In The Matter Of:
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
Monday
December 7, 2015
Capitol Reporters
208 N. Curry Street
Carson City, Nevada 89703
Original File 127152.txt
Min-U-Script® with Word Index
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PUBLIC EMPLOYEES' BENEFITS PROGRAM BOARD
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TRANSCRIPT OF PROCEEDINGS
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VIDEO CONFERENCE OPEN MEETING
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MONDAY, DECEMBER 7, 2015
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CARSON CITY, NEVADA
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The Board:
LEO DROZDOFF, Chairman
JACQUE EWING-TAYLOR, Co-Chair
CHRIS COCHRAN - Member
ROSALIE GARCIA - Member
ANA ANDREWS - Member
JUDY SAIZ - Member
For the Board:
BRIAN STOCKTON
Deputy Attorney General
For Staff:
DAMON HAYCOCK
Executive Officer
CELESTENA GLOVER
Chief Financial Officer
KARI PEDROZA
Executive Assistant
NANCY SPINELLI
Public Information Officer
Reporter by:
CAPITOL REPORTERS
Certified Shorthand Reporters
BY: KATHY JACKSON
Nevada CCR #402
123 W. Nye Lane, Suite 107
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Carson City, Nevada 89703
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(775) 882-5322
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CAPITOL REPORTERS (775)882-5322
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AGENDA ITEM
PAGE
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1.
Open Meeting; Roll Call
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2.
Public Comment
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Public comment will be taken during this agenda
item. No action may be taken on any matter
raised under this item unless the matter is
included on a future agenda as an item on which
action may be taken. Persons making public
comments to the Board will be taken under
advisement but will not be answered during the
meeting. Comments may be limited to three
minutes per person at the discretion of the
chairperson. Additional three minute comment
periods may be allowed on individual agenda
items at the discretion of the chairperson.
These additional comment periods shall be limited
to comments relevant to the agenda item under
consideration by the Board. Persons making
public comment need to state and spell their name
for the record at the beginning of their testimony. 5
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3.
Approval of the Action Minutes from the November 19,
2015 PEBP Board Meeting (Leo Drozdoff, Board Chair) 25
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4.
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Finalist presentations by vendors who responded to
RFP #3202 for Health Management Organization
(HMO) Services, the Board will have the
opportunity to ask questions of the vendors at the
conclusion of each presentation
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a.
Anthem
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b.
Prominence
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c.
Hometown Health
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d.
Health Plan of Nevada
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5.
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2nd Level Board Review and award of HMO proposals,
pursuant to NRS 287.04345, including (For Possible
Action):
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a.
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Disclose the review by the Board of the
vendors whose proposals scored the highest
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AGENDA ITEMS
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PAGE
b.
Identity criteria to evaluate the high
scoring proposals
c.
Consider the ranking given to proposals
by the evaluation committee
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d.
Evaluate vendors' responses
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e.
Award the contract based on the best
interests of the State
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6.
Public Comment
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7.
Adjournment
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CAPITOL REPORTERS (775)882-5322
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MONDAY, DECEMBER 7, 2015, CARSON CITY, NEVADA
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-oOo-
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CHAIRMAN DROZDOFF:
We'll call the meeting to
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order.
This is the December 7th PEBP Board Meeting,
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10:00 o'clock, start time here in the PEBP conference room.
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Kari, would you go through the role.
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MS. PEDROZA:
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MEMBER EWING-TAYLOR:
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MS. PEDROZA:
Jacque Ewing-Taylor?
Here.
Anna Andrews?
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MEMBER ANDREWS:
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MS. PEDROZA:
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MEMBER BAILEY:
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MS. PEDROZA:
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Judy Saiz?
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MEMBER SAIZ:
Here.
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MS. PEDROZA:
Jim Wells has been excused today.
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Chris Cochran in Las Vegas?
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Rosalie Garcia in Las Vegas?
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MEMBER GARCIA:
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MS. PEDROZA:
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Here.
Don Bailey?
Here.
Bob Moore has been excused today.
Here.
Jeff Garofalo has been excused
today.
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And, Rosalie, is Chris there with you?
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MEMBER GARCIA:
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CHAIRMAN DROZDOFF: All right. Rosalie, would
CAPITOL REPORTERS (775)882-5322
Not yet, he's not arrived.
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you let us know if and when he does show?
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MEMBER GARCIA:
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CHAIRMAN DROZDOFF:
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MS. PREDOZA:
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CHAIRMAN DROZDOFF:
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We sure will.
I sure will.
All right.
Chair Drozdoff?
I'm here.
Thank you.
We
have a quorum.
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Hopefully Chris will join us shortly.
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to public comment.
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we'll go to Vegas.
We'll move
We'll start in Carson City, and then
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MR. HARRIS:
Hit the green button?
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CHAIRMAN DROZDOFF:
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MR. HARRIS:
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CHAIRMAN DROZDOFF:
Hit it once.
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MR. HARRIS:
Thank you.
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Mr. Chairman, Members of the Board, my name is
Please.
Are we on now?
Okay.
There you go.
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Jack Harris.
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Employees of Nevada.
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the -- of our experiences with One Exchange to Medicare
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Exchange that -- and not all of it has been negative that we
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-- you know, over the years, in fact, looking across the
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board consistency since I started coming in 2006, we know the
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trials and tribulations that we've gone through in the
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process.
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I'm the president of the Retired Public
I come today to share with you some of
But the suggestion -- one of the -- kind of give
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you an update for those new members.
When we -- the process
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started, it came very quickly.
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introduced to it.
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a lot of -- a lot of contentious situations that came up.
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Through the next three years, we continuously
Within six months, we were
We enrolled in it and it was -- there was
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we've had meetings.
We had audits.
We had the upper echelon
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of what was Extend Health and then went to One Exchange,
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Towers Watson One Exchange and on the 11th, we're going to
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have a new name for it someway on that part, but the upper
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echelon who attend our meetings and we would express our
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concerns and it's, oh, yeah, we'll take care of it, but we
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really never made any progress.
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About -- I think about 18 months ago, I note
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that, Mr. Chairman, you had made the comments and we were
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still over in the old -- in the legislative building that
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maybe it was time that RPEN, that One Exchange or Extend One
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Exchange sit down with RPEN members in a direct conversation
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and that -- that comment was made.
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Shortly after that there was an interim
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legislative committee on benefits and we were expressing our
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concerns, and one of our concerns was that we had problems
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that just continued to go round and round in circles and
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never got any place.
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Well, at the end of that meeting, Brad Nations,
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who was vice president of customer service at that time,
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approached me and says, you know, we need to sit down and get
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together and talk and talk, you know, those of us that are in
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the field, those of us in the system, those of us that are
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monitoring what's going on.
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probably been 18 months or so we've met four times.
So since that time, it's
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The first time we met we sat down and we went
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through line by line their presentation and page by page,
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line by line and gave them, you know, what we thought how --
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what would be more effective.
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group presentation.
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That was the day before their
That next day, they updated or included our
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recommendations into their presentations and it went much
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smoother.
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They met a second time.
The second time we met,
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it was basically on relevance.
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first time they go through their information is when they
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were doing their enrollment, the enrollment meetings that
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their options to providers were not relevant to us.
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were just, you know, these were companies that we do business
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with, so they came back and made it relevant.
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One of the problems on the
They
The next also that, you know, the ones that are
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available in Las Vegas are not the ones available up here.
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The Medicare advantage that they were using as an example was
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only in Las Vegas, and it was confusing to our members up
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here.
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the presentation, now enrollment process more relevant.
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So we worked on that and they brought it in and made
The next time we met was our focus was on
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separation between enrollment and reimbursement, and we sat
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down and, again, before their presentation, the day before,
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we sat through and we recommended that they separate the two
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because it gets confusing.
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in, enrolling that knowledge of the system essentially.
You have people that are coming
You
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have those that are in reimbursement that have been in the
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system, and they are kind of accessing their information.
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They want clarification, how to access the information on
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that part, so that was the separate -- separation there.
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And so, you know, those three elements were put
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into place, and the presentations have been much much better
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going through and much more informative.
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The last time we met, this last time we talked
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about customer service.
You know, these meetings are two
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hours or more.
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was basically just kind of sitting across the table in a
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conversation, what can we do on customer service?
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we appreciate the fact that One Exchange now has a customer
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service representative in the south, Chris Garcia.
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contact with them.
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We've been sitting there, and the last one
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And we --
We're in
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We had other suggestions we made were website,
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that the website could be somewhat confusing.
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back to customer service, and I've got another issue I want
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to bring up.
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the customer service is that it seems to be very successful
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down in the south, that we know they have -- they are meeting
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a lot of people and probably 90 percent -- and Nancy has been
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involved in this.
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being solved just on a face-to-face with somebody that could
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Another, going
In customer service, our concern right now with
Probably 90 percent of the problems are
help them get through the system.
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We had just this last month, we had an extra
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customer meeting where one of the customer service
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supervisors was vacationing up at Lake Tahoe and offered to
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come over.
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have some extra sessions up here, and there was four extra
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sessions.
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was full, and there was over 140 people showed up to that.
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We had been working with Nancy to come over and
I understand.
I was at the last one when the room
And when we finally made it through the session I
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was in, again, the major concern was that reimbursement, how
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do we access, and that's something we're going to -- RPEN is
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working with them.
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We have seen a lot of progress.
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is the system is here.
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That's been very very beneficial for us.
Realistically, the reality
The system is here.
And, you know, I know we've had testimony from
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somebody -- you know, people in the past that said, well,
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let's bring everybody back home and go back to the old
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system.
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a system that we're finally making some progress, and we're
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working together on that, and there are still ways to go.
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There are things we need to work on.
We realize that's not going to happen, but we've got
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The PEBP staff going out into the communities,
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out to the rural areas and taking -- you know, doing their
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presentations.
One Exchange on the upper level is still very
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reluctant to do that.
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you know, they have got the ones in Las Vegas.
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going to be coming up here, doing these after the first of
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the year, I believe.
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those, but they are very reluctant to go out into the rural
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communities.
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They are talking about an option that,
They are
They are going to be doing some of
One of the options they said that suggested is,
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well, maybe we dropped -- if we do it in four times, take one
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of those and go out in the community.
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we're -- and, again, we hear this, that it's a business.
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They are making money off of us.
Why can't they add one to
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go out into the rural community?
We have talked about, you
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know, going to Ely or going to Elko, but our citizens mainly
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in Elko right now spend most of their big money going to
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Utah.
Our position is
That's where they do business and it's -- you know,
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they will drive the five hours to get there or the four hours
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to get there and from Ely, you know what I'm talking about,
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but yet those in Utah will be reluctant to go to Elko and
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Ely.
So we're still working on trying to do that.
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We'll share with you the other customer problem
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about customer service and I just want to make you aware of
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is that they think they are still reluctant to come up and
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give -- you know, we don't really give a lot of notice.
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don't give a lot of notice out there, and we've talked about
We
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that.
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walk-ins because we're doing the, you know, you have to make
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an appointment.
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You know, we kind of because they are afraid of the
You're doing it by appointment.
But we're trying to let them understand that from
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our viewpoint that here in Northern Nevada, we're a little
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bit different than Las Vegas and here in Northern Nevada,
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we've got more communities, more enrollees, more members that
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are spread out around the community out of the state, and
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they need to have a leeway, and they need to have a calendar
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on the calendar to know that there's going to be somebody
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here, at least here on certain days.
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through that, and those things we're making progress in.
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So we're working
I do want to share with you a personal experience
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that after I was through, I mentioned to the individuals
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involved that they probably picked the best person to go
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through this scenario in the whole state of Nevada since I've
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been involved in this process for, what, five years now.
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From the -- from the two meetings, I've made a
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point to make sure I go to the enrollment meeting and make
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sure I go to a reimbursement meeting and at the meeting in
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Sparks, my wife went to the enrollment meeting -- the
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reimbursement meeting and she came back and said, you know,
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we could be saving money.
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yeah, they said something about saving money.
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And I said saving money?
She said
So that afternoon, I went back and Debra Nelson
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was doing the presentation, and I was listening to her, and I
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realized that, yes, we could be saving money because we're
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not accessing -- I wasn't accessing my HRA account to my best
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benefit.
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total bill was 5,500.
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security by my Medicare and my HRA.
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on getting the right -- the right -- the code.
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code missing, and I submitted it on-line.
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minutes later, said it was rejected because insufficient
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information.
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I did have cataract surgery here last year.
The
It cost me nothing between social
We had a little problem
There was a
It came back five
So once I got that done, I submitted it on-line,
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came back, it said accepted pending, and I had my check for
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-- I think it was less than a week I had my check, so the
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system worked good once I got the right information.
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Found out that if I -- this is my personal.
I'm
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in Senior Care Plus, and I pay $157.
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to 167, but it didn't have the vision.
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dental.
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over here anyway that didn't have the vision, that I could
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pull from that to pay for my vision and my dental, so those
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things were already covered so that's a great bonus.
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I go on to make the change.
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My plan was going to go
It didn't have the
So I started looking at it, well, I've got my HRA
40 minutes, right
away, as soon as -- and I've called in the past.
I've called
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on a couple of different issues for members.
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they picked up the phone and I had contact with someone.
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we're in the enrollment process.
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you know, it's a busy time of the year, and we realize and I
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realize that.
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Right away,
Now
December 7th, there's --
40 minutes -- in the process of 40 minutes, I'm
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looking on the computer, and I'm looking at my options, my
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Senior Care Plus options, and I notice it says application,
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on-line application.
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City, Stephanie Rivera, who I think did a great job myself.
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We looked at that and she said, you know, I'll set you up
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with an appointment.
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on-line.
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some of you can.
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She suggested that I go ahead and enroll on-line, keep my
CAPITOL REPORTERS (775)882-5322
So I get the young lady in Salt Lake
And I said, well, I could do it
It looks like I can do it on-line.
She said, well,
Some of the providers you're not able to.
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appointment in case there's a problem.
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So once I did go on-line, I had to go find some
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information which took me about three minutes to fill out the
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application, took me another five minutes to read through all
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of the information that you have to sit and listen to when
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you do it on the phone because they have to read an entire
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policy for you.
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the consuming, went through that, electronically signed it
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and submitted it.
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That's why they say take 45 an hour to do
Well, the next morning, we had a meeting down
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here.
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meantime, I get a phone call from a benefit advisor from One
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Exchange asking me to call her, call me at this number and
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ask for me.
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morning.
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40 minutes for somebody to answer the phone.
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Stephanie again in Salt Lake City, who was very -- again,
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very helpful.
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message.
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on-line chat, and I'll leave the message and have her call
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you back.
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The Board met.
I came down to the meeting.
In the
Well, I called the next morning, at 5:30 in the
I figured I'll go early on that.
Well, it takes me
Well, it was
And she said, well, you know, I'll take the
I couldn't get the person to chat with her, see
Well, that morning, I -- when I had the meeting
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with some of our members from our organization at my house
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and I figured, well, you know, if I call, get a hold of this
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young lady that left the message, then I can, you know, free
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up the rest of the day.
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Well, by the time I got through, it was an Abbott
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and Costello routine.
It took me another 40 minutes to get a
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hold of somebody.
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forth from one person to another and he said, well, how can I
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help you?
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to ask for this individual because there's a question on my
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application.
Took me 20 minutes to be bounced back and
I said, well, I have a phone call.
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It says I need
Well, they went through the interview process
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again started.
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living facility.
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living facility and I have no plans of going into an assisted
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living facility.
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receiving intertribal services.
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been trying to do is she told me to call her.
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I had to confirm I wasn't in an assisted
I wasn't going to be going into an assisted
I also confirmed the fact I am not
And I keep saying all I've
By the time it's finished, again, this is the
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third different individual I have now, comes on, pulls up,
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well, let me pull up your records.
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already set.
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days, I had a confirmation from Senior Care Plus that --
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actually three days that they received the application and
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then another two days I had received the confirmation from
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One Exchange.
Oh, it looks like you're
It's been sent through.
It was within five
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One other thing to compliment Nancy and her
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staff, during the reimbursement, there was concern about or
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question about reimbursement for Medicare, and one of the
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forms was not in the packet that they had, and I got several
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calls the other day because not just our members called and
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wanted to know what is this about reimbursement.
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they would have to send it out, so I guess they did a mass
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mailing and sent it out to everybody, which is great, because
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it's another way we can access our reimbursement and save
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They said
money at the same time.
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So I just want in closing that there is -- we
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made a lot of progress, and we appreciate the fact that the
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One Exchange because we're dealing with the people who we are
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dealing with that understand our frustrations.
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been working with that.
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customer service, in-state customer service.
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concerns about those members who do not have, and we still
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have some out there, that have not had access to the
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internet.
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They have
We still have concerns about the
We still have
We have some concerns about, you know, those --
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the elderly that get involved, can get swayed very easily.
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When that happens this time of the year, we try to get the
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message out, and we also have some concerns about what we can
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be doing as an association and organization, and we're going
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to be working that in the future, making sure that such
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things like you need to get out there early on top of this if
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you're going to change because when that window comes, it's
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going to be very very busy for me.
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Another concern that's come up is that One
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Exchange will say that you can go on-line, get your
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prescription drugs or you can find out the cost and that, but
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one of the problems is it's not One Exchange.
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provider may not get the information to them until
It's the
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October 15th or October 14th, so people become frustrated.
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So we will get more training on our part, and we appreciate
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working with Nancy and Kathleen and what they have done for
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us.
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Thank you very much.
I thought -- we haven't
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done this.
We haven't done this in the whole time in this
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process, so I appreciate the opportunity to come forward.
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Any questions?
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CHAIRMAN DROZDOFF:
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Judy?
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MEMBER SAIZ:
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The form that you held up, it's for part B,
Any questions for Mr. Harris?
Judy Saiz for the record.
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Nancy, maybe you can answer this, do the Medicare eligible
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participants need to complete a form every year to get
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reimbursed if they are on a supplement.
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MS. SPINELLI:
Nancy Spinelli for the record.
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Yes, any retiree that's enrolled through Medicare
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Exchange, they have part B coverage, and every year they have
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to submit -- if they are having their part B paid through
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their social security, they have to submit a new request
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every year in December for the following year.
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are paying directly to social security through quarterly
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statements, then they have to continue sending those
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quarterly statements in.
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MEMBER SAIZ:
And if they
But my question was about the
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supplement.
If they have automatic deductions for, if they
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are on a part F plan, you know, a supplement plan through
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Humana, do they need to resubmit that every year or does it
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continue?
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CHAIRMAN DROZDOFF:
Hold on.
Hold on.
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MS. SPINELLI:
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If a retiree is enrolled in a plan that offers
So, again, Nancy Spinelli.
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auto reimbursement for their premium and they are enrolled in
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that, it continues.
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The only time they would have to re-enroll is if they change
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their plan, so no.
They don't have to re-enroll in that.
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MR. HARRIS:
Jack Harris for the record.
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CHAIRMAN DROZDOFF:
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MR. HARRIS: The Medicare retirement is actually
CAPITOL REPORTERS (775)882-5322
Go ahead, Jack.
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separate from the supplement, so this is your $104 that you
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pay.
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statement from social security that explains your benefits
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and it explains it to us.
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documentation that you attach to this.
You can submit and you have the -- each year you get a
You submit that with your
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MEMBER SAIZ:
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CHAIRMAN DROZDOFF:
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Right, okay.
Any other questions for
Mr. Harris?
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Just a comment from me.
I appreciate the time
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that you on behalf of your membership put in.
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a very balanced report.
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you worked together on, and then there's work still to be
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done.
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I think it was
Obviously, there's good stuff that
I do want to take a moment and thank PEBP staff
as well for the time that they have spent.
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Nancy, did you want to say something?
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MS. SPINELLI:
I do.
I just wanted to add as far
18
as the meetings this spring, I am looking -- working with
19
Towers to do rural meetings this spring in Winnemucca, Elko,
20
Ely -- Winnemucca, Elko, Ely, I think that's it, to do that
21
loop.
22
Nevada, Carson City.
And then in the fall next year do the loop in Southern
23
MR. HARRIS:
That would be great.
24
MS. SPINELLI: Do it like that so they have the
CAPITOL REPORTERS (775)882-5322
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1
opportunity out in those areas.
2
CHAIRMAN DROZDOFF:
3
So that's great.
4
Towers Watson?
And I'm assuming you're still meeting with
5
MR. HARRIS:
6
CHAIRMAN DROZDOFF:
7
MR. HARRIS:
8
CHAIRMAN DROZDOFF:
9
Well, the next time they come up.
All right.
Thank you.
Thank you.
Are there any other comments
in the north, public comment?
10
MEMBER GARCIA:
11
CHAIRMAN DROZDOFF:
12
MEMBER COCHRAN:
13
That was going to be -- okay.
Chris Cochran.
Excuse me, Mr. Chair?
Yes.
Just for the record, this is
I'm here.
14
CHAIRMAN DROZDOFF:
15
Thanks, Rosalie.
16
Go ahead, Peggy.
17
MS. BOWEN:
Great.
Good morning.
Thanks, Chris.
My name and my words
18
for the record, Peggy Lear Bowen, P-e-g-g-y L-e-a-r
19
B-o-w-e-n.
20
quick minutes and tremendous transparency.
21
And I want to compliment you for your beautiful
In regards to considerations and things for
22
today, I would hope that you would be watching what's
23
happening in Northern Nevada right now regarding medical care
24
and which groups, different public and governmental groups
CAPITOL REPORTERS (775)882-5322
21
1
are going with, and it's to the point now that Saint Mary's
2
Hospital and Renown Hospital are almost dead even and,
3
therefore, dead even in what they are offering in benefits
4
and for prices and things like that.
5
And what -- going with what we used to have in
6
our -- in our old and olden times where we could go to all of
7
the hospitals that were available to us in Northern Nevada,
8
that gives a great deal -- better dealings with your --
9
your -- for your -- for us, your clientele to be able to
10
select whatever hospital we wish to go to which provides
11
certain types of care.
