Health Care Reform Review Committee Report: May 9, 2018

Linda Cahn, President of the Pharmacy Benefit Consultants, presented on pharmacy benefits coverage under the Public Employees Retirement System (PERS).

Presentation was excellent and included a report of how well the Medicaid system in ND is doing to control costs. Cahn also reported on PBM (Pharmacy Benefit Plans) and definitions and how to look at and identify loop holes. Did talk about transparency, and doing bid on contracts.

Recommendation to the state is:

Rec. 1: If you can get blended contract and specific information on prices are carved out and rebates then blended is ok

Rec. 2: You need to have proof of a self-insured carved out contract will be less expensive than fully insured blended coverage.

Mr. Mike Schwab Executive Vice President North Dakota Pharmacist Association, gave a report. He evaluated the ND Medicaid pharmacy program which showed they have done very well with controlling costs over the 10 years. In other states with use of PBM many states have carved out pharmacy, most states mentioned PBM, thought they would have savings, found that did not occur.

Presentation given then by Shila Thorson, Director, State Department of Health and the state stroke program. Breakdown of data given, 33% of strokes in ND are between the ages of 18 and 65. She showed data and how to provide quick treatment.

Then June Herman advocacy of the American Heart Association provided input on the stroke system care. State funding was also reviewed. Did discuss that funding will be running out with next legislative system. All hospitals have been involved in progression of stroke care.

PERS presentation given by Sharon Schiermeister, Interim Ex. Director of the Public Employees Retirement system.

Shelly Peterson gave presentation on long term care and nursing facility care, Current system of care. Facility in ND 80 long term care with 90% occupancy. ND is at 54.92 beds per 1000 elderly. There has been a redistribution in beds in ND due to need. Pts are being discharged rapidly. 81% are using contract nursing. For the first time in 8 years seen a decrease use in contract nursing, down about 11%. 53% are on Medicaid. 38% are private pay. Average 47% are from 85 to 95 years of age. She shared concern with managed care plan and we should not allow to have a decrease Medicaid payment and shift to private pay. $270.71 for 24-hour skilled care is the current rate.

PACE Senior Care Services was then reported on by T. Cox. Northland PACE does promote independence for older adults and keep in homes if possible. Sites in North Dakota are in Bismarck, Dickinson, and Minot. Started in 2008 in ND. PACE provides care for medications and long term care if they move into that level of care. The required is primary care physician, RN, social care, etc. The financial piece is: PACE gets about$ 4,788 per month, which is about $57,500 per year, for long term care it is $94,535 per year. Currently there are 188 individuals in PACE.

Then reports were given by Dave Molmen, Altru Health system, on the tertiary hospitals and an Urban model concept for managed care of state’s Medicaid population.

Bruce Murry gave a report on Medicaid managed care for the developmental disabilities population. The dental association, reported on information regarding the managed care for dental services. Please refer to the minutes for complete report on these subjects.

I was also able to discuss with Shelly Peterson Director of Long term care about supporting APRN for CMS changes to allow APRNS to do admission and sign orders and follow in long term care. They are meeting with the congressional delegation in Washington DC at the end of the month and encourage and support this change.

I was also able to discuss with a representative from Sanford on the Sanford plan and rejecting orders on biologics. They are going to investigate.

Cheryl Rising, FNP


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