “reality” that you don’t get the highest care at low or no cost

Are current providers able to accommodate shifts in client (Kaiser does not have enough capacity)

Do we need RESIG?

Will it take a court order to get the data?

Health providers should have an incentive to ensure better overall health which might lower costs

What do the experts in this room suggest Sonoma Co/Calif/U.S. do?

How do we get data needed to make a difference?

Are we going to have enough control to stabilize costs?

Could we develop a self-insured health plan?

How can we deal with them – us climate?

We need a demographic study – age – gender – family make up

Who is using medical/hospital services?

How can we keep/get good doctors?

Look at other providers

Large group to leverage providers

Short term-form partnerships school, city & county

Real parity with labor and management

Importance of local doctors, hospitals

It’s not all about $

Too many layers of management district-JPA-broker-HealthNet-hospitals-doctors

Support local health care providers

Health care is personal

Practical Ideas
Key Ideas, Helpful Ideas for Bargaining

As a bargaining unit/and management get little information

Needs to be health committee included all bargaining units all have same information in district

Decisions to be made in April by July 1

Have a countywide, 40 districts negotiate prior to local district bargaining

Barriers in negotiation process to countywide negotiations

Negotiate at district level are “little guys on totem pole”

At table to include language to include broader issue i.e. K-16 health care issues

We solved it once and it came back

Day by day year round issue, every negotiation

Need continuity of people on committee with history and knowledge

Build Trust for countywide system that has leverage, experts, keep districts informed

Spring Conference and other get information out to districts management and bargaining units

Some districts are out there on your own

Some broker information felt not to be true

Include professional medical mathematics: expertise trust factor, neutral

Resig is a district business function not bargaining unit

Health issue broader role than business

Why does it cost Healthnet $750 family – we don’t understand

Resig unable to provide actuarial information/district can get individual

Get countywide actuarial

Bargaining unit sit down at table during cost discussions

Bargaining unit want information, don’t get it, frustrating

Teachers in SRCC pay own benefits, varies between districts & bargaining groups, works with 2 insurers, doesn’t work with classified, part-time if not 2nd incomp

Flex plan

Self-insured benefit pool, reimburse surplus or carryover co-pays

Trust issue re: district holding funds

Larger pool to leverage health care providers

Local impact

Districts and unions together bargain with carrier

Declining qualify of care

Cost containment

Education patient specific prescription medical center, Plain Tree 1986

Maintain current level of service

Evaluate current services

Look at options – different approach

Countywide health care rates not just schools

Costs based on data and utilization in Sonoma County

Dialogue with medical community

Collaboration in bargaining health benefits

Problem solving away from CBAs

Possible Solutions

Explore plan redesign

Trust concept

Local control

½ of 1% set aside for data collection analysis

Use countywide approach

Teach employees to ask questions about recommended care “what are my other options?”

Countywide health option orientation once a month for new hires before they make health plan choice

Have year round committee to study what plans are available, do plan design, etc.

Pay fees for wellness programs such as gym membership, weight loss, smoking cessation, etc.

Develop broad, long term solutions

Kaiser and HealthNet do joint wellness classes to share state costs and get enough enrollment in outlying areas

Consultants on set fee not a % basis

True partnership involves employer and employees sharing the cost of premiums

Allow people to opt out if they have other coverage

Incentives for wellness and prevention participation

Prescription monitoring and drug bulk purchasing to get good rates

We want communication between all the parties