12
another area and another, and it opens up a broader spectrum
13
for more and more complete care.
14
Some specialize in one area and
Again, a cautionary note, would you please,
15
please, please consider working with all of the hospitals so
16
that you don't have one hospital and one insurance carrier
17
all owned by the same company.
18
the financial records, because it makes situations happen,
19
and I can attest to mine, and I'll violate my own HIPAA.
20
When I went into Renown Hospital with a concussion, with two
21
doctors recommending that I have a MRI, that I was told I
22
would have a CT scan because MRI's were too expensive.
23
24
If you go back far enough in
And I didn't use to have these type of problems
until I became 65 years old and had to by my PEBP's
CAPITOL REPORTERS (775)882-5322
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1
requirements join Medicare part B.
2
part A because I do not have the 40 quarters and, therefore,
3
I am one of the original orphans.
4
term before the Nevada State Legislature.
5
I do not have Medicare
In fact, I coined that
And I read last meeting, coined the new term
6
feeling like a ghost because of lack of communication from
7
anyone as to -- today's December 7th, the date that lives in
8
infamy, and it's also the closing day for Medicare enrollment
9
for a great many people in changing your plans, and I have
10
yet to hear about what should be available to me in regards
11
to my plan and what it's going to be and any other plan that
12
I have simply because I'm held prisoner by not having
13
40 quarters and not having Medicare part A and not being
14
shipped off to Utah, which I also recommend that we bring
15
everybody back home.
16
When you look at your providers to please, please
17
consider that providers that might also bring your -- your A
18
and B Medicare folk back into the Nevada house so we are a
19
total entity with a large number of people to put our RFP's
20
out and get better responses because we are a bigger number
21
and deal with it that way.
22
I've had people involved in this system in Senior
23
Care Plus now telling me they are changing out of Senior Care
24
Plus which is Hometown Health and the reason they are
CAPITOL REPORTERS (775)882-5322
23
1
changing out is what they have been told for this coming year
2
is benefits have been restricted.
3
cut down in their offerings and that they cost -- everything,
4
including what your report said at our last meeting, it seems
5
Hometown Health, Renown, Renown in particular, is double
6
charging what other entities charge.
Pharmaceuticals have been
7
So and they have a unique situation, I don't know
8
how unique it is in Hometown -- in Renown within the last two
9
weeks, I can tell you that clients of this -- this PEBP have
10
been in the hospital.
11
specialists have been brought in to deal with them.
12
true orthopedic specialist is brought into them after they
13
left the emergency room.
14
They have not been -- no diabetic
No real
And you have the hospitalist, a panel of doctors
15
who were internists who are hired by the hospital to
16
determine exactly what kind of care you get that people's
17
lives depend now on what a hospitalist determines who is not
18
a specialist in the fields of their need and, therefore,
19
their needs may not be and, in fact, were not met.
20
And there was a point where one of your clients
21
actually said I am being starved, and I'm being withheld pain
22
medicine, and my insulin is not being provided properly
23
according to what my doctors have said what I need, and then
24
there was another TIA. And as soon as the TIA occurred in
CAPITOL REPORTERS (775)882-5322
24
1
the hospital immediately, and this has happened now twice
2
with people I know, one was not a PEBP person.
3
anything occurs in the hospital, a TIA or a stroke,
4
immediately everything is taken -- taken off treatment and
5
they are sent to rehab.
6
As soon as
They don't want them to have further
7
complications in the hospital that could later be brought
8
back to whether or not the hospital performed correctly, and
9
I know that's serious business, and I have no problems
10
telling you those sorts of things because I think you need to
11
hear that when you're looking at these plans.
12
about how the care is delivered and once the emergency room
13
is left, is it delivered by hospitalists or do they allow the
14
persons's doctors of the specialty areas to be contacted and
15
note -- and do they consult with them or do they do anything
16
else or simply hold you prisoner in that hospital because
17
that is where your insurance sends you, and that's truly
18
important.
19
And thank you.
Thank you.
Take a look at
Thank you.
Thank you
20
for having this meeting, and thank you for being so
21
transparent and wonderful and thank you for your hard work.
22
CHAIRMAN DROZDOFF:
23
MS. BOWEN:
24
Thank you.
Any questions?
If you have any questions, I'll be
happy to answer them.
CAPITOL REPORTERS (775)882-5322
25
1
CHAIRMAN DROZDOFF:
2
Okay.
3
MS. BOWEN:
4
CHAIRMAN DROZDOFF:
5
Thank you.
You're welcome.
We'll stay in the north.
Seeing none, Rosalie, would you help me out down
in the south, any public comments down in the south?
8
MEMBER GARCIA:
9
CHAIRMAN DROZDOFF:
No, no public comment here.
10
MEMBER GARCIA:
11
CHAIRMAN DROZDOFF:
All right.
Thank you.
Okay.
12
Item Three, approval of the minutes.
13
minutes?
14
15
Any
further public comment in the north?
6
7
Any questions for Ms. Bowen?
We'll move to Agenda
Any questions on the
If not, I'll take a motion.
MEMBER EWING-TAYLOR:
Mr. Chair, I move we
approve the minutes.
16
CHAIRMAN DROZDOFF:
Motion from Ms. Ewing-Taylor.
17
MEMBER BAILEY:
18
CHAIRMAN DROZDOFF:
19
Any further comments?
20
Seeing none in the north or the south, calling
Don Bailey, second.
Second by Don Bailey.
21
for the question, all those in favor, please say aye.
22
(The vote was unanimously in favor of the
23
24
motion.)
CHAIRMAN DROZDOFF: Any opposed? Any abstain?
CAPITOL REPORTERS (775)882-5322
26
1
Okay.
2
So we'll go to Agenda Item Four, and so we will
3
take these one at a time and only the people from -- and in
4
the order that are listed on the agenda.
5
Anthem, Prominence, Hometown Health and Health Plan of
6
Nevada.
7
Motion carries.
So it will be
I've got a couple of points before we move to
8
purchasing.
So the way we'll do it, if there's anybody in
9
the audience in the north or the south that's with one of
10
those companies, you know, I'm going to ask them leave very
11
shortly.
12
like to make, so I want to do that first.
I know that Ms. Saiz has a disclosure she would
13
MEMBER SAIZ:
Okay.
Judy Saiz for the record.
14
I want to disclose that as an insurance broker, I
15
work with all of these vendors.
16
Dennis, our DAG, and this wouldn't benefit me in any way no
17
matter which vendor is selected.
18
from them.
19
simple as that.
20
21
I sell a product.
CHAIRMAN DROZDOFF:
I did get an opinion from
I do receive commission
I receive commission.
It's as
So you plan to vote today?
You don't see any --
22
MEMBER SAIZ:
I do plan to vote today.
23
CHAIRMAN DROZDOFF:
24
MEMBER SAIZ: I don't see a conflict.
CAPITOL REPORTERS (775)882-5322
You don't see a conflict?
27
1
CHAIRMAN DROZDOFF:
2
purchasing to give their overview, please.
3
MS. BURCHETT:
Okay.
With that, we'll ask
I'm Gail Burchett -- I'm Gail
4
Burchett, G-a-i-l B-u-r-c-h-e-t-t, purchasing officer with
5
Nevada State Purchasing.
6
introduction to what we're doing today, and then I also have
7
some agenda items that we need to cover with the Board.
8
9
I want to give you guys a brief
Damon Haycock did a nice introduction, so I'll go
ahead and just go over that.
We currently have contracts
10
with Hometown Health Plan and Health Plan of Nevada to
11
provide the HMO services for the PEBP participants, but these
12
contracts expire on June 30th of 2016.
13
plan contract maximum is 217,200,000.
14
contract maximum which expires June 30th of 2016 is
15
359,200,000.
16
The Health of Nevada
Hometown Health
So we took on a procurement requested by PEBP and
17
began this procurement on September 8th, 2015, with RFP
18
Number 3202.
19
which meant that we could either take one company for the
20
statewide services or we could take two or more for regional
21
HMO services.
It was for statewide or regional HMO services
22
We allowed the vendors to go out there and give
23
us proposals, and we had the proposals due on October 27th.
24
We received four proposals. We had an evaluation committee
CAPITOL REPORTERS (775)882-5322
28
1
of four persons, experts in their field, evaluate the
2
proposals which we met on November 20th.
3
proposals, and the scoring criteria for that was conformance
4
with the terms of the RFP expertise and performance of
5
comparable engagements, demonstrated competence and
6
implementation, expertise and availability of the key
7
personnel and cost.
8
9
They scored the
Of the four proposals selected as finalist
vendors, three of them were selected for runoff or
10
presentations for the Southern Nevada area, and one proposal
11
was considered substantially higher scored and that was
12
Hometown Health for Northern Nevada.
13
So today you're going to see a presentation from
14
all four, but Hometown Health was considered substantially
15
higher for Northern Nevada.
16
Now today what is going to happen is that the
17
evaluation committee, although they have scored, their scores
18
will be 45 percent of the final scoring criteria, and the
19
Board's scoring criteria will be 45 percent.
20
presentations will be the other ten percent.
21
Then the
So what I'm going to need now is the Board's
22
technical and cost proposals score that they will read to me
23
and then after that, we will see the presentations which will
24
be the final ten percent. I will then calculate everything
CAPITOL REPORTERS (775)882-5322
29
1
else and be able to announce at the end of this meeting who
2
the -- who the intended contract person or persons --
3
companies will be.
4
5
So with that, I would like to get the scores from
Las Vegas first.
6
7
CHAIRMAN DROZDOFF:
questions.
So hold on.
8
Go ahead, Judy.
9
MEMBER SAIZ:
10
We've got a couple of
Judy Saiz for the record.
I was under the impression, it was my
11
understanding that this Board was going to vote on regional
12
HMO statewide and regional, and the evaluation committee
13
selected Hometown Health without any input from the Board and
14
that wasn't my understanding of the process, and I don't know
15
if others were thinking the same way I was, but that wasn't
16
my understanding.
17
HMO's and north and south collectively, and we were to make a
18
decision, and that didn't happen, and I'm wondering why.
19
The Board was to go through the statewide
MS. BURCHETT:
Well, we did provide you with
20
Hometown Health's proposals, as well, because you guys are
21
45 percent of that.
22
MEMBER SAIZ:
Okay.
Just to clarify, the letter
23
from you said that we would just be looking at Southern
24
Nevada and we did receive Hometown's information but that we
CAPITOL REPORTERS (775)882-5322
30
1
weren't supposed to evaluate.
2
evaluate Southern Nevada.
3
that wasn't my understanding.
4
collectively was going to decide on our 45 percent or
5
whatever percentage we were going to have, however it was
6
weighted, but that we were going to look at statewide and
7
geographically north and south, and I would just like to know
8
why that didn't happen and that's what we agreed on as a
9
Board.
10
11
MS. BURCHETT:
We were only supposed to
And, again, I'm going to state
My understanding was the Board
That was my direction from the
evaluation committee and PEBP.
12
MEMBER SAIZ:
PEBP?
Damon?
13
MR. HAYCOCK:
Damon Haycock for the record.
I
14
want to start off first with a disclaimer per the statute.
15
stayed completely out of the RFP process as required as the
16
executive officer, and so I did not take a controlling role
17
in this process as I would have more if I were able to
18
participate on the committee.
19
However, it was my understanding that the entire
20
Board was provided the entirety of all of the RFP proposals
21
in an effort to evaluate each and every one of those for
22
their merits and drawbacks and be able to come here and to
23
deliberate and to choose.
24
I
And so I recognize that the evaluation committee
CAPITOL REPORTERS (775)882-5322
31
1
as per purchasing rules, and I will defer to Ms. Burchett,
2
but that the evaluation committee came up with their
3
recommendation based on if they were only to do a single or
4
primary evaluation but because of this process that you as a
5
Board get the opportunity to agree with, disagree with or
6
have your scores weighted for all four participants, and so
7
that was my understanding that as part of a second level
8
review, the requirements are that you have to evaluate or are
9
supposed to evaluate the entirety of all RFP submissions.
10
MEMBER SAIZ:
Judy Saiz for the record.
11
I'll read this excerpt from Gail.
These four
12
vendors submitted proposals.
13
evaluating United Healthcare, Anthem and Prominence, as
14
Hometown has already been unanimously selected by the
15
evaluation committee for Northern Nevada.
16
However, you will only be
As part of your evaluation, there will be
17
presentations by the remaining vendors on their HMO offerings
18
for Southern Nevada at the December 7th Board meeting.
19
20
MEMBER BAILEY:
Mr. Chair?
For the record, Don
Bailey.
21
I got the same memo and it said exactly the same
22
thing.
So, therefore, I felt evaluating three out of the
23
four was my duty, but I did take it one step further, and I
24
did evaluate Home because they gave us the disc to do it, but
CAPITOL REPORTERS (775)882-5322
32
1
I think the thing is a little quirky right now to say the
2
least.
3
CHAIRMAN DROZDOFF:
I don't think there's any
4
question about that.
I mean, I think what we're running up
5
against candidly is we have a current Board that is, and I
6
don't want any of these terms to be pejorative in any sense.
7
The current makeup of the Board is quite a bit different than
8
previous makeup of the Board in terms of level of
9
involvement, and so I would concur with your analyzation that
10
things are quirky, and I think that's -- and I think that's
11
-- I mean, I think that's an issue.
12
I mean, what we're trying to do right now, and I
13
guess I share Ms. Saiz's concern which is, you know, it seems
14
like we were trying to find some level of -- we were trying
15
to not throw the process that was already completed with the
16
review committee out the window, recognizing that the current
17
makeup of the Board itself wanted to have a greater role in
18
that.
19
So was there anything in particular, Judy, that
20
you -- was there anyone in particular that you wanted to look
21
at more or are you just not happy with the process?
22
MEMBER SAIZ:
If I'm being honest.
23
CHAIRMAN DROZDOFF:
24
MEMBER SAIZ: The entire process to me wasn't -CAPITOL REPORTERS (775)882-5322
Yeah.
33
1
I'm going to just use the word completed professionally.
2
don't know what level, where it came from.
3
CHAIRMAN DROZDOFF:
4
MEMBER SAIZ:
5
CHAIRMAN DROZDOFF:
6
Okay.
I
Hold on.
Okay.
So wasn't completed
professionally, meaning the purchasing process?
7
MEMBER SAIZ:
I'm not sure if it was from
8
purchasing or if it was from direction from PEBP, I'm not
9
sure.
If it was from the contracting the department, I'm not
10
sure.
We received discs, I think you did too, as well, so we
11
received --
12
CHAIRMAN DROZDOFF:
13
MEMBER SAIZ:
Uh-huh.
-- five discs.
If we were to print
14
that out, there would have been reams and reams and reams of
15
paper.
16
Thanksgiving so we technically probably had one week, one
17
business week to look at this.
18
received hard copy, and I know you've been on evaluation
19
committees.
20
from in front of you, and you have a book here of proposals
21
here, proposal here.
22
We received this proposal the evening before
The evaluation committee
We all probably have, and you have something
You can compare.
When you have five discs with numerous files, one
23
was 600 and some odd pages from one of the vendors, it was
24
actually Hometown's and it's not conducive to an appropriate
CAPITOL REPORTERS (775)882-5322
34
1
review, I'm just -- it isn't fair play here.
2
evaluation committee that had it for three weeks and had a
3
hard copy that they can look at.
4
amount, 45 percent, had discs that we had to go back and
5
forth with discs and were told were not important enough to
6
do the Hometown Health.
7
8
CHAIRMAN DROZDOFF:
MEMBER SAIZ:
10
14
Well, I think you got to be
My opinion.
CHAIRMAN DROZDOFF:
Well, okay, but, you know,
let's not use pejorative words.
12
13
We, as the same weighted
careful about that, you know.
9
11
We have
MEMBER SAIZ:
Frustrated, do I sound frustrated,
I am.
CHAIRMAN DROZDOFF:
Well, I'm frustrated too
15
because, you know, again, for -- I've been on this Board
16
since 2008, and I will simply tell you that the level of
17
interest by this Board which is fine about contracts is
18
remarkably high compared to how it's ever been in the past.
19
So I think moving forward, we have to evaluate
20
whether we even -- whether, you know, this first level review
21
has any merit at all.
22
marry and apparently in a pretty poor way, marry what has
23
historically happened with the current level of interest in
24
the Board by the Board. Am I correct about that?
CAPITOL REPORTERS (775)882-5322
What we tried to do in this case was
35
1
MEMBER EWING-TAYLOR:
2
CHAIRMAN DROZDOFF:
3
Yeah, if I could.
Yeah, please, you've been
around longer than me.
4
MEMBER EWING-TAYLOR:
5
CHAIRMAN DROZDOFF:
6
MEMBER EWING-TAYLOR:
In so many ways.
Absolutely.
Yes, this Board is unusual
7
in its desire to dig into these details, and I have to admit
8
I'm part of that.
9
when I started 13 years ago.
I think it's a pendulum.
We were here
We went way over here and
10
didn't get involved hardly at all except when, you know,
11
staff would bring us something to ratify essentially, and now
12
the pendulum is kind of going back in this direction, and I
13
think that's probably a good thing.
14
15
I think what I had anticipated in this process
and this particular process is new.
16
CHAIRMAN DROZDOFF:
Yes.
17
MEMBER EWING-TAYLOR:
We have not done this
18
before, but what I anticipated and what I would have expected
19
was some sort of synopsis from staff.
20
each Board member would be expected to review the entire
21
proposals of every vendor, so that was a bit of shock,
22
especially as Judy said, we had a week, and we all have day
23
jobs.
24
I did not expect that
So I am not as nearly as prepared as I would like
CAPITOL REPORTERS (775)882-5322
36
1
to be or as I would be going into a normal RFP review
2
meeting, and I think that is -- that level of lack of
3
preparedness is frustrating to me.
4
5
CHAIRMAN DROZDOFF:
So what would you guys like
to do?
6
MEMBER BAILY:
Can I say one thing?
7
CHAIRMAN DROZDOFF:
8
MEMBER BAILEY:
9
I would like -- the evaluation committee I think
Of course.
For the record, Don Bailey.
10
did a wonderful job and they did their job, but now it came
11
back to us at our request by a member to further evaluate,
12
and we had five to evaluate.
13
because we were instructed.
14
Health, but the vendors did a marvelous job in their
15
presentations.
16
disc and what the evaluation committee went through, I think
17
have done a good job, Mr. Chairman.
18
Actually, it got down to four
We didn't have to do Hometown
We haven't heard them yet but what's on the
What frustrates me, just like Jacque and Judy, we
19
didn't have a lot of time.
20
discs and you total up the information, you have almost 1,000
21
pages and that is just incredible for us to comprehend in a
22
short period of time.
23
24
And if you really take those
I like the binders, and the reason I like the
binders is they are so workable. You can make your notes.
CAPITOL REPORTERS (775)882-5322
37
1
You can tab them.
2
discs, we have to do it on a computer, and I in no way was
3
going to pull out those sheets on my printer.
4
going to happen.
5
6
You can flip back and forth.
With these
It just wasn't
So I probably in fairness to you, Mr. Chairman, I
probably didn't do the job that you expected me to do.
7
CHAIRMAN DROZDOFF:
No, no, I think -- like I
8
said, I'm struggling with -- I feel like -- you know, I just
9
don't know.
I feel like there's a process that exists.
10
Clearly it's -- this Board doesn't like that process.
11
frustrated with the fact that -- you know, I'm frustrated
12
candidly with people trying -- I think people tried their
13
best to fit a square peg in a round hole, and I think we have
14
to be careful about using, you know, inflammatory terms.
15
I'm
I mean, I think what we would be -- we have two
16
issues to figure out.
17
have this HMO process and if people aren't -- if this Board
18
is not comfortable with the where we are, we have to decide
19
what we're going to do with regard to them moving forward.
20
We have the issue of today which is we
And then in a general sense back to your comment
21
about quirkiness, I think we have to be honest with ourselves
22
what this first level of review really is because it's
23
essentially -- I don't know that it serves us much purpose
24
right now, and so I think we have two issues.
CAPITOL REPORTERS (775)882-5322
38
We have to try
1
to figure out what we want to do with the HMO's specifically,
2
and then we have to figure out in a general about contracts
3
in general, how we want to operate as a Board.
4
Anna?
5
MEMBER ANDREWS:
Anna Andrews for the record.
6
want to share with my fellow Board members.
7
CHAIRMAN DROZDOFF:
8
MEMBER ANDREWS:
9
And then Rosalie.
I was the only Board member on
the committee that did the review.
I had to hunker down in
10
my office for a whole week going through the binders, you
11
know, comparing and scoring and doing all of this stuff.
12
I
When we showed up at the meeting at the
13
purchasing office, the other members of the committee were
14
there.
15
go through.
16
did it by the book, by the rule, by the purchasing rules and
17
Gail, all she did was write down the numbers and score.
18
We all commented on the fact that we had so much to
And I'm here to tell you and assure you, we all
I just want to bring everybody to -- to
19
everybody's attention the following, last meeting, we all
20
voted on doing away with the second level review, and we
21
agreed on that.
22
PEBP is to get enough Board members to participate.
23
time and again the problem.
24
I do know the struggle for purchasing and
That is
So I think that we really need to sit down and
CAPITOL REPORTERS (775)882-5322
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1
discuss openly, call me, e-mail me, ask me, I'm willing to do
2
it because I was being asked to do the next one and I can't.
3
I'm going to be out of country, but I think that as the Board
4
moves on further with this, let's say that we all agree, yes,
5
we do away with the second level review and we have five
6
Board members on that first committee, are we going to be
7
back to this discussion where everybody wants all of the
8
books in a month or two months to review them.
9
CHAIRMAN DROZDOFF:
10
MEMBER ANDREWS:
11
CHAIRMAN DROZDOFF:
That's precisely right.
That's all I have to say.
Well, that's precisely where
12
I'm at too, and I agree with -- I agree with the perspective,
13
and I'm glad you offered it, and I think that's my struggle
14
as well.
15
Rosalie?
16
MEMBER GARCIA:
To add another kink, I had not
17
received the discs and was not aware or been notified to keep
18
an eye out for them or else I would have let somebody know,
19
so I am completely not available to give my rankings today.
20
CHAIRMAN DROZDOFF:
Yes?
21
MEMBER EWING-TAYLOR:
22
So I have a comment and a suggestion.
Thank you, Mr. Chairman.
A comment
23
was I think a lot of the angst over this is because of a
24
miscommunication about the Board's expectations and staff's
CAPITOL REPORTERS (775)882-5322
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1
expectations to what a second level review looks like, and
2
I'm -- I will take some responsibility for that.
3
and we all know the dangers for that, as I said earlier, we
4
get a synopsis of what the committee did, and I have served
5
on a HMO -- I have served on every RFP committee, every class
6
of RFP committee since I came on the Board, and I understand
7
well how much work it takes.
I assumed,
8
So I think if we continue with this, if we do
9
this again, we need to have very clear expectations about
10
what information we get from staff and staff needs to have
11
very clear expectations of what we want and maybe even more
12
importantly what we don't want.
13
So in line with that, my suggestion would be that
14
we clarify the Hometown Health situation.
At least one
15
person thought that we were supposed to evaluate them.
16
letter said we weren't, so I don't know if they are here to
17
present.
18
but that we -- the vendors are all here.
19
time and money in to bringing people up and preparing their
20
presentations, so I think we do owe them that opportunity to
21
speak to us and have us go ahead.
22
ability, understanding that not everyone is as prepared as
23
they wanted to be, make the selections and move forward.
24
MEMBER SAIZ: Mr. Chair?
CAPITOL REPORTERS (775)882-5322
The
I don't know what we're supposed to do with them
41
They put a lot of
And to the best of our
1
CHAIRMAN DROZDOFF:
2
MEMBER SAIZ:
Judy?
One of the items that I would have
3
expected, like you said a summary, I was thinking the same
4
thing, having worked for PEBP how many years ago did these
5
evaluations, and I've done proposals for my clients
6
repeatedly over the years.
7
received because I wouldn't have them as a client for very
8
long.
9
I would never hand them what I
I would expect a summary, at the very least a
10
disruption report, at the very least, a summary of the number
11
of providers without digging through every disc, and I don't
12
know who -- who would have provided that to us, excuse me, if
13
it would have been Aon, if it would have been PEBP, you know,
14
the contract area.
15
that.
16
we would need before we could make a valid decision.
17
would need, you know, analysis of the number of providers,
18
and I did that myself, pulling them from those discs, just
19
more of a summary like Jacque said.
20
I'm not sure who would have provided
But like I said, the very least, a disruption report
We
I would like to also comment, prior to what
21
Jacque just said, I was thinking to myself, these people came
22
from far away and near, whatever, but we should hear them out
23
today, score them the best of our ability and then whether
24
the Board decides to make a decision based on what we have
CAPITOL REPORTERS (775)882-5322
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1
done or, no one wants to hear this, but postpone it for a
2
couple of weeks or until the very first of January or
3
whatever, taking our assessments from the presentations here
4
and then having the ability to do a complete evaluation, and
5
that's up to the Board but that's my suggestion.
6
CHAIRMAN DROZDOFF:
7
MS. BURCHETT:
Anybody else?
I would like to add that we do
8
have time, contracting time to postpone a decision today.
9
don't have to have contracts signed and in place until the
10
We
June BOE so we would have time to postpone things.
11
CHAIRMAN DROZDOFF:
12
Tina?
13
MS. GLOVER:
Hold on.
Wait.
This is Celestena Glover for the
14
record.
15
such as Anthem and Prominence, who are not currently in our
16
system, it does take several months to get them loaded, get
17
testing done and all of that.
18
IT portion, but we're not talking about vendor A just takes
19
over on July 1.
20
participants that will have to transition if they wish to
21
remain on the HMO.
22
them know what's available.
23
24
We cannot postpone too long.
If we choose vendors
Chris can speak better to the
There's a lot of work because we have
We've got to get documentation out to let
So we have very limited time in order to get one
vendor selected or vendors get to the appropriate BOE and
CAPITOL REPORTERS (775)882-5322
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1
everything that goes on in-between now.
2
BOE, the lead time is generally five weeks prior to that
3
meeting.
4
CHAIRMAN DROZDOFF:
5
MS. GLOVER:
And keep in mind,
At least.
So if you put it off in January, we
6
don't get signed contracts back until towards the end of
7
January.
8
that only gives us until March and April because open
9
enrollment is May, so we don't have time.
10
We're not going to get the BOE until March, and
decisions made fairly soon.
11
12
We need to have
CHAIRMAN DROZDOFF:
All right.
Well, let's --
Rosalie, why don't you say what you wanted to say.
13
MEMBER GARCIA:
Go ahead.
First, I have a question and then
14
I do want to concur with Judy's recommendation.
15
that, I think that might be in the best interest of everyone,
16
new and old.
17
If we can do
My question is with regard to Hometown Health,
18
what would happen if the Board determined that their proposal
19
was not good enough for our northern members?
20
CHAIRMAN DROZDOFF:
Well, you know, I guess I
21
would like to not answer that because I think we -- I think
22
what we should do, what I heard from you, Judy, and Jacque is
23
why don't we and Don, why don't we -- why don't we hear from
24
the vendors, and why don't we cross that bridge if and when
CAPITOL REPORTERS (775)882-5322
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1
we need to cross that bridge.
2
I think that there was why -- an agreement that
3
the people are here and we should at least hear them out.
4
Let's -- let's not worry about hypotheticals until they are
5
not hypotheticals anymore.
6
that --
So if everybody is good with
7
MEMBER BAILEY:
8
CHAIRMAN DROZDOFF:
9
MEMBER BAILEY:
10
I have one question.
Don?
For the record, Don Bailey.
This is a technical question.
When I was asked
11
to do the Exchange RFP, I was told by the former director
12
that we needed two Board members to sit on that.
13
CHAIRMAN DROZDOFF:
14
MEMBER BAILEY:
15
CHAIRMAN DROZDOFF:
Well, yeah, no.
Is that true or false?
I think what Anna -- well, I
16
don't know.
17
previous meeting what we basically said is the answer is to
18
have more than one or two but to have not a quorum but a
19
healthy dose of this Board so that we avoid exactly what
20
we're going through right now.
21
I mean, what I do know is that -- at our
And at some point, you know, the Board members
22
choose not to be on those committees, and I would speak for
23
myself as a Board member, that if I was not on a committee
24
but a Board of my peers were, you know, I think that that
CAPITOL REPORTERS (775)882-5322
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1
should -- you know, that should reflect a pretty healthy dose
2
that that's where the Board should go.
3
I think the difficulty we're having now, and
4
again, I don't necessarily want to relive the past because I
5
really don't want to inflame people.
6
best job they could.
7
nothing wrong with it, we're just at a point that this
8
Board's expectations were different than previous boards.
9
This is an oddball one.
10
I think people did the
We're just at a point now, and it's
It's a very important one.
The HMO
is a very extremely important one.
11
So, again, moving forward, we seem to have a
12
pretty good plan, as Anna outlined that there's going to
13
be -- we're going to at least offer moving forward on all of
14
these vendor committees, contract committees, you know, up
15
just south of a quorum so that the Board's involvement is
16
heard.
17
We're just -- unfortunately we find ourselves
18
here that not too many people are happy with where we find
19
ourselves.
20
take everybody's suggestion which is to let's hear from them.
21
Let's hear what they say and if people still have angst about
22
it, we'll figure out what to do about it then.
I don't know what to do about that other than to
23
Judy?
24
MEMBER SAIZ: Just one more small comment.
CAPITOL REPORTERS (775)882-5322
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I did
1
offer to be on this evaluation committee, and I was told that
2
they already had one Board member, just for the record.
3
CHAIRMAN DROZDOFF:
4
MEMBER BAILEY:
5
MR. HAYCOCK:
6
CHAIRMAN DROZDOFF:
7
MR. HAYCOCK:
8
The motion by Jeff Garofalo last Board meeting
9
was to have a minimum of two Board members on all of these
10
Okay.
Again --
See, that's my question.
Can I answer that, Leo?
Yeah.
For the record, Damon Haycock.
important contracts moving forward.
11
CHAIRMAN DROZDOFF:
12
MR. HAYCOCK:
13
CHAIRMAN DROZDOFF:
14
MR. HAYCOCK:
And as many as --
Not to exceed five.
Right.
If we look at a prospective basis,
15
I think the intent was to allow for almost a majority of the
16
Board members to participate in how that works out for your
17
time factor and your desire I think will solve this problem
18
moving forward.
19
In the past, my understanding before I arrived at
20
PEBP is that any Board member was traditionally offered an
21
opportunity to participate but may not have been more than
22
one.
23
we've offered -- I think we've only had two RFP's that I've
24
been with when we actually started and one of them is for
CAPITOL REPORTERS (775)882-5322
All I know is since I've been on -- been with PEBP that
47
1
Pharmacy Benefits Manager one and we offered it to multiple
2
people.
3
So we hear you, and we're going to fix it moving
4
forward.
I think as Chair Drozdoff has said, excuse me, this
5
one is a little quirky and had the motion been a minimum of
6
one, no more than five, then you technically could have not
7
had this meeting at all, and we could have amended the RFP
8
process and the current RFP committee could have selected the
9
vendor and vendors that they wanted.
10
But because we need a requirement of at least
11
based on the motion at the last meeting, that's kind of why
12
we're in a conundrum right now.
13
credit here, we have folks from these HMO plans here that are
14
willing to participate and present.
15
perhaps you'll hear enough information that you feel
16
comfortable about making a decision.
So I think to everybody's
Once they present,
17
CHAIRMAN DROZDOFF:
18
MR. HAYCOCK:
If not, then we have to play with
20
MEMBER SAIZ:
Excuse me?
21
CHAIRMAN DROZDOFF:
22
MEMBER SAIZ:
19
Right.
the timing.
Yes?
Was Hometown informed that they
23
were awarded this or going into contract negotiation or
24
whatever, were they informed without going through this?
CAPITOL REPORTERS (775)882-5322
48
1
MS. BURCHETT:
2
No, Hometown has not been informed.
3
Gail Burchett for the record.
Nobody knows
how anybody has scored yet.
4
MEMBER SAIZ:
Okay.
5
MR. HAYCOCK:
And I would like to add -- Damon
6
Haycock for the record.
7
This memo did not go out to anybody else because
8
we didn't want any -- we didn't want the HMO's to show up
9
thinking it was a done deal.
And so as you have your
10
45 percent availability to choose who you want and the ten
11
percent for the -- for the presentations, my understanding,
12
and I need to defer to Gail, whose been running this process,
13
that today you have a 55 percent vote.
14
whoever you select, that 55 percent stands over the
15
45 percent of the original committee.
16
And if you select
And so I think at the end of the day, had you had
17
the opportunity to review the materials in the way that you
18
wanted them, and if you were more prepared, and I apologize,
19
Rosalie, I didn't know you did not receive your packet nor
20
did I know it went out in disc form, so, again, we can fix
21
that going forward.
22
not going to do second level reviews in the future but rest
23
assured anybody on a committee of PEBP will receive the
24
binders.
Although, it may be moot because we're
I've never seen it with discs before so my
CAPITOL REPORTERS (775)882-5322
49
1
apologies.
2
themselves once we get through this specific contract.
3
I think a lot of these problems will solve
CHAIRMAN DROZDOFF:
Can we -- so we're going to
4
start with Anthem, and we'll go Anthem, Prominence, Hometown
5
and HPN.
6
MS. BURCHETT:
7
MR. HAYCOCK:
8
Megan was getting them or Gail
brought them.
9
10
Megan?
CHAIRMAN DROZDOFF:
We're going to hear the
presentation.
11
All right.
Folks, we appreciate you bearing with
12
us.
We had a couple of questions we needed to work through.
13
I appreciate you're here.
14
you and you can make your presentation however you want.
We'll ask -- we'll turn it over to
15
MR. MURPHY:
16
CHAIRMAN DROZDOFF:
17
18
Fantastic.
Thank you.
Thanks.
Please identify your company
and your names first.
MR. MURPHY:
Absolutely.
First, I would just
19
like to thank the committee for allowing us to be here.
20
We're looking forward to the opportunity today to engage in
21
how we may further serve the state and once again come back
22
and serve the state employees.
23
24
My name is Mike Murphy.
I'm the president of
Anthem Blue Cross Blue Shield in Nevada. I have with me
CAPITOL REPORTERS (775)882-5322
50
1
today, Pete Sable, who leads our provider engagement and
2
contracting area for the state of Nevada and Gabrielle
3
Sandstone, who leads our account management and sales
4
organization.
5
as well, for questions throughout, and I think the format you
6
all set out was that we'll make the presentation and ask
7
questions later, but obviously feel free to stop us as we're
8
going.
9
along.
10
We have some of our other team members here,
I'm more than happy to address any questions as we go
On the next slide, just we're going to focus
11
really on three areas in the discussion today, cost of care,
12
consumer engagement and provider collaboration.
13
we look across the country and locally, we believe when you
14
put these three things together in a right way, you end up
15
with better health outcomes, and we end up with better
16
patient satisfaction and customer satisfaction and for you
17
all employees' satisfaction.
18
these pillars across the country, and we think we have a lot
19
to deliver here.
20
You know, as
We spent a lot of time building
Just to start off a little bit about the Blues
21
and Anthem across the country, I think most of you may know
22
this, but nearly one in three Americans is covered by Blue
23
Cross and Blue Shield plan.
24
in our Medicaid plans, and our Medicaid plans nearly
CAPITOL REPORTERS (775)882-5322
We have Anthem across 14 states
51
1
40,000,000 members.
2
You know, the way that Blue Cross and Blue Shield
3
operates, we operate from border to border across the
4
country, as well as border to border in every state which is
5
really important, and as you look across over the right side
6
that leads to relationships with providers that are pretty
7
vast.
8
of the hospitals across the country and nearly 92 of
9
physicians in one way or another, and obviously those
10
relationships are very different, whether they're PPO
11
engagement, HMO engagements, but we understand how the market
12
works, and we believe that it's really important to not only
13
do that in the metropolitan areas but in rural areas as well.
14
When you look down at the bottom there, the Blues
You can see we have got relationships with 96 percent
15
are nearly two times the size of our largest next national
16
competitor.
17
that's something we try and earn everyday.
18
We believe people vote with their feet and
We talk a lot about our national presence but
19
local presence, we have over 400 employees in both offices in
20
Reno and Las Vegas.
21
that we serve folks under, our Medicaid brand and Ameri
22
group.
23
the Medicare population.
24
the state, individual, small group, large group.
CAPITOL REPORTERS (775)882-5322
You may recognize some of our brands
We serve the state, as well as care more.
We serve
We serve the FEP membership here in
52
I have
1
obviously extensive experience in both self-funded groups and
2
fully insured groups.
3
Just to back up a little bit, I know all of you
4
know the Health Insurance Exchange.
5
Currently, we're -- you know, we're obviously very engaged in
6
helping develop that.
7
everybody knows but, you know, we really tried to be an
8
integral part of developing, one, the first steps of that,
9
the continual steps of that to figure out how we can make a
10
It started back in 2014.
We had some growing pains in 2014 that
process that worked.
11
We're the only carrier right now in the rural
12
areas.
We're the only carrier on the Shop Exchange serving
13
small groups.
14
we operate in every segment of the business to understand the
15
scope of Nevada, understand the providers and understand our
16
customers throughout the state.
Again, we believe it's really important that
17
The next page, you know, a little bit of the
18
local flavor across the country, you know, many national
19
accounts, large employers have trusted us with their employee
20
benefit plans and for many reasons.
21
a consideration, but we develop a partnership with our
22
clients, figure out what those either plan designs, those
23
benefit designs, those costs, the things that they are
24
willing to give up, the things they are not willing to give
CAPITOL REPORTERS (775)882-5322
53
One, obviously, cost is
1
up, so when you talk about things like CDHP plans,
2
self-funded HMO plans, narrow networks, we call them high
3
performance networks because you can narrow things by just
4
narrowing by cost, but you can also narrow networks really by
5
effectiveness, and we think that's really most important.
6
In ten of our 14 states, we're trusted with the
7
state employees, either their employees or their retirees and
8
serve nearly 3,000,000 folks across the country in our 14
9
states and state employee accounts, and you can see some of
10
the larger national employers there.
11
And, you know, the reason that we put some of
12
these out, one, their names that you recognize but, two, it's
13
to show the collaboration that we have.
14
IBM, you know, you may be familiar with our Watson
15
technology.
16
to figure out how to bring that technology to providers to
17
help them practice medicine more effectively.
18
For instance, with
We brought Watson to health care with IBM to try
Finally, just in the community, you know,
19
obviously, that's very important to us, as well, both in
20
Northern Nevada and Southern Nevada, whether you're talking
21
about the Scale of the Strap event that we started with the
22
Stratosphere down in Las Vegas, I guess our Health Care
23
Heroes event that recognizes providers throughout the state,
24
tries to further that collaboration.
CAPITOL REPORTERS (775)882-5322
54
1
Our most recent, the Northern Nevada Food Bank,
2
we're -- one, we were donating dollars to local food pantries
3
here but, two, and Gab is going to talk about this in just a
4
little bit, introducing our Live Health On-line, our
5
tele-help platform into the rural areas to make sure folks
6
have more access and easier access to health care where they
7
need and when they need it.
8
9
10
With that, I'm going to turn it over to Pete.
He's going to talk a little bit about the provider
collaboration.
11
MR. SABLE:
12
Once again, my name is Pete Sable.
13
regional vice president of Providers Solutions for Anthem
14
Blue Cross Blue Shield, and I wanted to start talking a
15
little bit about our team.
16
longstanding Nevada members.
17
in our Reno and Las Vegas offices, and just I wanted to talk
18
about how we interact with providers.
19
time of negotiation or when somebody calls with an issue as
20
our single point of contact.
21
Sounds great.
Thanks, Mike.
I am the
The team members that we have are
I have staff physically located
We don't consider the
We are in daily communication face-to-face with
22
our providers each and every day.
23
with monthly newsletters, which we'll talk about changes in
24
medical policies or plans or changes to any of our networks.
CAPITOL REPORTERS (775)882-5322
55
We also supplement those
1
We also supplement those with spring and fall face-to-face
2
provider seminars, and we do them both in the Reno Sparks and
3
also the Las Vegas, Henderson area, and we also supplement
4
those with webinars.
5
And I did want to take an opportunity to share
6
with you that in Northern Nevada with Anthem, we're
7
contracted with all of the hospitals and systems up here.
8
the state employees wouldn't have to choose between hospital
9
systems with Anthem, and we believe that both organizations
So
10
have strength, and we believe that the state employees should
11
make the choice on which hospital they would want to go to.
12
We also believe that this would give the state of Nevada the
13
ability to support all of the hospitals in Northern Nevada.
14
This slide is basically talking about sort of the
15
spectrum of care.
At Anthem, you know, we are skilled in
16
being able to follow all of our members throughout the
17
spectrum, whether they are healthy, at risk or chronically
18
ill with needs of disease management or case management.
19
our clinical approach puts members where they should be.
20
It's not just a, you know, one suit fits all.
21
the members at the center of care.
22
approach that helps us identify and address what's called
23
care gaps and provide personalized care to help keep costs
24
under control.
We want to put
We used a team based
CAPITOL REPORTERS (775)882-5322
56
So
1
One of the really great things that we had done
2
and I was very excited to be a part of this, we had put in a
3
patient center medical home initiative.
4
personal health care, and basically what this is doing is
5
moving away from what is traditionally called a volume based
6
payment system, and it's moving towards a value based
7
approach.
8
We call it enhanced
This is -- we made significant investments in
9
primary care and to kind of put it simply, we're trying to
10
put the PCP in control, kind of put them at the quarterback
11
and going kind of towards the, I like to say the Marcus Welby
12
type of health care where you'll have one physician helping
13
to coordinate all of those cares.
14
We give them hotspot reportings as I had talked about the
15
gaps in care.
16
physicians.
17
We give them information.
We'll share all this information with our PCP
And what is so great about this is that when we
18
have met with and received feedback from our providers, they
19
are very humbled and they will say, Pete, this is amazing
20
because they thought that all of their members had had their
21
mammographies or everybody had gotten their colorectal
22
screenings and really felt that they were operating at a
23
quality level much higher than they really were.
24
We provide them with all of the technology,
CAPITOL REPORTERS (775)882-5322
57
1
information, learning collaboratives and really share a lot
2
of information to make this very interactive and to make sure
3
that they are aware that they have these tools.
4
So so far our results, nationally we saved $9.51
5
PMP on reimbursed medical cost savings, very happy about the
6
3.3 lower ER costs and volumes, and 7.84 percent fewer acute
7
inpatient admissions which are very big drivers for cost.
8
9
As I had stated on EPHC, we believe the
doctor-patient relationship is really pivotal to transforming
10
health care.
11
nation to improve primary care reimbursement.
12
is instead of making it a disincentive, we supplement them in
13
helping them to create care plans with patients that have
14
complex health problems.
15
influence how patients prioritize their health, so it's not
16
just transactional, hey, I have a cough.
17
seeing the doctor.
18
time and there's a gain share component that associates with
19
that, so they are incentivized, and that's where the value
20
base comes in for them.
21
That's why we put that we were the first in the
So what we do
We give them opportunity to
I'm coming and
It's them really wanting to take extra
Again, we give them 24-hour coordination around
22
the clock, patient guidance.
We have on-line technology, as
23
Mike had said, Gab will talk a little bit about with our Live
24
Health On-line, and we really look at risk stratified care
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1
management which is enabling systematic assessments of
2
patients with health risks.
3
the whole person.
4
Okay.
We really want to be looking at
As far as Anthem, Blue Cross Blue Shield,
5
collectively we lead the nation with more than 250
6
accountable care organizations and patients sent in medical
7
homes across the country.
8
participating in these care delivery models and over 130,000
9
providers participating, these programs we're doing in each
10
11
There are over 12,000,000 members
of our states.
And my last slide here is talking about our Blue
12
plan, whether they are part of the Anthem or part of our
13
National has a quality program, and each one of these are
14
going to follow the same tenants.
15
focused on delivery and patient center, quality care.
16
are going to be accountability across the care continuum.
17
There's going to be practice transformation and, lastly,
18
accept value based reimbursements.
19
Gab?
20
MS. SANDSTONE:
Okay.
They are going to be
They
Thank you.
I'm going to be talking
21
about consumer engagement and get into a lot of the tools and
22
some of the things that we have so when we talk about
23
consumer engagement, there's a lot of things you can see
24
about that and one of them is we basically expanded our
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1
region a different way virtually and have really beefed up,
2
you know, our member portal, our transparency tools, and
3
we've got some really great mobile apps that I'm going to go
4
over with you in just a second.
5
But we're really doing this because our consumer
6
tools actually connect with people and give the people the
7
tools that they need to be able to make health care easier
8
for them and better, so having these tools available at their
9
fingerprints.
10
As we know -- everybody has a smart phone?
Everybody in the room have a smart phone?
11
MS. BOWEN:
No.
12
MS. SANDSTONE:
No?
Okay.
One person doesn't
13
have a smart phone.
14
people into technology, many of your kids going to school,
15
they are, which is a great opportunity for them to also have
16
the information at their fingertips as well.
17
A lot of people do.
There's a lot of
So the innovation at work, two of the great
18
things that we're proud of is our Anthem.com website.
This
19
is what we call our member portal.
20
can actually go on and, you know, there's a list of things
21
here.
22
provider search.
23
kids are sick and you need to access care, you can go
24
on-line, and you take a look at the Blue Card program, and
CAPITOL REPORTERS (775)882-5322
The members within Anthem
You can look up your claims, access your EOB's,
So if you're going to Disney Land and the
60
1
I'll go over that in just a second.
2
Estimate your cost tool for prescription, also
3
estimate your cost tool for procedures.
We have where you
4
can actually go on and buy a TV at Best Buy.
5
Wal-Mart.
6
you can actually do this for your health care.
7
to go on-line and shop for an MRI or shop for knee surgery,
8
using our estimate cost tool will actually give a continuum
9
of every facility, all of the different locations and the
Then you go to
You go to Target and start looking around.
Well,
If you want
10
different prices that it would cost you.
11
tool, working a lot with Pete's team and providers as well to
12
put you -- all of the different procedures.
13
So it's a great
There's inpatient procedures, outpatient
14
procedures, and we're also adding some professional visits as
15
well on there too, so a great opportunity to have that at
16
your fingertips.
17
And then you also have the mobile app.
18
addition to everything you have on Anthen.com, you can do all
19
of those same things on a mobile phone.
20
about that is you actually can have a virtual ID card.
21
you have kids going to school out of the state and they lost
22
their ID card, they can go on to the app and the ID card can
23
be faxed directly to the provider's office, so some great
24
opportunity for some neat tools.
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In
And the great thing
So if
1
So Live Health On-line, this is actually included
2
in the plan that we have with you that we're offering to the
3
state employees.
4
interactive, you know, video, live two-way where you can
5
actually get on with a doctor.
6
and hopefully we'll have enough time, I want to show you a
7
video at the end, you can actually choose your doctor.
8
9
So Live Health On-line is our convenient
The great thing about ours,
When the screen comes up, you can look at the
doctors.
You can see who's available at that time.
There is
10
24/7 access.
11
want to look and say, well, I want a male doctor, I want a
12
female doctor, you might want one that speaks Spanish.
13
have the ability to do that before you go into what we call
14
the waiting room.
15
So if it's 2:00 o'clock in the morning, you
You
Then you go into the waiting room and the video
16
actually pops up.
17
interaction with that physician.
18
you can tell the physician my doctor is Dr. Jones in Sparks,
19
Nevada.
20
physician so your primary care has that.
21
There's a doctor you can have that
Once you have that visit,
We can fax and e-mail that visit over to that
And lastly, that physician on that, if they say,
22
okay, I need to send you some antibiotics.
23
Wal-Greens down the street, which location, and that
24
physician will e-mail and electronically send that
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You want to go to
1
prescription down to the pharmacy, and you can go down to the
2
pharmacy.
3
the rurals that might not have access to get to a physician
4
or, again, who wants to go to the emergency room, you know,
5
2:00 o'clock in the morning if you can do something on-line,
6
so it's a great and easy convenient tool and we're putting it
7
into the state of Nevada plan that we're offering for your
8
HMO members.
9
co-pay for your PCP, that's traditionally how we do that and
10
11
So, again, great opportunity for some folks out in
And your co-pay structure for that is the
it will get charged to the credit card.
This is a new option that we just added, so Live
12
Health On-line psychology is actually a new program that
13
we've been working on for quite a while, so it's actually
14
another convenient way for you to speak with a licensed
15
therapist for stresses, anxiety, depression.
16
one, if you can -- when you log in, if there are licensed
17
psychologists on-line, you can get on-line.
18
might take a few days for them to get back to you.
19
Otherwise, we are literally just rolling this out.
20
availability of psychologists might be a little bit limited,
21
but we are really happy to have this as an extra option.
22
Now, with this
Otherwise, it
So the
The cost share are very similar to what mental
23
health benefit co-pay will be.
It will be the same thing on
24
a Live Health On-line visit as it would be had you gone down
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1
the street to visit a psychologist.
2
things that we're offering for Anthem.com and for Live Health
3
On-line.
4
So a couple of new
And this slide talks about some of the worksite
5
solutions we have.
So say you have got a state location that
6
has many many employees or maybe you've got a rural location,
7
we can actually put these kiosks, if you will, in a location.
8
Now they are different costs for different ones, from the med
9
suite, which is actually an enclosed, it looks like a full
10
cubicle.
You can walk in, and you can actually put the blood
11
pressure thing on.
12
and I think they swipe your head for something else, all
13
kinds of gadgets in there.
14
people to take a look at what it looks like.
15
You've got a temperature for your ear,
It's a great opportunity for
Then there's the consult and on the far right is
16
an actual portable, actually a tabletop.
17
right here on the table top.
18
had the state wanted to do this and try it in maybe one of
19
the locations where they felt this would be a good
20
opportunity, we can definitely work with you on putting one
21
of those in.
22
We can put it just
So these are some options that
So this model is kind of what Mike talked about
23
when we first started and what Pete talked about with the
24
enhanced personal health care is we're putting the member in
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1
the middle and when we say consumer centric is the provider
2
working with the member, and part of our strategy is to
3
ensure that we increase the healthy behaviors of these folks.
4
So we want the providers engaged, and the providers have an
5
invested outcome with the enhanced personal health care.
6
Then, of course, you have got your primary nurse
7
team, customer service and all of the innovative tools.
8
is one way that we keep the member in the middle of our
9
approach.
10
This
Wellness, everybody talks about wellness and want
11
to talk about what are we going to do to get these employees
12
healthier?
What are we going to do to engage these
13
employees?
Often times it is a little difficult to engage
14
people in wellness programs, but we have got some great
15
opportunity for us to be able to provide you programs.
16
know, as Mike said, we have 14 states across the country, and
17
we work with a lot of large national accounts, a lot of other
18
state accounts, and we've got a lot of local accounts up here
19
and down in Las Vegas and have had the opportunity to work
20
with many of those folks to say what can we offer you?
21
You
So we're here to offer a consultative approach to
22
say we can put this type of a program in and probably the
23
best type is an incentive based type program.
24
said, your engagement, if you don't have incentive basis
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Because as I
1
usually maybe in the single digits, as you give incentives
2
and we can -- you know, you know your population better so we
3
can work collaboratively to say what works best with these
4
type of folks.
5
incentive based program, you can actually double that
6
participation rate because, again, that's probably the most
7
difficult thing to do.
8
And if you do put in some kind of an
But why do we want to do that?
One of the things
9
that we want to do is we want to increase healthy behaviors
10
but at the end of the day, it's actually helping to reduce
11
the cost for you -- for you and for PEBP.
12
So here's some -- here's some events and some
13
screens that we can actually do to promote some of the health
14
and wellness, health screenings.
15
at each one of the different locations.
16
massages and then, of course, we can put in incentive based
17
programs in there based upon any kind of budgetary monies
18
that you have available that we can work with you on.
19
We can set up health fairs
We've got table
So when we're talking about an HMO, you've got an
20
HMO now.
You got one in the north.
You got one in the
21
south.
22
apart from the other HMO's that are out there?
23
couple of things on here just to talk through and one of them
24
is our open access model where you do not need a referral to
CAPITOL REPORTERS (775)882-5322
Well, what makes Anthem different?
66
What sets us
I put a
1
go to a specialist.
2
to a specialist but if you have an earache and you want to go
3
to that ear, nose and throat doctor, you do not have to go
4
through a PCP to get that referral.
5
to that ear, nose and throat doctor or if you have a heart
6
condition and you want to go to a cardiologist, you can.
7
we're very pleased with our open model has been working for
8
many many years and many of our clients are very pleased with
9
the model.
10
You'll have a different co-pay if you go
You can just go directly
So
Blue Card network access, I mentioned this
11
earlier in a couple of slides before, and I'm just going to
12
give you a quick overview what Blue Card is.
13
as Mike said, we're in 50 states and we're actually able to
14
tap into every Blue Cross plan across the country.
15
what does that mean to an HMO member.
16
are restricted typically to the state of Nevada.
17
outside the state, you have no coverage.
18
Blue Card is,
Well,
You say, well, HMO's
You go
With Anthem, you do and it's through the Blue
19
Card program but there's two levels.
So if it's short-term,
20
meaning less than 90 days, again, for example if you're in
21
Disney Land and you don't need to go to the emergency room
22
but you are very sick, you can use the Blue Card access for
23
urgent care.
24
card and they would direct you to go to an urgent care
CAPITOL REPORTERS (775)882-5322
You would call the number on the back of the
67
1
facility in California and anywhere that you're at and have a
2
Blue Cross provider at that co-pay.
3
The second piece of it is our long term access.
4
This is a really great feature.
So for these kids that are
5
going to college outside of state so they are outside for
6
more than 90 days or with divorced parents that have kids
7
living outside of the state, they can actually hook up with
8
what we call a host HMO.
9
would hook up with the HMO in Texas, and they would have two
And say they are going to Texas, we
10
cards.
11
an HMO card where they come home in Nevada, and they would
12
have an HMO card in Texas and be able to take advantage of
13
the HMO benefits that they have in Texas and have a co-pay as
14
if they were here in Nevada, so a really great feature to
15
offer through our Blue Card program under the HMO program.
16
They would actually have a home HMO.
They would have
And the last bullet is really what Pete was
17
taking about, the patient center medical home.
18
our HMO, we've structured that more, again, high performance
19
providers, not necessarily narrowing our network.
20
patient model home and some of the incentives that we've been
21
providing or the incentives that the providers are getting
22
for these HMO members is also embedded into the HMO product
23
that we're rolling out for you and for the numbers.
24
As part of
So the
So whole health connection, what is that?
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So not
1
only are we a medical carrier but we also have dental,
2
vision, life and disability, and we believe that throughout
3
this whole program, it's not just all about the medical.
4
What happens when you go to the dentist and you're -- you
5
know, you've got some gum disease, it doesn't just affect
6
your teeth.
7
So our whole health connection takes all of the different
8
plans so any specialty ancillary products that you would
9
purchase through Anthem would fall under the home, the whole
10
It affects your health care, same with vision.
health connection.
11
This next slide talks about the vision.
We
12
provided a proposal for you that has a vision benefit
13
embedded for the north and for the south.
14
program under Anthem, you would have access, of course, to
15
our vision providers but this also helps connect and connect
16
the dots.
17
eye doctor can actually detect if you have diabetes, and that
18
person might not even know they have diabetes.
19
So under this
So for example, you're going to an eye exam, the
And if that comes up in the screening while
20
you're there for that vision exam, the health record note
21
will be sent to the primary care physician and, again, that's
22
what we call our whole health connection.
23
connect the dots, and it does help the gaps in care, and
24
that's not anything that the member has to do, that's what we
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So it really does
1
do on the back end when we go in and say, okay, state of
2
Nevada employees now have vision and medical plan, that's how
3
everything gets all connected.
4
Okay.
Client reporting, this is another thing
5
we're really really proud of is we've got an awesome client
6
reporting packets that we like to tout.
7
on-line access so PEBP Board members or maybe the consultant
8
would like to get on, customizable, comprehensive.
9
you would be new coming on with us, but we do give you back
10
It's a 24/7 access,
Again,
history, but we also give you benchmarking.
11
A lot of people say, well, what are the other
12
states doing and how do we look?
13
visits?
14
name drugs versus generic drugs.
15
helps you understand the health of your membership, but it
16
also helps us understand where the gaps in care are or maybe
17
where the spikes in care are.
18
Are we too high on our ER
Do we have too many people, you know, taking brand
So the benchmarking really
And based upon these reports, this is how we come
19
back to you, and we talked about doing the wellness and the
20
health fairs.
21
You're doing a health fair to engage the members and get them
22
healthier but if you don't know where the majority of the
23
problems are, you can't address the issue.
24
Well, what do you have a health fair for?
So for example, if you have a lot -- we see a lot
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1
of low back issues, then we'll come in and put in some
2
massage chairs.
3
asthma, let's do some education on, you know, on the asthma,
4
and so the reporting that we have is not only financial but
5
it's also clinical, and the clinical and the financial rollup
6
together, and that's how we're able to come back to you and
7
give you recommendations and work with you on putting a
8
program together with you.
9
just the client reporting that spit out a bunch of numbers,
10
it really is an analytics tool that helps us help you put a
11
program in so we can drive some healthier behaviors for your
12
members.
13
If we see a lot of COPD's, we see a lot of
So that's why we think it's not
So account management, if we get the business,
14
you will be assigned an account management team.
15
to walk through the structure and give you an idea of what
16
that would look like.
17
is very important to the PEBP Board and, of course, it's very
18
important for the members as well.
19
a service team from Las Vegas and our Reno locations.
20
have a core team.
21
Reno.
22
So I wanted
I know servicing an account like this
So we will actually have
You'll
You'll actually have an account manager in
You'll have an account manager in Las Vegas.
And part of that account team will have an
23
account coordinator that helps with the day to day claims
24
issues and my team also has a claims advocate, actually
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1
assigned one claims advocate and the good thing about having
2
that is that person knows you, knows the account.
3
understand when something happens and maybe the uniqueness of
4
your account, as well.
5
important role.
6
They
So having a claims advocate is an
And then there is also some other support
7
divisions.
8
to hear about drugs and likes to look at, you know, how many
9
drugs people are taking and what it looks like.
Then you
10
look at these names that come across the screen.
What is
11
that name and you have to Google it because you can't spell
12
it or pronounce it.
13
Pharmacy account manager, everybody always likes
So our pharmacy account managers will come out
14
and will talk to you really about the clinical programs that
15
we put in place, what we're doing when we're managing our
16
formularies.
17
support for our team and a great support for a group, a great
18
group like PEBP.
19
So pharmacy account managers are a great
Premium specialist, you've got enrollment.
You
20
have got billing.
It's a big component of that and that's
21
probably -- you know, for your HR staff, that's probably
22
maybe not a big issue, but it's a big part of what they have
23
to do to keep enrollments.
24
is actually assigned so it doesn't go into a mailbox.
CAPITOL REPORTERS (775)882-5322
We have a premium specialist that
72
That
1
person, again, gets to know your account, gets to understand
2
the needs of your team, and you have that one go to person
3
for any enrollment and billing issues that you have.
4
Provider services rep, that falls on Pete.
5
has his team that works together with the north and the
6
southern providers.
7
He
And then, of course, at the bottom is additional
8
resources, we have a local underwriting team.
9
have underwrites up here in Reno and we have them down in Las
10
We actually
Vegas as well.
11
Our reporting and analytics team, if you have a
12
special need and you really want to dive into -- as a matter
13
of fact, we had a group up here that was really interested in
14
the behavioral health.
15
behavioral health claims and so they wanted me to dive into
16
what are they going for?
17
or are we really having a problem with alcohol or drugs or is
18
there something that I'm not looking at?
19
They seemed to have a lot of
Are they just going for counseling
So we send that data to our analytics team and
20
they will come back and really dive deep into that specific
21
issue for you.
22
for us.
23
to focus in and hone in on trying to find out why we see some
24
claim spikes in certain areas.
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So reporting and analytics team is really key
And, again, it will be really key for you for trying
73
1
Member issue resolution, subject matter experts,
2
we have a marketing manager.
3
marketing pieces, we could do that as well.
4
of collateral, and I'm sure you know that, but we can
5
actually create come collaterals as well, so we have got the
6
support there.
7
So if we want to do any kind of
We've got lots
And our leadership team, you know, with Mike and
8
Pete and myself, we do have a leadership team all based
9
locally here in the great state of Nevada.
10
And this is just a picture of your core team.
So
11
you have your leadership team and account management folks
12
down at the bottom there, so just wanted to give you a little
13
personalization.
14
So to summarize and say, all right, the top ten
15
reasons -- the top five reasons why you want to choose
16
Anthem, again, the local presence, national strength but we
17
do have the local presence for you, trusted brand and
18
financial strength, I think that's important in this day and
19
age, you know, collaborative partnership.
20
things that we can bring to the table for the PEBP Board and
21
help you manage through a lot of the processes you have to
22
work through, especially through a benefit program such as an
23
HMO.
24
There's a lot of
The network strength, that basically goes where
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1
you go.
You've got that national presence, even though you
2
still have an HMO and, you know, I'll just tout that our
3
consumer friendly tools are, you know, state of the art, and
4
we're excited about having those.
5
So I would like to --
6
MR. MURPHY:
I would like to add a couple of
7
things as we're getting through.
Hopefully what you hear
8
throughout her presentation is the approach is collaborative
9
with you.
We can't tell you that we know everything, and
10
health care changes.
11
been in it from where we've been full circle, with the HMO's
12
and things that have been going on and where we sit today, it
13
has got to be a partnership.
14
You all know that in the time we've
You all know the hindrances and some of the
15
boundaries of where you want to go with the plan and
16
hopefully what you hear is we're not only collaborative with
17
you, we're collaborative with the provider community and
18
that's really important.
19
We have changed the payment mechanism in the
20
provider community to get providers engaged in health
21
outcomes is what allows us to have an open access HMO and
22
actually have providers that are still engaged in the health
23
outcomes and cost of patients.
24
It's also really important that we get health
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1
care where you need it.
So you heard a lot about Live Health
2
On-line.
3
getting that -- it's getting those lower level or lower
4
acuity issues out of the ER and getting them either on-line,
5
getting them in a provider that's open later that has
6
different hours and/or out of state so folks aren't utilizing
7
primary care through the ER's and trying to keep costs down.
8
You heard a lot about our Blue Card access.
It's
So we're obviously very involved in how we're
9
taking care of the whole health of the patient, and that's
10
really important for the outcomes for satisfaction of your
11
employees, as well as future costs and really trying to
12
develop programs over the long haul for you.
13
So, as I said, we appreciate the time to come in
14
and talk with you a little bit.
15
to answer questions or, you know, address any issues that you
16
may have had for the RFP or questions that you may have had
17
for there.
18
CHAIRMAN DROZDOFF:
I would be more than happy
Yeah, I think we will.
19
Certainly, I appreciate the time and effort that went into
20
this.
21
have a couple of sort of specific questions that are likely
22
to be asked of all of folks that are here.
We're going to start with Judy, who's got -- going to
23
MEMBER SAIZ:
Judy Saiz for the record.
24
What you're presenting here today, is it for one
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1
particular region or are you presenting and proposing for
2
statewide, as well as only a north, as well as only a south
3
or statewide and statewide, all three?
4
MR. MURPHY:
So what we laid out in the proposal
5
would be a solution for the north, a solution for the south
6
or a solution for the full state.
7
said in opening, we operate from state line to state line,
8
and I have, you know, offices in both areas.
9
confident we can execute any of those three options.
Obviously, you know as I
So we're fully
And as
10
some of you know, in the past, we executed an option up here
11
in the north where we provided a plan in Northern Nevada.
12
MEMBER SAIZ:
Can I continue?
13
CHAIRMAN DROZDOFF:
14
MEMBER SAIZ:
Yes.
I think anyone would be concerned
15
with disruption to our members, and I've already disclosed
16
that I sell products for all of the vendors that are here
17
today, but the other Board members might not be aware, I
18
think I read in the proposal that you have all hospitals in
19
the state; is that correct?
20
in the state?
You contract with all hospitals
21
MR. MURPHY:
We have a contract with all of the
22
hospitals in the state.
The proposal that we have laid out
23
has a contract with all of the hospitals in the north.
24
not have a contract with Saint Rose down in the south and
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We do
1
that's what is in the proposal.
2
different benefit design together, we -- you know, as I said,
3
we have -- we have different networks and we have -- we have
4
a relationship with every hospital in the state and they are
5
in-network.
6
MEMBER SAIZ:
If we chose to put a
So in the north, you would have
7
Saint Mary's, Renown, Northern Nevada Medical, Carson-Tahoe
8
just within this region.
9
MR. MURPHY:
10
MEMBER SAIZ:
Yes.
I read in the proposal that -- I
11
extracted from the proposal, I hope I extracted correctly but
12
just in the Clark County that you had something like 500
13
providers.
14
sticker someplace.
15
just in the north -- I mean, in the south only.
16
the north, do you -- let's see, you're right here.
17
know, Pete?
Was I correct in that?
I'm sure I saw 500 providers and that's
18
MR. SABLE:
19
MEMBER SAIZ:
20
23
24
Up here in
Do you
Yeah.
How many do you have in Washoe,
Carson area?
21
22
I think I saw, I have my
MR. SABLE:
PCP's.
So up in the north, we have about 322
We have 62 OBGYN's and about 1,100 specialists.
MEMBER SAIZ:
Okay.
Okay.
So if we had a
disruption with the current vendors, if you were awarded
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1
whether it's north, south or statewide, what do you have in
2
place for disruption, say a pregnant mom, you know, whose
3
been seeing a certain doctor and hospital, what would you do
4
in that case?
5
MS. SANDSTONE:
So we have continuity of care.
6
So we go into a group and there's always going to be somebody
7
like that or somebody going through treatment.
8
do is have them fill out a continuity of care form.
9
take that back to our nurses and we'll work with that person
So what we'll
We'll
10
to ensure for either the provider if they're going to --
11
whether it's in-network or out of network and, again,
12
depending upon say for example a pregnancy, depending upon
13
how far along they are, we'll let them continue with their
14
care, with their provider and get them to -- get them to an
15
in-network or hospital which, again, we shouldn't have any
16
trouble with that.
17
But the continuity of care process is a very
18
buttoned down process, that filling out that form, getting it
19
over to the nurse cases, and then actually we just had
20
another case up here where we had to reach out from somebody
21
was on a C PAP machine, and we had to reach out to the vendor
22
to make sure that that C PAP machine would be able to be
23
continued to be rented for that member in their home.
24
that just gives you an idea that the nurses will not only
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So
1
call the patients and let them know but let the vendor know
2
we'll continue that care as soon as our effective date starts
3
and the old carrier effective date ends.
4
MR. SABLE:
Real quick?
5
CHAIRMAN DROZDOFF:
6
MR. SABLE:
Yeah.
I also wanted to share that we built
7
our networks with scalability in mind, and we monitor them to
8
meet the needs of our clients.
9
have to have, you know, 232 PCP's.
So we are not set that we
We obviously have the
10
ability to go out and reach any one of our providers.
As
11
Mike had said, in our global PPO network, we are contracted
12
with almost every single provider within the state, and we
13
have done that for other clients as well.
14
it to meet the needs of the clients.
15
MR. MURPHY:
So we try to scale
And just to close that, there's
16
different reasons that we have or don't have providers in a
17
network.
18
provider that's a concern, obviously whether it's reaching
19
out and seeing if we can come to an agreement with them, if
20
we don't have an agreement with them or sitting down and
21
explaining that the reasons that we don't have an agreement
22
with a provider because we feel like it's -- there's good
23
reasons for it, whether it be costs, whether it be quality or
24
the reasons that we're not.
CAPITOL REPORTERS (775)882-5322
So sitting with you all, if there's a specific
80
1
MEMBER SAIZ:
I have just a couple of more.
2
CHAIRMAN DROZDOFF:
Here's my plan, the way we're
3
going to do this is keep going, and then we'll do a couple of
4
up here and then I'll go down to Rosalie and Chris down
5
south.
6
MEMBER SAIZ:
Okay.
Would you have a customer
7
service, dedicated customer service line specifically for
8
PEBP clients?
9
10
MS. SANDSTONE:
Yes, we would, we would establish
that team.
11
MEMBER SAIZ:
Okay.
You know that med suites
12
that you offer, that was in your proposal, tell me just a
13
little bit more about that.
14
going to give an example, and I don't know what the outcome
15
is with Tonopah but the hospital closed in Tonopah, this to
16
me would be something that would be helpful maybe in that
17
area.
18
Say cost wise, if -- okay.
I'm
So just say that example, you're in Tonopah, what
19
would you -- which one of these would you propose and what
20
kind of cost would that be to say to PEBP or would that be
21
included?
22
MR. MURPHY:
Here's what I say, when you say what
23
would the solution that we would recommend be, I think that's
24
something, again, we have three levels of that for a
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1
discussion around what makes sense.
2
space constraints, whether it's activity constraints, things
3
of that nature, just say what do we think is most appropriate
4
for whatever area we're thinking about putting in.
5
there's an area that has privacy already, you may not need a
6
full suite and so you may not put that in because obviously
7
they're more costly.
8
privacy, obviously that cubicle arrangement is probably a
9
little bit more appropriate.
10
We have whether it's
If
If there isn't an area where there's
From a cost standpoint, typically, I hate to say
11
this, but we work with clients.
12
that we do.
13
We have implemented these in the state of Georgia.
14
implemented them in different places as we've had different
15
customers and we just -- some of it kind of depends on how
16
many we're talking about and because they are manufactured
17
from, you know, another area, so it's really hard to say.
18
don't have any of them included in the proposal but certainly
19
we would be more than willing to work with them.
20
Obviously, it's something
It's something that we do across the country.
We
We
I would say the cost options actually start out
21
fairly reasonable, anywhere from $3,000 on up to actually
22
have the full suite, as you see some of these things.
23
I said, we'll work with the state.
24
through these care in the right place. So to the extent that
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And as
We are trained to get
1
this makes sense in our collaboration of how we develop plans
2
where we say we have got a real problem out in an area to get
3
to ER utilization, you know, more than anything else, we need
4
to do it as a partner just to put these things in, to figure
5
out how we get to the end game which is reducing costs and
6
having better outcomes.
7
MEMBER SAIZ:
I don't know, Leo, if you saw that
8
one in our conference but I did see I think it was the middle
9
one here, that's a pretty neat thing to see.
10
MR. MURPHY:
You know, one of the neat things
11
we're doing on the provider side with Live Health On-line is
12
we're actually going to be turning this around to providers,
13
and we're going to let providers engage with this platform to
14
make it their own.
15
are engaged in the Live Health On-line but helping the
16
provider community on the flip side for maybe some of those
17
small providers that don't have the ability to actually
18
interact with telehealth if they want, to use our technology
19
and start to engage.
20
a community here that puts care in the right place at the
21
right time.
So for instance, we have providers that
Again, what we're trying to do is build
22
MEMBER SAIZ:
23
CHAIRMAN DROZDOFF:
24
I think that might be it for me.
You know, something else,
we'll give everybody a chance. We'll go to Anna.
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1
2
MEMBER EWING-TAYLOR:
I have a clarification for
a question that Judy asked, if I could?
3
CHAIRMAN DROZDOFF:
Yeah, go ahead.
4
MEMBER EWING-TAYLOR:
5
Just real quickly, you had indicated that you
Thank you, Mr. Chairman.
6
have contracts with all of the acute care hospitals in
7
Northern Nevada.
8
MR. MURPHY:
Yes.
9
MEMBER EWING-TAYLOR:
Yet in your response to
10
1.1.6, you indicate there is no acute care hospital in Carson
11
City.
12
13
MR. SABLE:
I mean, we're contracted with
Carson-Tahoe if that's what the questions is.
14
15
You've got a zero there.
MR. MURPHY:
So maybe a mistake.
back.
16
MEMBER EWING-TAYLOR:
17
MR. MURPHY:
18
I would appreciate that.
Because it actually is -- they are
in our network.
19
MEMBER EWING-TAYLOR:
20
MR. MURPHY:
21
CHAIRMAN DROZDOFF:
22
Let us check
Okay.
Thank you.
And thank you for pointing it out.
So we'll go to Anna and then
we'll go down south.
23
MEMBER ANDREWS:
Anna Andrews for the record.
24
The question I have is you made a comment and I
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1
think Ms. Sandstone asked the question a while ago, we all
2
have smart phones and a member of our audience said, no, we
3
don't.
4
membership that does not have technology, does not have
5
internet, does not have a smart phone?
6
just going to have to call a number and wait and wait and
7
wait or what kind of outreach do you have to offer to those
8
members?
9
That is my question, how do you bridge the gap with a
MS. SANDSTONE:
Meaning, are they
So the dedicated line that we
10
just talked about for Judy is we would actually set up a
11
dedicated customer service line for your members.
12
case, somebody that doesn't have a smart phone, they can
13
absolutely call customer service and reach one of our member
14
representatives and talk to them about any -- they can look
15
up a provider for them.
16
have a question about going to a different provider in a
17
different state, they can look that up, if they have a
18
question about a claim.
19
smart phone and on the Anthem.com, you can do with customer
20
service.
21
They can look up any EOB.
So in that
If they
So anything that you can do on the
And also that account management team we talked
22
about, as well, that's here locally, we have that account
23
management team that can reach out as well.
24
you're -- if you want to know about a provider issue, we go
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You know, if
1
to Pete's team and work with a provider.
2
lot of the outreach that that member doesn't have that smart
3
phone can absolutely have, and all of the phone numbers will
4
be on the back of their ID card, the behavorial health phone
5
numbers, the customer service phone numbers and the provider,
6
and even pharmacy phone numbers are on there as well.
7
MR. MURPHY:
So there's still a
Just from a care side, a service
8
side and making sure that we're able to engage with the
9
customers there but obviously even without a smart phone, all
10
of the on-line tools that we have work with a desk top
11
computer, the engagement, the things that we're doing to
12
bridge the gap are these things like these kiosks.
13
the things like developing the relationships with the docs to
14
encourage them to extend office hours so they are not ending
15
up in ER, and we're providing -- you know, we're trying to
16
build those relationships with the docs so that there is more
17
access for folks on the care side, as well as on the surface
18
side, whether it's, as I said, on the computer or on the
19
phone, traditional phone.
20
21
22
23
24
CHAIRMAN DROZDOFF:
They are
Chris, or, Rosalie, do you
have anything?
MR. COCHRAN:
Cochran for the record.
Yes, Mr. Chair.
This is Chris
I do have a couple of questions.
And just to make sure for clarification, you
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1
know, you're a national company and I know, you know, Blue
2
Cross Blue Shield for being one of the first insurers in the
3
U.S., you know, if you go back to the 1930's.
4
But I have the question, when you talk about your
5
provider network beyond Nevada, I am under the assumption
6
that when you talk about all of the hospitals that you
7
contract with, that are any of our members, what would their
8
access be?
9
are separate, correct, beyond the state?
10
They wouldn't be included in this because they
They are separate
contracts?
11
MR. SANDSTONE:
So under the HMO, the HMO model
12
is designed to stay here within the state.
13
to go outside of the state of Nevada, it would be if it was
14
an emergency or as I talked about more of an urgent need,
15
where they need to go.
16
and they need to go to the emergency room and they need to go
17
to a hospital, they will have access to the Blue Card network
18
access.
19
be able to have accesses there.
20
So if they choose
So, again, if they are in New York
They just call the back of the card, and they will
But it's not like they can just go to any Blue
21
Cross provider across the country.
That would be under our
22
PPO platform.
23
still having that short term and that long term Blue Card
24
access that I talked about.
CAPITOL REPORTERS (775)882-5322
Under the HMO, a little more restrictive but
87
1
Does that answer your question?
2
MEMBER COCHRAN:
It does, but what about say for
3
specialty services that may not be available within the
4
network, would they have access to those services outside the
5
network?
6
MS. SANDSTONE:
Yes, absolutely.
So say for
7
example someone up here in Reno and the specialty that needs
8
-- like say for example the transplants that we cannot do
9
here, we will work -- there's many hospitals in California
10
that we'll work with.
So the nurses and the doctors and our
11
nurse case management that's assigned to that person will
12
actually help with that transport and/or work with that
13
physician in California.
14
the patient would have to worry about.
15
that using our Blue Card network, of course, and getting the
16
discount to make sure that they stay in network.
17
absolutely, we would work to ensure that that patient has
18
that care outside the state of Nevada.
So that wouldn't be anything that
19
MR. MURPHY:
20
MEMBER COCHRAN:
21
24
So, yes,
And the one thing -So that's critical that they
stay in-network?
22
23
We would take care of
MS. SANDSTONE:
Absolutely, yes, that's our whole
goal.
MR. MURPHY: That is what I was going to add is,
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1
one, it helps them stay in-network.
Two, in the short term,
2
network that Gabrielle discussed what we're trying to do with
3
somebody on the road with an HMO what's their option?
4
typical option is show up at the ER and hope to justify that
5
it's emergent and that's the reason that they went there, if
6
they're on he vacation or something like that.
7
sure that folks have appropriate access to appropriate care
8
in the appropriate setting at the appropriate time.
9
just one of those ways that we're trying to keep kind of
10
those lower acuity issues out of the ER.
11
MEMBER COCHRAN:
Okay.
Their
It's to make
So it's
And I just have one final
12
question, and this may help me going forward too, but apart
13
from the premiums and the co-pay, what is the difference
14
between an open access HMO and a PPO?
15
MS. SANDSTONE:
Okay.
So the open access HMO, we
16
all understand HMO's have one tier.
You're in-network.
You
17
go out of the network, you pay, right?
18
model, we've given you open access.
19
through that gatekeeper.
20
If you want to go directly to your cardiologist, you can skip
21
that method and go directly to that specialist.
22
what an open access is with an HMO.
So under an HMO
So you don't have to go
You don't have to go to that PCP.
So that's
23
You still have to stay within the HMO parameters
24
and go to a specialist within the HMO network and within the
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1
state of Nevada, unless what we just talked about, if you
2
can't get the care here, we'll work with you to get the care
3
outside.
4
Now, a PPO program has two levels of coverage,
5
in-network and out of network under a PPO program.
And under
6
a PPO, you get what we call our Blue Card National Network
7
that comes with Anthem's Blue Card PPO, and that program
8
basically allows you complete what we call reciprocity.
9
can go across state lines.
You
You don't have to call anybody.
10
You can go to any Blue Cross provider at any time and have
11
in-network benefits across the United States under a PPO
12
program, so that's the difference.
13
PPO's basically a national plan for us.
HMO is
14
more your state plan but with that flavor of having that Blue
15
Card access outside of the state.
16
MEMBER COCHRAN:
Okay.
So but just for
17
clarification, any proposal that we received that didn't have
18
those contracts outside of the state of Nevada, if it was a
19
PPO or an HMO, they would be pretty much the same, correct?
20
21
22
MS. SANDSTONE:
I'm not sure I understand your
question.
MEMBER COCHRAN:
In terms of -- well, I mean, if
23
you have a provider here that doesn't -- that's located say
24
in Nevada and they don't have a provider network outside of
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1
the state and they were a PPO, they couldn't go there anyway
2
without going network.
3
But under an open access HMO, they would have a
4
comparable set up to those in the PPO in the state if the --
5
if the provider was only in say the state of Nevada.
6
MR. MURPHY:
There's one critical clarification
7
to that and that's in a PPO, there would be a level of out of
8
network benefits that somebody would have that would be
9
reduced benefits from their primary.
In an HMO, they have no
10
benefits unless it's an emergent situation or one of those
11
other two situations that we outlined in either the short
12
term or the long term.
13
between the PPO and HMO.
14
That's the critical difference
MEMBER COCHRAN:
I just try to -- I have a hard
15
time thinking of that open access because it implies there's
16
no gatekeeper and that's kind of what, you know, HMO's were
17
known for before so -- but I do appreciate the clarification.
18
That's all of the questions I have, Mr. Chair.
19
MR. MURPHY:
And I'll add just one thing to what
20
you said which is it's why and part of the reason that open
21
access works with us and as Pete went through our PCMH
22
program, the only way you used to be able to control cost and
23
utilization was to say if you go out of -- if you veer from
24
this, unless you go through the gatekeeper of your primary
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1
care, you're not getting any -- you're not getting any
2
benefit.
3
We are paying the providers to be engaged in that
4
outcome and to be more engaged with the patients, and those
5
are the savings that we've seen that Pete described earlier
6
is because that provider is engaged in this -- in this model,
7
we're actually getting better engagement without having to
8
absolutely force somebody through that gatekeeper.
9
there's a lot of discrepancy or, you know, discussions around
10
I mean,
whether gatekeepers work or they don't work.
11
We believe that when you collaborate with the
12
providers, you give them data, and we give them incentives
13
that when you change that payment mechanism model, we can
14
move the needle.
15
CHAIRMAN DROZDOFF:
If you're done, Chris -- if
16
you're done, Chris, we'll go to Rosalie.
17
MEMBER COCHRAN:
18
Yeah, I don't have anymore
questions.
19
MEMBER GARCIA:
20
CHAIRMAN DROZDOFF:
21
22
We're good here.
All right.
Don, do you have
anything?
MEMBER BAILEY:
I just have one.
They covered
23
most of mine, but can you get back to the customer service in
24
rural areas because we have a lot of difficulty with a number
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1
of seniors and our active employees that work in the rural
2
areas so could you cover that one more time.
3
Card work into that program?
4
MS. SANDSTONE:
Does that Blue
So for those rural areas in
5
Nevada, you -- Blue Card really doesn't come into play.
6
comes into play is our network that we negotiated out there.
7
So with Pete's team, we've done a really great job of
8
negotiating with providers out in the rurals.
9
lot of the mines out there.
10
What
We insure a
A lot of the hospitals are
already out there.
11
So actually in the rurals of Nevada, that's
12
actually covered under our HMO network.
13
service standpoint, getting access to the provider network
14
would either be hard copy.
15
directly.
16
customer service and find where a provider is.
17
So from a customer
We can give them to the provider
They could go on-line to search.
They can call
And then, again, the customer service is there to
18
help them understand their benefits, to help them navigate
19
through the system.
20
Somebody might not know what that is, so the customer service
21
reps will be there to help answer those questions for them.
22
I need an EOB.
MEMBER BAILEY:
What is an EOB.
The second part of that, Pete may
23
be involved in this, I don't know.
24
there are very few in the rural areas, what hospitals do you
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What hospitals, because
1
have?
2
MR. SABLE:
I head up to Elko, Northern Nevada,
3
Eastern Regional Medical Center, Humboldt.
4
with, you know, the Nye Regional is very very sad that that
5
had occurred.
6
that we have, Mesa View.
7
We're contracted
We are contracted with every rural hospital
We're everywhere.
And the cool thing is, as Gab said, we have a lot
8
of clients.
We are one of the largest commercial carriers in
9
the rural markets.
So as soon as the billboard goes up that
10
there's a provider coming to town, somebody is opening
11
something up, we're getting four or five phone calls, so
12
we're getting them before they even break ground.
13
And, you know, they are very sensitive markets.
14
They are very very small and they are mature markets and, you
15
know, we do our best to outreach and make sure that as we had
16
said throughout our presentation that they are aware of all
17
of the different components of what we bring to the table for
18
them but understanding that they serve a much smaller area.
19
Does that make sense?
20
MEMBER BAILEY:
Yes.
Now, with the members, how
21
do you communicate with members in the rural counties?
22
you do it by mail?
23
think one of the questions earlier was a lot of our seniors
24
do not have the mechanisms to respond to that, wouldn't even
CAPITOL REPORTERS (775)882-5322
Do you do it by computer?
94
Do
Because I
1
know how.
2
Do you cover that with snail mail or how do you?
MR. MURPHY:
We have snail mail communications.
3
We have e-mail communications and as well as we're working
4
through it.
5
think we're reaching a segment, whether, you know, Amanda
6
back here, that is here, will sit down and will craft some
7
communications and whether -- you know, we'll figure out ways
8
to communicate but, yeah, I mean, we really crossed all
9
methods of communication.
10
11
12
If you're all getting to a point where we don't
MEMBER BAILEY:
Because that's important for our
members.
MR. SABLE:
And we visit the market.
We go into Winnemucca.
So, I mean,
13
we go into Elko.
You know, we visit
14
the hospitals.
We visit the providers.
15
go to Pahrump.
You know, we make sure that we have
16
everything covered.
I go to Mesquite.
17
MEMBER BAILEY:
Okay.
18
MS. SANDSTONE:
We have another neat little
19
communication.
I didn't put it in the presentation.
20
called a Health Note.
21
condition so, you know, a cardiologist, you know, the
22
medications that he takes and the blood work that he takes,
23
those three things trigger a Health Note.
24
out to the member to say, you know, make sure you stay on
CAPITOL REPORTERS (775)882-5322
I
It's
So basically if my husband has a heart
95
That's going to go
1
your medication.
Here's a list of your medications.
Please
2
reach out to customer service if you need anything, and
3
that's snail mail.
4
out to Health Note.
It comes in a nice little note that comes
5
MEMBER BAILEY:
And that's called Health Note?
6
MS. SANDSTONE:
Health Note, yeah, it's called a
7
Health Note.
8
which is actually imbedded into the -- into the HMO program.
9
It's part of our healthy lifestyle program
MEMBER BAILEY:
Okay.
That's it, Mr. Chair.
10
CHAIRMAN DROZDOFF:
Okay.
Jacque?
11
MEMBER EWING-TAYLOR:
12
I just have a couple of questions revolving
Thank you, Mr. Chairman.
13
primarily around pharmacy and the formularies, so this is
14
going to be disruptive to our participants, and I would like
15
to know how you would handle that disruption and help them
16
through that, as well as potentially their providers.
17
physician may find it disruptive as well.
18
The
And the second one, I'll just ask both of them
19
right now, how often do you make formulary changes during the
20
year and how do you communicate that?
21
MS. SANDSTONE:
So I'll start with the first
22
question.
So your first question as far as the formulary, so
23
we quoted on this plan what we call our full four tier
24
formulary, so it is our formulary that we offer to our large
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1
employers, so you got the full one, not the narrow one
2
because there are some smaller network of pharmacy.
3
So our pharmacy is managed through our team and
4
we update our formulary I would say probably quarterly and
5
let's just say a drug comes off patent and it's no longer
6
going to be a brand name and it's going to be drug, what we
7
do is we actually get a list of everybody that would be
8
effected by that.
9
can pay less money.
10
It could be a good thing because now they
You know, it's going off a brand and now
it's going onto -- you know, they can now get it generic.
11
So we'll actually have communication that goes
12
out to every single member and we can even give the PEBP
13
Board a list, here's the member that are effected by X, Y, Z
14
drug if we do decide to move it because sometimes we'll move
15
it forward and sometimes we will move the drug in a different
16
direction, depending upon different recommendations from the
17
pharmacy board.
18
very open about the communication and ensure that the members
19
have plenty of time to see what tier that's going to fall
20
under.
21
So we do manage that quarterly, and we're
MEMBER EWING-TAYLOR:
And so do you plan or can
22
you do something similar to that if you're selected with the
23
changeover because that disruption during that time period
24
that I'm also concerned about.
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1
MS. SANDSTONE:
So if we were awarded the
2
business, what I would ask is give us a list of the
3
medications and especially let's just talk about the high
4
cost drugs is going to be the ones that you're going to be
5
worried about so what are called the specialty drugs.
6
you got someone on, you know, very high cost drugs, some kind
7
of an MS drug or something like that, we want to make sure
8
that we go from the vendor that they are on today to make
9
sure kind of that continuity of care, that we have that
So if
10
continuity of care going over to the new vendor or even prior
11
auths, if we can get a list of say the drugs that have prior
12
auths, we can grant those prior auths once we get that list,
13
and we'll just go ahead and grant those and then after that,
14
then the physicians will resend the auths to Anthem.
15
We can do a 30, 60 or even a 90-day grace period,
16
if you will.
17
that, as long as we can get the information from prior
18
carrier, we can absolutely do that.
19
You know, we will work with you on that to do
As far as the pharmacy chains, I got to believe
20
there's not going to be much disruption.
We have every
21
pharmacy chain.
22
shouldn't be an issue.
23
Let's see if there's any gaps of care.
24
gaps in care in the rurals. I know you got some smaller
CAPITOL REPORTERS (775)882-5322
So from a provider disruption standpoint, it
But, again, let's look at the list.
98
There might be a few
1
pharmacies up here, and we'll let you know if we find any
2
gaps.
3
MR. MURPHY:
The last piece obviously is whether
4
we can with our medical director, we have conversations.
5
medical director has conversations with the treating
6
physician all of the time.
7
you know, a drug that's formulary, if there's special
8
circumstances, we work through those transitions all of the
9
time.
10
Our
If there's a question about a,
You know, it's -- I hate to say, it's not the
11
first group as that comes on.
Continuity of care is really
12
important so the people aren't disrupted, especially those,
13
obviously, specialty drug treatments or any of those things.
14
It's really important.
15
MEMBER EWING-TAYLOR:
16
CHAIRMAN DROZDOFF:
17
have any other questions?
18
No?
That's it.
So before I ask, does anybody
I just have a couple.
So in response to Ms. Saiz's questions about, you
19
know, is this north, south, statewide, you said it could be
20
any of the above.
21
north, south, statewide and if so, why?
22
Do you have a position on what's best,
MR. MURPHY:
I would say it's obviously -- it
23
would be important to us to be able to look at the full
24
state.
I think we operate from border to border.
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There's a
1
recognition that the two areas are very different.
2
3
CHAIRMAN DROZDOFF:
I would say there's three
areas.
4
MR. MURPHY:
Well, three areas, I'm sorry.
The
5
three areas are very different.
6
when you say what is best, I think in any situation where
7
we've looked at the state or any client that's statewide,
8
you're going to come up with different solutions.
9
And so when -- you know,
So I think even if we were awarded the business
10
statewide, which we would work differently around strategies
11
in the north, south, whether it's funding, whether it's
12
benefit design, whether it's the network options and the
13
things that we would want to do.
14
you -- what would you recommend, I would recommend you went
15
with us across the whole state.
16
be --
17
18
CHAIRMAN DROZDOFF:
MR. MURPHY:
20
CHAIRMAN DROZDOFF:
22
I think that would obviously
Yeah, that might have been
the softball.
19
21
So when you say what would
It is, as long as you asked it.
But there's a point in that
one.
MR. MURPHY:
You know, I do think and I
23
understand I think what the point is.
24
the Board and there's an ease for the state to deal with one
CAPITOL REPORTERS (775)882-5322
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There's an ease for
1
vendor and one solution and being able to get used to the
2
tools and all of those things across one vendor, but I
3
believe those markets in those areas are very different but,
4
you know --
5
CHAIRMAN DROZDOFF:
That's really where -- I
6
don't think there's any question that I believe that there's
7
definitely positives to using a vendor statewide, but you did
8
touch on the follow-up that I wanted to take which my be a
9
little bit more difficult, maybe not.
Yeah, because I think
10
there are three different parts of the state, and I like the
11
answer that, you know, you're going to be somewhat flexible
12
or somewhat different depending on where you are, and I think
13
that's as it should be.
14
But I will tell you, you know, we have -- we have
15
folks in these different parts of the state that look at the
16
issue from an equity standpoint and so while I do agree that
17
it makes sense to be as flexible as possible because you have
18
to be given the three different kinds of circumstances you're
19
dealing with in this state, how did you then balance that?
20
How do you balance the flexibility that you want to provide
21
with, if you would, for lack of a better term, equity among
22
all state employees?
23
24
MR. MURPHY:
So what I would say to that and it's
not unlike many of our national accounts that have
CAPITOL REPORTERS (775)882-5322
101
1
employee -- you know, I'll take this from a large standpoint
2
across the country where, you know, we're looking at three
3
different areas of the state where you've got some -- you
4
have got a host of employees in New York.
5
host of employees in Kentucky, in Louisville, Kentucky and
6
you have host of employees in California.
7
same dynamics.
8
9
You have got a
You face those
And I think the balance unfortunately to answer
it specifically is difficult until you get into it and say
10
what are we willing to test?
11
to test?
12
standpoint and how different are the costs in the choice --
13
in the choices that we want to make in the north, the south
14
and the rurals.
15
What boundaries are we willing
How close in equity do we need to be from a benefit
Obviously, in the rurals, there's some rural
16
areas, there isn't a choice.
17
is nothing that you can do to do that unless you're going to
18
send a helicopter and helicopter them to an in-network
19
facility and that balance is something we find together, and
20
we find that together with a lot of our clients, whether they
21
are municipalities or whether they are national accounts or
22
whether they are some of our local accounts.
23
24
You have one facility.
There
Again, we have got multiple accounts locally that
have multi state facilities, and we face this a lot.
CAPITOL REPORTERS (775)882-5322
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You sit
1
down and we talk, and we collaborate.
Okay, what can we
2
push?
3
market maybe use to from a benefit design.
4
more popular and here's what may be palatable.
Here's the differentials in cost.
5
Here's what the
Here's what is
And as we work down that list of things that are
6
palatable, we get to equity because you got to balance that
7
cost in the equity of what people are used to because
8
sometimes you go the other way and you're actually providing
9
a richer or different benefit that is kind of the norm in the
10
market, and we have to get to those things to say this may
11
not be the norm in the market.
12
the area.
13
there's some different things to do because we're managing
14
the disruption of your employees, and that's a very difficult
15
thing to do any time you're making change.
16
difficult.
17
This may not be the norm in
We think we can pull back here.
We think that
Change is very
So, you know, I'm sorry, it's a difficult
18
question to answer, but that's the balance is sitting and
19
working -- sitting down and working with you to say what can
20
and can't we do.
21
CHAIRMAN DROZDOFF:
So maybe this -- again, I'm
22
just sort of edging into it, I think that's correct, but
23
based on your experience in other states, like, what does
24
that process look like? When you say we deal with this
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103
1
together so, like, great, we'll go but how?
2
Do you have routine meetings with staff?
3
catch us catch can based on a specific issue that's brought
4
to your attention?
5
how is that sort of putting the meat on the bones?
6
that happened in the past?
7
What do you do?
Do you do it on a
Like, maybe historically, how is that --
MR. MURPHY:
How has
You know, I think it happens in the
8
past in different ways, depending on the urgency of the
9
client.
So we will get -- we have clients that are concerned
10
about it.
We talk about it in our quarterly meetings as we
11
sit down and discuss those things, but there isn't a real
12
urgency.
13
We have had clients that literally on renewal
14
that Gab has worked with day one of the following benefit
15
year, that we lay out a plan to say this is what our goal is
16
and we can walk through benefit to benefit.
17
takes some time and when you say does it catch us can catch
18
can, absolutely not.
19
work plan over a year that leads up to open enrollment
20
because it's not just changing.
21
changing.
22
formularies.
23
that and so, no, it's sitting down actually and drawing out a
24
plan which we're -- you know, we're use to doing.
CAPITOL REPORTERS (775)882-5322
Sometimes it
We have got to sit down and lay out a
It's communication.
It's funding.
It's
It's continuity of the
It's continuity of doctors and networks and all
104
1
CHAIRMAN DROZDOFF:
Your focus initially will be
2
to provide for and ensure that there is as little disruption
3
as possible and then on a very routine basis once you're
4
satisfied and we're satisfied that that is satisfied that
5
then you will move to evaluating or testing as you put the
6
specifics and the specific features in the market place.
7
MR. MURPHY:
Yeah, you know, the reporting that
8
Gabrielle talked about really is where we start.
9
and we sit down and we go through the analytics to say here
10
is where we think some of the hotspots and cost are coming
11
from, either because of the utilization and the things that
12
we're seeing.
13
You know,
Those reports are shared with you all of the
14
time, and then it's working through, talking about plan
15
design of, you know, if we're talking about plan design
16
equity between the north and the south, it's sitting down,
17
hey, let's look at the differentials here.
18
sheeting these things out and sitting down with the team of
19
folks and working, but it starts with data, and it starts
20
with talking about utilization and are there those things
21
that are popping out?
22
and do we want to curb them because, again, we can curb it.
23
Here's what the solution is.
24
disruption to find the solution and that's where we sit
CAPITOL REPORTERS (775)882-5322
Can we curb them?
It's spread
How do we curb them
Are we willing to take that
105
1
together, and we talk about it as a team, but that's kind of
2
how the process would work.
3
4
CHAIRMAN DROZDOFF:
else?
Do you have anything
Anything else down south?
5
MEMBER GARCIA:
6
CHAIRMAN DROZDOFF:
7
MR. MURPHY:
8
Okay.
No, we're fine down here.
Okay.
Thank you very much.
I appreciate the time.
Thank you
very much.
9
CHAIRMAN DROZDOFF:
10
Okay.
Give me one second.
So here's what we're going to do, we do
11
have three, and I'm always mindful of time, and we have some
12
Board members that have issues.
13
MS. BURCHETT:
14
MEMBER SAIZ:
15
MS. BURCHETT:
16
Judy on this.
We're kind of loose on this.
and the revised score.
We have the initial score
Don't we get to revise?
MS. BURCHETT:
Do all of the scoring for all of
the -- I'm game for anything.
23
24
Yeah, I kind of agree with
MEMBER EWING-TAYLOR:
21
22
Well, you just heard a
CHAIRMAN DROZDOFF:
19
20
We don't know yet.
presentation so I need the scores.
17
18
I need to get the scores for this.
CHAIRMAN DROZDOFF:
Board.
Okay.
I'm hearing from my
They prefer -CAPITOL REPORTERS (775)882-5322
106
1
2
MS. BURCHETT:
end.
3
4
CHAIRMAN DROZDOFF:
at the end.
5
6
To do all of the scores at the
-- to do all of the scoring
I agree with you.
So let's take a break.
It is 12:20 and come back
in an hour, and we'll get to the next three.
7
(Whereupon, a brief recess was taken.)
8
CHAIRMAN DROZDOFF:
9
10
and get started.
Mr. Chair, we need to have
somebody unlock the screen for us.
CHAIRMAN DROZDOFF:
As we're doing that, would
you like to introduce your team?
15
16
The vice chair, Ms. Ewing-Taylor, is in
MS. BURCHETT:
13
14
We will get back
another meeting, but she should be back shortly.
11
12
All right.
MR. MILLER:
Good afternoon.
My name is Marcus
Miller.
17
CHAIRMAN DROZDOFF:
18
MR. MILLER:
You need to press the button.
Good afternoon.
My name is Marcus
19
Miller.
I'm the CEO of Prominence Health Plan.
20
today is Glenn Padillo, our vice president's marketing.
21
have Nelson Leatherwood, director of sales, Rayne Niehaus, VP
22
of operations and also in charge of our TPA subsidiary.
23
we are fortunate enough to get the contract, Rayne Niehaus
24
will be in charge of implementation.
CAPITOL REPORTERS (775)882-5322
107
With me
We
If
1
Then we have our chief medical officer, Dr. Ron
2
Rowes.
3
officer, and we also have Lisa Foster here that's on our
4
Prominence team that some of you might know.
5
And behind me is Dave Challis, our chief financial
So we -- agenda -- once we get the computer
6
going, there's an introduction to our Prominence team which I
7
think you have it now.
8
Prominence, proposal highlights, service highlights and
9
health care services.
10
Then we'll talk about who is
So if you go to the slide who is Prominence
11
Health Plan, Prominence was established in 1993 in Reno as --
12
and was known as Saint Mary's Health Plan.
13
2014, Saint Mary's Health Plan was acquired by Universal
14
Health Services and renamed Prominence and so since June
15
2014, we are called Prominence.
16
On June 1st,
I have known Saint Mary's history.
I came with
17
the acquisition.
18
need to say Nevada and not Nevada.
19
been here ever since last June.
20
from Switzerland, so I like the mountains and all of the
21
other things that go with it.
22
One of the first things I heard is that I
And I can tell you I've
I love it.
I'm originally
UHS as we commonly refer to is a very large
23
organization.
It runs basically acute care hospitals and
24
behavioral health facilities in Northern Nevada.
CAPITOL REPORTERS (775)882-5322
108
They own
1
Northern Nevada Medical Center which is part of our network.
2
The other two key hospitals in Northern Nevada are Saint
3
Mary's Hospital and Carson-Tahoe, and then UHS also owns the
4
Las Vegas largest health system of five hospitals and the
5
sixth one is supposed to open in Henderson in September 2016.
6
In addition to HMO Prominence, we also offer
7
point of service, PPO.
We have a fair party administrator,
8
and we are also participating in the Exchange.
9
know, the open enrollment is still continuing on that
And, as you
10
Exchange, and then we also have Medicare advantage plans in
11
Nevada and in Texas.
12
So the transition from Saint Mary's to
13
Prominence, we were trying to accomplish a couple of things.
14
One is to keep the strengths that Saint Mary's Health Plan
15
had and that is the localness connection to Nevada, the
16
strong customer service reputation and the strong provider
17
and that works what we have so none of that has changed.
18
We were also determined to fix the weaknesses so
19
a financial strain of UHS, we have very significant resources
20
and commitments behind us.
21
the technology ever since we started on June 1st, 2014, and
22
with the acquisition, of course, also the barriers to
23
providing some services disappeared.
24
be provided because of Catholic directives. That is gone.
CAPITOL REPORTERS (775)882-5322
Technology, we're also upgrading
109
Both services could not
1
There are no limitations.
2
that need to be -- need to be current in the health plan.
3
So we have all services available
So what we have today is essentially a very
4
strong health plan financially.
5
focused, and we do well in competitions.
6
much into having exclusive deals.
7
competition is actually a good thing for the communities that
8
we serve.
9
10
We are very customer
We are not very
We believe that
So with that, I'm going to pass it on to Glenn.
MR. PADILLO:
Good afternoon.
I'll talk a little
11
bit about just a few highlights on our proposal and then also
12
focus on some of our service related items and what we think
13
is the uniqueness to our proposal for the state.
14
As Marcus said, we promote choice, and we promote
15
competition, and the proposal that we have provided mirrors
16
that philosophy where we have provided regional HMO high
17
deductible health plans for both -- for all regions so that
18
you can make a decision if you want to offer those plans
19
along side another carrier, and that way you'll have more
20
than one option.
21
certainly with the makeup of the communities that are in play
22
right now, it gives different delivery systems in addition to
23
different carriers, so you open up that flexibility and
24
opportunity for employees to make decisions.
CAPITOL REPORTERS (775)882-5322
It will give your employees a choice and
110
1
In addition to that, we think as Marcus said,
2
when the competition is in play, it's good for the client.
3
It's good for the consumer.
4
makes all of us stronger and has some impact on what I think
5
you'll see in future cost controls and premium increases
6
because competition will drive everybody to be more
7
competitive.
It makes all of us better and
8
In addition to that, if you should decide to
9
award a bid to just one carrier, we provided options for
10
that, both in all regions where we've had HMO plans that are
11
designed very similar to what your HMO plans that exist
12
today.
13
And then in addition to that, we took a look at
14
the plans primarily in the north and the south, and we
15
blended them to bring both plans kind of closer to the middle
16
so that should you choose to offer a statewide plan that has
17
the same benefits for all regions that that would also be an
18
option to give you some additional flexibility, as well, and
19
those options are assuming that Prominence would be the only
20
carrier.
21
I want to focus the rest of my time on service
22
because that's what Marcus had said is going to differentiate
23
us is our approach to service.
24
corporate offices still remain in Reno. We still provide
CAPITOL REPORTERS (775)882-5322
And just as a reminder, our
111
1
local services for claims, billing, enrollment, customer
2
service, local management for our medical team and also our
3
relationship with our providers is handled locally in each of
4
our communities.
5
But what really sets us apart in this proposal is
6
a very unique and innovative feature that's exclusive to
7
Prominence Health plan and cannot be provided by anyone else.
8
It's a very consumer centric approach to member engagement
9
and that we should have a significant impact both on cost and
10
quality in the upcoming years.
And this is accomplished
11
through our integration with Accolade which is a highly
12
innovative company around decision support and personalized
13
engagement with all of our members and their families.
14
It's a program that is offered to customers such
15
as Comcast, Lowe's, time Warner, Blue Cross and Blue Shield,
16
just to mention a few of them, and what's really unique about
17
it is that we would give every state employee and every
18
member of their family the opportunity to have their own
19
personal health assistant, and that is a person that they
20
build a relationship with over the time that they are insured
21
with us.
22
phone numbers.
23
navigate through the health care which for a lot of people
24
can be very complex.
CAPITOL REPORTERS (775)882-5322
They get their contact information, their e-mails,
It's their person that they can reach out to
112
1
They personally help them with all of the issues
2
related to health care.
3
They help them become better informed and when they become
4
better informed, employees have a tendency to make better
5
choices, fewer errors within the system, see the right
6
providers at the right time.
7
They educate them on their benefits.
One of the unique features is that the personal
8
health assistance goal is really to engage everyone early so
9
instead of waiting for a phone call to come in and kind of
10
deal with things on the back end, the personal health
11
assistant looks for ways to engage customers and the members
12
early.
13
kind of highlight because it's very hard just to kind of show
14
you from a power point, but I was able to listen to some
15
calls that one of our call centers, and I got a couple of
16
experiences that are really different than what I've ever
17
seen before.
18
the carrier side, and I've never quite seen this type of
19
approach to customer service.
20
And I'll give you a few examples in a minute that
I've been doing this for about 30 years all on
I'll give you a perfect example.
Their goal,
21
they want to get involved early so they can provide a lot of
22
information, support, direction, engage them in decisions
23
about their health care and then help them coordinate it.
24
They kind of become the eyes, the ears and the legs of the
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1
members that we serve, so they help them navigate a health
2
care system.
3
And the two examples that I have that I thought
4
were very very different, one was an inbound call.
5
with a personal health assistant, was listening at the call
6
center.
7
new ID card.
8
you.
9
new ID card.
10
I sat
Somebody called in and said I would like to order a
Typical insurance company would be, okay, thank
Let me validate the new information.
I requested an
In seven to ten days you should have it in the
mail.
11
It started out that way.
Let me validate so far
12
information.
I'm looking up your benefits now, and then the
13
whole process changed where the personal health assistant
14
said, so, tell me what's going on.
15
card?
16
I can help you with that.
17
on.
18
I can put you in touch with the right provider.
19
something in your life maybe we can talk about that will help
20
me understand what type of provider you want to see.
21
They are a little hesitant.
Why do you need a new ID
Well, you know, I just need to see a provider.
Well,
Why don't you tell me what's going
You know, is there something I can help you with.
Maybe
Is there
She said, okay, I'm
22
ordering your ID card, asked another question, and finally
23
the person on the phone said, well, I'm having some financial
24
troubles.
I'm in jeopardy of losing my home.
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I really want
1
to talk to a counselor, but I don't know how to go about it,
2
that's why I was looking for my ID card.
3
The nurse on the phone says, well, let me ask you
4
a few questions, and she started asking questions about what
5
had happened, and then she pulled up the benefits, and
6
they're looking at the benefits.
7
have some telephonic counseling services.
8
like, if you are ready to talk to someone, why don't I
9
connect you with a counselor right now.
10
And she said, you know, you
So if you would
The person said that would be great, clicks the
11
phone line, connects with the counselor, does a nice soft
12
transfer, introduces the member, puts them on a line with a
13
counselor and disconnects.
14
minutes.
15
be about a 30 second phone call.
16
in the mail.
17
additional questions.
18
The phone call took about ten
Typically, at a customer service center, that would
Thank you very much.
Here's your ID card.
It's
Call us if you have any
And then the more impressive one I saw was an
19
outbound call.
Each of the personal health assistants keep
20
what they call is a portfolio of clients, and that portfolio
21
of clients includes people who have a high utilization of
22
services, you know, the 20 percent that use 80 percent of the
23
care.
24
those clients that they serve.
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They make outbound calls every month to each one of
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1
And so I sat with a nurse one day, and she pulled
2
up a list of clients, and she said pick one.
3
not getting set up, I'll call a relative or somebody.
4
calling anybody on the list I want to call.
5
person.
6
answers the phone and says, hey, Mary, how you doing?
7
assuming he had an iPhone, cell phone, had her name and phone
8
number saved, saw who it was, knew the person would had
9
called.
I'll say his name is Bob.
10
So I figure I'm
She's
So I pick a
She dials the phone.
Bob
So I'm
Mary is sitting at a desk with two computer
11
screens up, one screen are all of Bob's benefits.
12
screen are all of this personal information, including notes
13
from all of their conversations they have had over the last
14
year, year and a half.
15
with her is much different because they built this
16
relationship over time.
17
The other
He's a client, so his interaction
So she starts talking to him.
I want to check in with you.
Hey, Bob, how are
18
you feeling?
It's been a month
19
since we talked.
He starts telling, well, I'm still dealing
20
with this issue.
I'm still kind of losing my balance.
21
it looks like you were supposed to get some services.
22
you get some tests a couple of weeks ago?
23
results?
24
supposed to let me know. They said I should be going for
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Didn't
What were the
I haven't really got the results yet.
116
Well,
They are
1
some more tests.
2
Well, have you got those tests scheduled?
No, I
3
don't have the tests scheduled yet.
Well, you know, I see
4
here, Bob, you're still playing football, excuse me, hockey
5
on Thursday night.
6
you aren't going to be able to make those hockey games.
7
why don't we get on the phone with the provider.
So if we don't get this taken care of,
So
8
Can I call your provider for you right now, gets
9
on the phone, calls the provider, does a three-way call with
10
Bob and the provider.
11
about Bob.
12
tests and gives out test results.
13
calling, it went right through.
14
nurse's station.
15
Bob on the phone.
16
This is so and so.
I'm here to talk
I would like to speak to your nurse who schedules
And because it was a nurse
They put him through to a
They get the nurse on the phone.
Bob says hello.
I've got
I'm looking for my test results.
17
They get the test results.
She helps explain the test
18
results.
19
test that's not scheduled yet.
20
scheduled while Bob is on the phone.
21
get it scheduled.
22
from customer service are still on the phone call talking.
I understand Bob is supposed to go in for another
Can we get that test
The nurse hangs up.
They work it out and
Bob and the nurse
23
Now she's asking about Bob's wife who is in her
24
third trimester of pregnancy that had fallen and broken her
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leg.
All of the notes in the system about everything going
2
on with Bob, they talk about that for a while.
3
finally said I'll check back with you in a couple of weeks to
4
see how things are going.
5
looking around and being in customer service centers, you see
6
the timers up on, you know, call waiting and there's nothing
7
like that.
8
9
And then they
She hung up the phone.
And I'm
And I look at the phone and the only clock is the
phone clock that tells you how long the call was.
She was on
10
the call for 25 minutes.
11
client to help them get test results, schedule another
12
appointment, check on their spouse to see how everything was.
13
And every person who's insured with us has the opportunity to
14
have that kind of one on one relationship with a personal
15
health assistant who are backed up by a full clinical team.
16
So when the conversations get too complicated, they will
17
bring in a nurse or physician to help answer some questions.
18
She spent 25 minutes with one
So what do you wind up for all of that?
Well,
19
there's a lot of metrics we look at, but I want to focus on a
20
couple of things what I think are the important ones.
21
65 percent of all people get in contact with the personal
22
health assistant so almost two-thirds of all employees.
23
not mandatory.
24
process.
It's not required, but it's an education
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It's
1
When they call customer service, as most people
2
will, they get introduced to their personal health assistant.
3
67 percent of all of the contacts happen prior to them
4
seeking care.
5
relationship, they start to see that there's advantages to
6
ask questions ahead of time.
7
before somebody seeing a doctor or looking for services, they
8
are talking to the personal health assistant.
9
So as they get engaged with this trusted
So two-thirds of the time
Over 90 percent of all of the health care costs
10
that accumulate throughout the year occur through these
11
discussions with their health -- their personal health
12
assistant.
13
population, you're dealing with 90 percent of the cost.
14
Utilization trends change, and I'll show you a slide in just
15
a minute here.
16
So the interaction when it's two-thirds of the
They make 23 contacts a year with people like Bob
17
who have chronic conditions either inbound calls or the
18
required outbound monthly calls, and the customer
19
satisfaction rating is 99 percent client satisfaction and 70
20
net promote a score which is another way of looking at
21
customer satisfaction, that's in the range of Google and
22
Amazon.
23
range in that area.
24
Typical insurance companies are in ten to 15 percent
So where does this all lead at the end?
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I mean,
1
ultimately it improves in customer service.
It includes the
2
client level of satisfaction but in the long term, there's a
3
cost savings associated with this.
4
care, the right setting, the right time, seeing the right
5
providers, and this slide talks about over an 18 month period
6
when Accolade first launched with a client that there was
7
over that 18-month window an eight percent savings in cost
8
versus a control population.
People getting the right
9
So they gradually introduced Accolade to all of
10
the employees and compared the results of the employees who
11
worked with the personal health assistant versus those who
12
didn't, and there was an eight percent savings in cost.
13
Utilization went down for inpatient hospitals, outpatient
14
hospitals, surgery, X-ray and lab but went up for outpatient
15
behavioral health and pharmacy, services that are more
16
readily available, that are more direct purchase that are
17
available by phone and could be impactful in a quicker
18
orientation than some of the other services.
19
So in looking at our proposal, when you see cost,
20
you see options.
21
very unique approach to customer service that cannot be
22
duplicated by anyone else because it's exclusive to us.
23
24
You see choices.
MR. ROWES:
And for us, you see the
Supplementing what we consider a very
strong networks of providers, we have also contracted with
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1
Centers of Excellence in states around Nevada, in terms of
2
Utah, California, Arizona and as far away as Texas for
3
certain services.
4
some of these families going to these outside Centers of
5
Excellence and we're willing to underwrite those expenses in
6
terms of travel, lodging and meals.
7
We understand that costs can run high for
There is only one constant in health care and
8
that constant is change.
9
that occur during the health care process as painless as
10
It is our goal to make the changes
possible.
11
Glenn has gone out of his way to explain to you
12
our personal assistant program and care management that every
13
member is assigned and can access on their own.
14
important to uphold the triple aim idea of the right place,
15
service at the right place at the right time and the right
16
care.
17
This is very
We also understand that in any transition of
18
care, there is transition to new physicians, and we are
19
putting together openings in every physicians' schedule to
20
accommodate their new members coming in, so there will be as
21
little problem gaining access as possible.
22
Coordination of authorizations for the scheduled
23
procedures are part of our process, and we also have 24/7
24
nurse hotline, as well as telemedicine availability.
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Quality is the only currency now being negotiated
2
in health care, and that is the currency that we demand that
3
our providers give.
4
Medical management as we touched or care
5
management as it may be known is part of our individual care
6
management program and if you think that what we're talking
7
about today is all about disease, you're wrong.
8
What we know is that the psychosocial aspects of
9
every individual affect their ability to effectively and
10
efficiently interact with the health care system, that is
11
what care management is about.
12
individual care managers are about.
13
That's what personalized
We understand that there are rural areas that do
14
not have access directly to care, but we do offer
15
telemedicine and in addition, I am presently negotiating with
16
both the individual nurse practitioners to look at areas that
17
are associated with federally funded programs such as FCQA's,
18
the Veteran's Administration and India Health Resources that
19
can bring resources to areas that do not have provider
20
services.
21
I'm also discussing with an ambulance service
22
that is presently just completing a federal grant in point of
23
a contact of ambulances, whether they will triage to
24
hospitals or doctor's offices or urgent care centers as need
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1
be and thus enable us again in areas that are underserved to
2
bring services that presently aren't available or minimally
3
available.
4
And so I think Prominence health care is looking
5
not at health care in 2016 but looking beyond in terms of the
6
care management, in terms of the triple aim goals that we
7
have and developing that and coordinating that with the
8
personal assistance who -- who will affect care management
9
and get our patients the right care at the right time at the
10
right place.
11
Thank you.
MR. MILLER:
So in closing, let me just summarize
12
a couple of things.
13
care, at least if you look at our own experience, I think
14
what you want to have is you want to have a company that
15
underwrites your program that's going to stay in business and
16
they will actually deliver, so that's I think a fair two
17
points, strong ownership and support from Universal Health
18
Services, and then you have the benefit design that is
19
providing a flexibility in our case benefit design is
20
essentially mirroring what you now have.
21
adding the high deductible plans that could be offered along
22
side.
23
24
At the end of the day, I think health
Plus, we are also
But then as long as you have made the selection,
it is, okay, what happens if you need service or your
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1
employees, where dependents need service, and that's where
2
local administration comes in.
3
service as we believe in with Accolade for health services
4
comes in, completely different experience, and I can tell you
5
that those employees are not evaluated like a typical call
6
center employee.
7
average talk time absolutely not.
8
9
That's where we, customer
How many calls do they take?
It's between
It's completely different.
And then it's all that matters at the end it is
really every member has an individual issue at the call
10
center and that needs to be addressed.
11
company potentially but at the end, it is really the
12
individual that matters, and that's what we are focused on
13
because if we do that right, then the plan will be
14
successful.
15
16
So thank you again for having us here, and we are
happy to answer whatever questions you have.
17
18
Yes, big insurance
CHAIRMAN DROZDOFF:
Thank you.
We appreciate you
being here very much.
19
So I think what we'll do is we'll sort of what we
20
did earlier.
We'll give each Board member an opportunity to
21
ask a series of questions and see where that takes us.
22
So, again, Judy, I'll start with you.
23
MEMBER SAIZ:
24
I have a few questions. One of them is
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Judy Saiz for the record.
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1
reporting, do you offer monthly reporting, loss experience,
2
and do you offer that on a regular basis or just quarterly
3
or?
4
MR. PADILLO:
5
MR. MILLER:
We would do that monthly.
We also have a talk availability or
6
whatever.
Our analytic engines that we use is called Versik,
7
V-e-r-s-i-k and so that, you know, for example, if you're
8
interested in the illness program by member, if you want to
9
go to five or ten percent that really create the high cost,
10
they can do that.
11
to identify care gaps.
12
care physician.
13
We can do physician profiling.
We use it
So then we can go back to primary
Actually, if a customer service approach we have
14
it, we're going to go at it two ways.
15
through Accolade to contact to a member.
16
primary care physician, and we try to connect both of them to
17
get those care gaps taken care of.
18
MEMBER SAIZ:
Okay.
We are going to go
We will contact the
So Accolade, you spoke a lot
19
about Accolade.
I have a couple of questions about that.
20
What are the qualifications of these sisters?
21
proposal that you have different levels, and you have your
22
immediate level of sisters and then it transitions to like
23
nurses or whatever, the doctors.
24
people that are talking to the clients, what are their
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I read in your
But what are the basic
1
qualifications and where are they located?
2
MR. MILLER:
About one-third of those health
3
assistants are actually RN's.
4
and different backgrounds.
5
looking for people that have -- that are good listeners and
6
have empathy, and it's a very vigorous process.
7
essentially have been at this for seven or eight years.
8
a period of time, they have developed to identify what it
9
takes.
10
The rest of them have various
What Accolade does is they are
I
Over
It's a very difficult hiring process and a very
difficult firing process.
11
So for example, one of the standard questions
12
that I ask applicants is, okay, you got this member on the
13
phone.
14
learned that my 12-year-old daughter has terminal cancer.
15
How do I tell her that?
16
and so that's what we're looking at.
17
It's a mother and she calls you up and said I just
It's one of the interview questions
Then they are set up in cubes, in carriers, so
18
outline is backed up by medical personnel, if needed by
19
social workers and by psychologists to address whatever
20
particular topic is.
21
The health assistants themselves are only on the
22
phone for two hours at a time.
Do not burn them out because
23
as you can imagine when you go past ID cards or claim issues,
24
you wind up with having some very difficult, draining
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1
conversations.
2
and recover.
3
Staff, Arizona.
4
So they give them a chance to kind of process
The call center that we are using is in Flag
MEMBER SAIZ:
So if these guys are only on the
5
phone a couple of hours at a time, how can you ensure they
6
get the same sister every time they call in.
7
MR. MILLER:
You have an option when you call.
8
You can leave on a voice mail and then that person calls you
9
back or if you prefer not to wait, you talk to whoever is on
10
the phone but because of CRM tool that's specialized,
11
everybody that will talk will have a whole history, but the
12
call really is to connect with as much as possible with the
13
same health assistant that's feasible, but there may be
14
situations where you just would like to get an answer right
15
now, and so then they whoever is available.
16
17
18
MEMBER SAIZ:
just realized that.
Sorry, I didn't have my mike on.
I
Sorry, Las Vegas.
Can you off the top of your head tell me how many
19
public sector clients you have in Nevada?
20
Rayne, you might.
21
MS. NIEHAUS:
Four.
22
MEMBER SAIZ:
Bodies or something?
23
MR. MILLER:
24
MS. NIEHAUS: I'm sorry, could you ask the
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Microphone.
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1
question again.
2
3
MEMBER SAIZ:
I think I saw you proposal.
It was
7,000 public sector clients in Nevada, is that true?
4
MS. NIEHAUS:
Yes.
5
MEMBER SAIZ:
Okay.
And then if you -- I think
6
you saw where you would be the dedicated person, do the
7
implementation and who would PEBP's client be?
8
be, sorry, account manager, would there be a separate one
9
north, south?
10
Would there be one?
Would there
How would you envision
that?
11
MS. NIEHAUS:
Well, for north and south, you
12
would each have one for each area is how we would set up the
13
account management.
14
MEMBER SAIZ:
Okay.
15
MS. NIEHAUS:
Each region, each area has
16
different issues so that's how we would set it up.
17
MEMBER SAIZ:
18
questions.
19
the plan that you set up?
20
21
22
Okay.
Just a couple of more
Do you need referrals to go to a specialist on
MR. PADILLO:
Not in the north but in the south
there would be.
CHAIRMAN DROZDOFF:
So for the folks in Las
23
Vegas, I don't know if you heard that, but the question about
24
closed or open or do you need a referral is in the north you
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1
do not, in the south you do.
2
MEMBER GARCIA:
3
MEMBER COCHRAN:
4
MEMBER SAIZ:
We got that.
Yeah, we got that.
Can you tell me briefly, you're
5
NCQA accredited in your network.
6
Mary's in Northern Nevada in Reno?
Up here you have Saint
7
MR. PADILLO:
Yes, we do.
8
MEMBER SAIZ:
And Carson-Tahoe Hospital, I know,
9
down south, I know.
10
11
You have down south.
MR. PADILLA:
We also have the Saint Rose
MEMBER SAIZ:
One question about your wellness
facility.
12
13
program, you mentioned wellness.
14
of what you would offer us for the wellness program.
15
MR. ROWES:
16
MEMBER SAIZ:
Can you give me a synopsis
Sure.
And it would be an inhouse one,
17
right, just what am I trying to say, no additional cost
18
wellness.
19
MR. ROWES:
Right, all of this is no additional
20
cost.
We do have in-house three coaches, two dieticians, one
21
tobacco sensationist.
22
providers' offices, as well as the hospitals to develop
23
wellness programs for the patients centered around -- some of
24
this being centered around disease management but also
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They are outreaching to both the
129
1
reaching out to all of our members in terms of what is
2
important to them.
3
One of the things that you find that when you're
4
developing programs, it's really a matter of what's important
5
to the individual.
6
the best thing for you but that may not be what you want.
7
You think you're -- you may want more dietary advice or you
8
may want smoking sensation.
9
having available the programs to reach out to the individual
10
and what is important to them in terms of, if you will, their
11
care plan, and every member will have a care plan.
12
13
I could tell you that going to the gym is
MEMBER SAIZ:
It's really individualizing and
I think that was it for my
questions.
14
CHAIRMAN DROZDOFF:
Okay.
Anna?
15
MEMBER ANDREWS:
16
I have a couple of questions.
Anna Andrews for the record.
The first one is
17
availability in the rural areas, particularly, you know, the
18
counties that are not necessarily tied to the north or the
19
south.
20
And the second question would be about how do you
21
reach out to the membership that doesn't necessarily use
22
smart technology, PC's and how can you ensure that they have
23
the same level of care as those of us who might have a
24
computer, a smart phone, et cetera?
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MR. ROWES:
Well, basically, number one, we can
2
go out to the areas, and I have a masters in public health.
3
One of the basic tenants is you reach out to community
4
leaders and you reach out to those communities that may not
5
have the same resources as what you're talking about that are
6
underserved, and so you reach out to those areas.
7
it by mail obviously.
8
if need be.
9
We can do
We can reach out on a personal level
We do have telemedicine.
We do -- and as I told you before, we are
10
reaching out to the individual nurse practitioners, as well
11
as the -- the federal granted ambulance service programs that
12
may bring additional outreach to these areas that are
13
presently underserved.
14
Does that answer the question that --
15
So we're very sensitive to that.
MEMBER ANDREWS:
As a follow-up, I want to know
16
what hospitals or practitioners do you have in the rural
17
areas, for instance, Nye County or, you know, the smaller,
18
Humboldt County, the smaller counties that we have in Nevada?
19
MR. LEATHERWOOD:
We have a list of the number of
20
facilities and locations in our RFP, but we have Humboldt
21
County, Lyon County and Nye.
22
hospital facility.
23
hospital facility, we pretty much contracted with them
24
already.
In Pahrump, we have that
And pretty much wherever there is a
I'm not so sure that there's any out there that we
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haven't.
2
There's about four counties that we don't have
3
any affiliation with, but I don't think there's anything in
4
those counties, such as Mineral and Esmeralda and Pershing.
5
And some of them, like Storey County, doesn't have a location
6
but they are closely accessible to Carson and Reno.
7
pretty well have, I think if the facility is available, we
8
have them contracted.
9
So we
We even have I believe in Bishop, I think we have
10
a hospital there.
11
there's someone in that part of the state that needs to
12
quickly access care, we have those facilities as well.
13
14
So if there's -- that's contracted.
MEMBER SAIZ:
Mr. Chair, can I ask something
quickly?
15
CHAIRMAN DROZDOFF:
16
MEMBER SAIZ:
17
just to clarify.
MR. LEATHERWOOD:
19
MEMBER SAIZ:
there, I know.
So I know you do.
MR. LEATHERWOOD:
22
MEMBER SAIZ:
24
We may very well have.
Hawthorne, because I have clients
21
23
Sure.
I think you have Mineral County,
18
20
So if
Oh, okay.
Just to clarify, so you know that
there are fewer counties that they don't have coverage in.
MEMBER ANDREWS: Just a follow-up, you said
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1
Bishop, that's in California.
Do the members, are they
2
treated like they are in-network?
3
MR. PADILLO:
4
MEMBER ANDREWS:
5
CHAIRMAN DROZDOFF:
6
MEMBER EWING-TAYLOR:
They not treated out.
I believe they are in-network.
That's all I have, Mr. Chair.
Okay.
Another follow-up to Anna's
7
and Judy's.
So I'm looking at your proposal where you list
8
the number of acute care facilities you have by county and
9
removing the three counties that you double counted, you
10
indicate that you got three hospitals in Washoe and two in
11
Carson and yet when I heard you talking about them, I heard
12
two in Washoe and one in Carson.
13
those five are?
14
MR. LEATHERWOOD:
15
MEMBER EWING-TAYLOR:
16
MR. LEATHERWOOD:
17
MEMBER EWING-TAYLOR:
18
MR. LEATHERWOOD:
19
MEMBER EWING-TAYLOR:
20
list three in Washoe, West Hill?
21
22
23
24
MR. LEATHERWOOD:
So can you tell me what
Northern Nevada Medical Center.
One.
Saint Mary's.
Two.
And Carson-Tahoe.
That's not Washoe.
You
Oh, the behavioral health, West
Hill.
MEMBER EWING-TAYLOR:
I didn't realize that's
considered acute care. Okay. And then what are the two in
CAPITOL REPORTERS (775)882-5322
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1
Carson?
2
MR. LEATHERWOOD:
3
MEMBER EWING-TAYLOR:
4
Douglas?
5
do have Barton?
Carson-Tahoe and then Barton?
Barton Memorial, is that in
And you list zero in Douglas.
6
MR. LEATHERWOOD:
7
MEMBER EWING-TAYLOR:
8
in Douglas, that's a good thing.
Carson Valley?
You
Yes.
But you didn't list anybody
Okay.
9
CHAIRMAN DROZDOFF:
10
down south now to Chris and then Rosalie.
11
MEMBER GARCIA:
12
I have a question.
Okay.
Thank you.
Hi.
So we're going to go
This is Rosalie Garcia.
I just -- thank you.
I had
13
one -- I needed a clarification.
14
slides you mentioned or stated that, and I could have gotten
15
this wrong, you will supplement out of state care travel; is
16
that correct?
17
MR. LEATHERWOOD:
In one of the beginning
Yes, Centers of Excellence, we
18
will actually pay up to 35, I believe it's 3,500 -- 3,000 to
19
cover family members that need to be transported and stay in
20
a facility if the member is sent to a Center of Excellence,
21
like Salt Lake City or California or Arizona.
22
23
24
MEMBER GARCIA:
And is there pre-approval
required for that?
MR. LEATHERWOOD: Yes, there is a
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1
pre-authorization based upon the needs of the individual.
2
MEMBER GARCIA:
Thank you very much.
3
MEMBER COCHRAN:
4
I'm curious about this high deductible HMO, how
For the record, Chris Cochran.
5
does that work?
It strikes me as being -- going against the
6
grain of what an HMO is about.
7
MR. LEATHERWOOD:
8
MEMBER COCHRAN:
9
10
Well, the HMO -Did I see in your proposal --
didn't I see something in your proposal about high deductible
HMO?
11
MR. LEATHERWOOD:
Yes, we are offering -- we
12
actually have four that we're offering as options that the
13
state can select one or two.
14
north region, south region or and/or both up to two of the
15
plans and they vary in deductible, but it works just the
16
same.
17
a high deductible health plan, as well.
18
They can select it for the
I belive on your self-funded indemnity side, you have
And we have proposed the same very similar
19
various deductible plan options because we believe that not
20
only in the PPO or indemnity side, the HMO attracts the
21
people that want to manage their care.
22
involved in the selection process of their expenses, and so
23
this makes that available.
24
is a 2,500 dollar deductible. One is 3,000. One is 4,000
CAPITOL REPORTERS (775)882-5322
They want to be more
We have proposed four plans.
135
One
1
and one is 5,000 and, of course, the rates vary.
2
as if --
3
MEMBER COCHRAN:
4
CHAIRMAN DROZDOFF:
5
second.
6
off, other than you.
Are reduced
So they would pay -Hold on, Chris.
Chris, one
Can you ask the folks down there to turn their mike
7
Thank you.
Now go ahead, Chris.
Now we lost you, Chris.
8
Well, I guess we lost you so I guess I'm just going to ask
9
that there not be any kind of side chatter, if you would,
10
while that mike is on.
11
MEMBER COCHRAN:
Okay.
12
CHAIRMAN DROZDOFF:
13
MEMBER COCHRAN:
Can you hear me now?
Yes.
All right.
So the -- so this
14
works in terms of a patient would go to one of the providers
15
within the plan.
16
They would pay that out of pocket before their co-pay would
17
be kicking in down the road once they met the deductible.
18
They would pay what an established rate.
MR. LEATHERWOOD:
Let's use for example our HD
19
Core One, HMO HD Core One plan, 2,500 dollar deductible, so
20
they would access the service in-network HMO physicians and
21
hospitals.
22
our contracted fee and that would go toward the deductible of
23
the 2,500.
24
The expenses that they would be charged would be
The way our HMO high deductible plans work, we -CAPITOL REPORTERS (775)882-5322
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1
it's a 2,500 dollar deductible and then two times for family
2
but the deductible with us is what we call an embedded
3
deductible.
4
but if one individual goes into the hospital or is incurring
5
medical expenses, they are only subject to the single portion
6
of that which is 2,500.
7
So you may have a 5,000 dollar family deductible
The balance for the family can be made up or
8
satisfied through a combination of the remaining family
9
members.
So it's significantly a better benefit than if you
10
have a non-embedded deductible, which means if you have 2,500
11
single, 5,000 for a single with a non embedded deductible,
12
one person goes in and they have to satisfy the family
13
deductible.
14
satisfy the single.
15
With us, it's embedded so they don't have to
MEMBER COCHRAN:
So as a follow-up, I would
16
assume then that the cost of that plan would be significantly
17
less than the regular HMO, correct?
18
MR. LEATHERWOOD:
19
MEMBER COCHRAN:
20
your packet?
21
deductible plans.
22
That's correct.
Okay.
I didn't notice.
MR. LEATHERWOOD:
Are the fees included in
I assume they are for high
Yes, the rates are.
We've
23
quoted a statewide program which is on a standalone basis
24
with options for the high deductible. Then we quoted
CAPITOL REPORTERS (775)882-5322
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1
separately the north region with a north plan, and separately
2
we quoted the high deductible HMO plans which can be offered
3
with our product or it can be offered with any other
4
carrier's product that you're offering.
5
So if you for some reason didn't select us in the
6
north but you wanted our HMO, we could still offer our up to
7
two HMO high deductible plans in conjunction with whatever
8
plan that you've got offered there and the same thing goes
9
for the south.
10
MEMBER COCHRAN:
And I'm assuming the differences
11
in the cost between the north and south are because the
12
contracted rates between for providers in the north is
13
significantly higher than it is in the south?
14
MR. LEATHERWOOD:
Yes.
15
MEMBER COCHRAN:
Okay.
16
CHAIRMAN DROZDOFF:
17
MEMBER EWING-TAYLOR:
All right.
Thank you.
Judy?
I'm looking at your
18
proposed rates and your plans here.
19
plan, is that -- is the original plan north one and your high
20
deductible is north two and then for the south north one --
21
south one and south two?
22
MR. LEATHERWOOD:
The high deductible
That's right.
So the north HD
23
Core One would be that 2,500 dollar deductible plan.
24
would be the rates for that HD Core One and if it says north,
CAPITOL REPORTERS (775)882-5322
138
Those
1
then it's solely for the north region.
2
the rates for the HD Core Two, or I'm sorry, HD Core Three,
3
HD Core Four and the HD Core Five for both north and south.
4
Then we have provided
So in the rating schedule, vendor cost schedule,
5
you'll see regional north and then when you go back beyond
6
the base plan, that's when the HD plan appear.
7
8
MEMBER SAIZ:
deductible?
9
10
So the base plan, is it the zero
MR. LEATHERWOOD:
The base plan is what we use to
mirror your current plan.
11
MEMBER SAIZ:
Yeah, so I could -- okay.
And then
12
the 2,500 deductible, is that high deductible you're talking
13
about?
14
MR. LEATHERWOOD:
Yes, that is HD Core One and
15
then 3,000 would be HD Court Three, and the 4,000 HD Core
16
Four and the 5,000 deductible is HD Core Five.
17
MEMBER SAIZ:
Okay.
Okay.
Thank you.
18
MEMBER BAILEY:
19
CHAIRMAN DROZDOFF:
20
MEMBER EWING-TAYLOR:
21
Continuing on along these lines, you now said a
No questions.
Jacque?
Thank you, Mr. Chairman.
22
couple of times that we could select one of your products for
23
the north without the south or vice versa.
24
rurals fall in that?
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139
Where do the
1
2
MR. LEATHERWOOD:
Wherever we have the HMO
availability.
3
MEMBER EWING-TAYLOR:
4
the north or could we do a south and a rural?
5
MR. LEATHERWOOD:
So do they go along with
South is Clark County and the
6
immediate area, Nye.
7
north of Clark that we have facilities in.
8
would be north.
9
Up north is pretty much everything
So Humboldt, that
We consider that north.
MEMBER EWING-TAYLOR:
Okay.
So just to clarify,
10
if we select one of your products for the north, we get the
11
rurals?
12
13
14
15
MEMBER SAIZ:
I only saw north, south and
statewide.
MEMBER EWING-TAYLOR:
trying to figure out.
16
MR. LEATHERWOOD:
17
MEMBER EWING-TAYLOR:
18
19
20
21
22
23
24
Well, that's what I'm
It would be north.
Yeah, okay.
So if we pick
south, we don't get the rurals?
MR. LEATHERWOOD:
That's -- well, you would
exclude Nye County if you don't take the south.
MEMBER EWING-TAYLOR:
Okay, right.
That's what I
wanted to clarify there.
My other questions have to do primarily with
pharmacy and the transition which will not be easy sometimes.
CAPITOL REPORTERS (775)882-5322
140
1
So how do you help our participants transition from their
2
current formulary to a new formulary and then within that, I
3
would like to know also how many times you change your
4
formulary in a year and how do you notify the participants?
5
MR. ROWES:
Once the formulary is set, we can't
6
decrease the formulary.
We can increase the formulary, but
7
we can't take drugs off, okay.
8
can add drugs if need be.
9
the constant.
So the formulary is set.
We
And as I said before, change is
So as new drugs become available, they can be
10
added onto the formulary but for the year, the formulary is
11
set, and we can't take away that which is in the formulary.
12
Number two, we have a 90-day transition of care
13
period.
14
one health plan to another, at least 90 percent of those
15
formularies are about the same.
16
about the ten percent where there might be variation, and
17
that's where there's a 90-day transition of care where we
18
guarantee even if it's not on our formulary that the member
19
can get it and that enables us to reach out to both the
20
member and the provider who is writing the prescription to
21
see if there are equivalent alternatives.
22
23
24
So even if -- now, most formularies, if you go from
MEMBER EWING-TAYLOR:
It is really you're talking
It does.
Does that help?
But as follow-up
again.
MR. ROWES: Yes.
CAPITOL REPORTERS (775)882-5322
141
1
2
MEMBER EWING-TAYLOR:
been through step therapy already with the current system --
3
MR. ROWES:
4
MEMBER EWING-TAYLOR:
5
Absolutely.
MR. ROWES:
7
MEMBER EWING-TAYLOR:
9
-- do you make them go
through it again?
6
8
If that participant has
No.
Just require the
documentation?
MR. ROWES:
Absolutely.
We want the
10
documentation that step therapy has taken place, and we will
11
honor that, yes.
12
MR. PADILLA:
If I could, one addition on timing,
13
the formulary is set every January, and it doesn't change
14
until the following January.
15
MEMBER EWING-TAYLOR:
16
MR. ROWES:
17
MEMBER EWING-TAYLOR:
18
19
Unless you add.
Right.
Do you do that on a regular
basis or on just as needed?
MR. ROWES:
No, the formulary is constantly being
20
looked at by the pharmacy and therapeutics committee of which
21
I chair, and we look at classes of drugs on a regular basis,
22
even bringing in experts from the surrounding communities
23
providers to go over the drugs and make sure we're accurate
24
in how therapeutic regimens may be changing.
CAPITOL REPORTERS (775)882-5322
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1
MEMBER EWING-TAYLOR:
One final question about
2
pharm up.
So in your north one and south one, in specialty
3
pharmaceuticals, north one is 30 percent.
4
covered in south one.
Can you talk a little bit about that?
5
MR. ROWES:
6
MR. LEATHERWOOD:
7
In terms of the coverage.
It's covered under our program.
What are you looking at?
8
MEMBER EWING-TAYLOR:
9
MR. LEATHERWOOD:
10
11
They are not
What are you looking at?
MEMBER EWING-TAYLOR:
proposal.
It says it's not.
I'm looking at your cost
It looks like page six.
12
MR. LEATHERWOOD:
13
MEMBER EWING-TAYLOR:
14
MR. ROWES:
15
MEMBER EWING-TAYLOR:
16
pharmaceuticals, it's listed at 30 percent.
17
one specialty pharmaceuticals, it says not covered.
18
For the north?
Well, I'm looking at both.
South?
MR. LEATHERWOOD:
Under north one specialty
And under south
And that may have been as a
19
result of what your own SBC's specify because we tried to
20
mirror the north regional plan and the south regional plan
21
and if your south plan did not provide for specialty care
22
co-insurance, then it was not included.
23
24
Now we've rated -- if that's not the case and it
is included, our rates reflect it so it would be included,
CAPITOL REPORTERS (775)882-5322
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1
but that's not what we saw in your RFP.
2
MEMBER SAIZ:
Yeah.
3
CHAIRMAN DROZDOFF:
4
MEMBER EWING-TAYLOR:
Yeah.
Damon, can you or someone
5
on your staff tell me whether or not our -- Nancy is nodding
6
her head.
7
MS. SPINELLI:
8
MEMBER EWING-TAYLOR:
9
Specialty drugs are covered under.
They are covered?
So they
should have been covered in this; is that correct?
10
MR. LEATHERWOOD:
Do you know what percentage?
11
In your SBC it didn't note that, and so we rated it based
12
upon what the plan design is in mirroring it.
13
a 20 percent or whatever it is, that would be included.
14
because we mirrored -- tried to mirror the plan.
15
MEMBER EWING-TAYLOR:
Okay.
If you have do
So since it should
16
have been included at 20 percent, Nancy, is that what you
17
just said?
18
MS. SPINELLI:
It's a flat co-payment.
19
someone looking it up right now.
20
MEMBER EWING-TAYLOR:
21
22
23
24
included.
Okay.
It's
I have
It should have been
So will you then include it in that south one?
MR. LEATHERWOOD:
Yes, we would.
We based our
rates on your experience.
MEMBER EWING-TAYLOR: Right, okay.
CAPITOL REPORTERS (775)882-5322
144
Great, thank
1
you.
That's all.
2
CHAIRMAN DROZDOFF:
3
MEMBER SAIZ:
Judy?
Well, I'm looking at the plan
4
design for 2016 under Health Plan Nevada and it says
5
specialty drugs applicable, retail co-payment applies.
6
MEMBER EWING-TAYLOR:
7
what we just said.
8
under cost proposal.
9
10
Yeah, that's essentially
They are covered.
MEMBER SAIZ:
They should be on here
Retail co-payment applies, not a
plan co-payment is the way I look at it.
11
MS. SPINELLI:
Let me see what that says.
12
MEMBER SAIZ:
13
MR. LEATHERWOOD:
Okay.
Yeah, we just need
14
clarification and documentation to show what they are
15
providing but from what we could see in the SBC, it didn't
16
show anything for specialty care, unlike your north which
17
showed -- reflected a 30 percent.
18
19
20
CHAIRMAN DROZDOFF:
Do you have anything else
while she's checking?
MEMBER EWING-TAYLOR:
Yeah, so what I really
21
wanted to clarify was whether or not they were going to offer
22
that tier one essentially, especially pharmaceuticals and
23
they said that they would.
24
CHAIRMAN DROZDOFF: Provided that Nancy confirms
CAPITOL REPORTERS (775)882-5322
145
1
her answer right now.
2
MEMBER EWING-TAYLOR:
3
MEMBER SAIZ:
Okay.
One more question, that's it.
4
you tell us briefly about your telemedicine and who the
5
telehealth?
6
MR. ROWES:
7
MEMBER SAIZ:
8
Tele-Doc is the actual company.
Okay.
Tele-Doc is and so they are
not based out of Nevada, right?
9
MR. ROWES:
10
11
Can
No, that's correct.
MEMBER SAIZ:
And can you tell me a little bit
about it, just the process, tell me the process.
12
MR. ROWES:
Well, the Tele-Doc, telemedicine
13
concept is any member will be able to call into the Tele-Doc
14
system and for a set fee.
15
16
MEMBER SAIZ:
at.
17
18
Set fee, that's what I was getting
MR. ROWES:
Yes, set fee is actually $50 I
believe.
19
MR. LEATHERWOOD:
20
MR. PADILLA:
21
No, it's $10.
We have the summary benefits.
Let's check on that.
22
MR. MILLER:
What we decided to do is that we
23
gonna match whatever the co-pay is for a primary care
24
physician.
So depending on the benefit plan, maybe $10,
CAPITOL REPORTERS (775)882-5322
146
1
maybe $20, maybe $30, I don't know what's in here.
2
MR. LEATHERWOOD:
3
care physicians charge.
4
it's 30, it would be 20.
5
It's $10 less than the primary
MR. MILLER:
So if it's 25, it would be 15.
If
So what we're trying to do is
6
encourage telehealth other than somebody going to the
7
emergency room or even an urgent care clinic.
8
better.
It's much
9
MEMBER SAIZ:
Okay.
10
MR. PADILLA:
And also that can be by phone or
11
smart phone, regular phone, computer, any one of those.
12
13
MR. LEATHERWOOD:
Your south is on a 15 dollar
co-pay so their co-pay on Tele-Doc would be five.
14
MEMBER SAIZ:
Okay.
15
MR. PADILLA:
And Tele-Doc is one of the largest
16
providers in the country for telehealth medicine.
17
they have over 12,000,000 lives they cover throughout the
18
country.
19
20
MEMBER SAIZ:
Okay.
Thank you.
I think
That's all I
have.
21
CHAIRMAN DROZDOFF:
22
All right.
Anything else from anybody?
So I just have a couple of questions.
23
Maybe the answer is the same on patient care other than
24
pharmaceutical. So what is your transition plan if -- you
CAPITOL REPORTERS (775)882-5322
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1
know, for our beyond pharmaceuticals, if you had a doctor
2
that's not in network or something, how does that work?
3
4
MR. ROWES:
Again, the transition of care period
is 90 days.
5
CHAIRMAN DROZDOFF:
6
MR. ROWES:
Okay.
Right.
During that time, it is
7
incumbent upon us to find an equivalent provider for that
8
member within their geographic area.
9
mentioned, under the primary care level, we will make
In addition, as I
10
available, make sure there are available slots within the
11
doctor's schedule to accommodate the new members coming in
12
but if you're talking about specialty, again, it's a
13
transition of care of 90 days.
14
CHAIRMAN DROZDOFF:
15
ever had any issues with that?
16
what happens if, you know?
17
MR. ROWES:
And has that ever -- have you
Has there ever been any --
Continuation of care.
The example
18
you might be looking for is if a person is in the middle of
19
chemotherapy.
20
CHAIRMAN DROZDOFF:
21
MR. ROWES:
Okay.
That's a good example.
That would come to the medical
22
director.
I rule on medical necessity continuation of care.
23
You know, I wouldn't get in the way of that.
24
therapeutic regimen is over and maybe it's time for routine
CAPITOL REPORTERS (775)882-5322
148
Once the chemo
1
follow-up, that would be the time to consider transitioning
2
into network, both for the financial benefit of the member,
3
as well as keeping them within our network, which I think is
4
better for communication and collaboration.
5
CHAIRMAN DROZDOFF:
And how -- how flexible or
6
how -- I mean, once your network is set, is it set?
7
how do you -- do you add providers?
8
MR. ROWES:
9
I mean,
We would be happy to add providers of
quality and certainly who can fill a gap within our network,
10
yes.
11
constant dynamic to it.
12
communities, bring different specialties and skill sets,
13
we're open to those people, and we encourage those people to
14
apply into our network.
15
So, no, it's not a fixed thing.
It's -- there's a
As doctors move into the
CHAIRMAN DROZDOFF:
Okay.
And do you have -- you
16
know, maybe I'll ask it this way, how much experience do you
17
have with state employee programs elsewhere within your
18
larger company?
19
MR. ROWES:
20
CHAIRMAN DROZDOFF:
21
MR. ROWES:
22
23
24
Within United Health Services?
Yeah.
I would have to defer.
What's United
Health Services and state employees throughout the state?
MR. MILLER:
Yeah, I'm not aware that we have
state employees, but we have, you know, county employees.
CAPITOL REPORTERS (775)882-5322
149
1
Obviously, we have cities, a number of them.
2
I believe we have, Rayne, City of Reno.
3
public sector.
4
MR. LEATHERWOOD:
Washoe County,
So we do have the
But your employees right now
5
are currently accessing our Universal Health Systems such as
6
down in Vegas where we have five hospitals instead of six, so
7
they are currently servicing those members.
8
CHAIRMAN DROZDOFF:
9
all of the options that you've provided us.
10
Okay.
And so we appreciate
And I asked this question before so it may seem
11
like a softball but which -- Nevada is an interesting state.
12
There's -- you know, you've talked about it.
13
population center in the south.
14
population center in the northwest and then there's the
15
rurals, so we tend to think of it as three bands within the
16
state.
17
There's the
There's sort of a quasi
So within your statewide options, statewide
18
offer, I mean, which -- which of those do you think is the
19
best and why, and how do you accommodate that, if you would,
20
large variability if you're talking about your state plan
21
between Las Vegas, Reno, Carson, Douglas and the rurals?
22
MR. LEATHERWOOD:
Correct me if I misinterpret
23
your question.
It sounds like you're asking me which area
24
can we provide the services best, is that?
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CHAIRMAN DROZDOFF:
No, I'm asking is it better
2
in your view to have a separate north plan and a separate
3
south plan or is it better to have a separate -- or is it
4
better to have an overall state plan, maybe I'll start with
5
that.
6
MR. LEATHERWOOD:
And I think that comes back to
7
the client as to what they feel would be best suited for
8
their population.
9
is getting the same benefit and at the same rate, same way
10
with the high deductible plans so that's an approach that
11
sometimes a large employer would prefer to have.
Obviously, a statewide plan where everyone
12
Then, again, if --
13
CHAIRMAN DROZDOFF:
14
MR. LEATHERWOOD:
15
CHAIRMAN DROZDOFF:
Can I stop you there?
Sure.
Is it the same benefit or is
16
it -- because earlier we talked about, you know, one area in
17
the north is you had to get a referral.
18
to get a referral.
19
20
MR. LEATHERWOOD:
One of our proposals was
statewide.
21
CHAIRMAN DROZDOFF:
22
MR. LEATHERWOOD:
23
24
In the south you had
Right.
North, south, rural,
everything.
CHAIRMAN DROZDOFF: Uh-huh.
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1
2
MR. LEATHERWOOD:
Another option is just regional
north.
3
CHAIRMAN DROZDOFF:
4
MR. LEATHERWOOD:
Uh-huh.
Another option is just regional
5
south, those are the base plans.
6
north, regional south.
7
for north and south.
8
with a more consistent level benefit for both and --
9
11
We proposed a mirror of those plans
We also then blended the two to come up
CHAIRMAN DROZDOFF:
10
Currently you have regional
MR. LEATHERWOOD:
That's what I wanted --- that's our statewide program
that we offer.
12
In addition, we then offered our four high
13
deductible HMO optional plans that they can be offered in
14
conjunction with our plans.
15
conjunction with another carrier's plans if you end up
16
deciding, well, let's go that way, but we would like to have
17
this high deductible HMO option to allow employees to engage
18
in their own health care a little more and realize the costs
19
involved, and I think you probably have a fair portion of
20
your indemnity side that's probably enrolled in your high
21
deductible but it's a cost containment program and a cost
22
feature.
23
24
They can be offered in
CHAIRMAN DROZDOFF:
No, and as I said, I think we
definitely appreciate all of the options. I guess what I'm
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trying to get to back to the statewide is that I appreciate
2
the fact that you've offered a blended approach but in
3
reality, the level of what's going to be offered in an area
4
where there's one hospital or an area where there's seven or
5
ten different hospitals are going to be different.
6
you -- I guess what I'm asking is how do you take that one
7
blended plan, recognizing there's going to be a different
8
experience, whether you're in the urban population center in
9
Las Vegas or in the rural northeast Nevada, how equivalent
10
really are those plans?
11
So how do
How do you make them --
MR. LEATHERWOOD:
Being a level plan whether the
12
employee is in Las Vega, in Reno or in Humboldt, they are
13
going to realize the same benefit, same cost co-pay if they
14
go to the hospital or go to the doctor.
15
travel up to a hospital here or down to Vegas, you know, they
16
would still be covered under that HMO program.
17
MR. MILLER:
If they choose to
If I can, I think maybe I know where
18
you're heading, and I absolutely think I understand the
19
question.
20
unit cost.
When we blended, we had to take into consideration
21
CHAIRMAN DROZDOFF:
22
MR. MILLER:
23
24
Uh-huh.
Which is much higher in the north
than it is in the south.
CHAIRMAN DROZDOFF: Right.
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MR. MILLER:
And we have to take into
2
consideration utilization which is like you say also depends
3
on what services are available, and I think there is evidence
4
that the more services that are available in a particular
5
area of a higher utilization is.
6
So when we blended, we had to make false
7
assumptions.
8
your prospective, I think you probably could argue and say,
9
well, a blended rate itself is really kind of subsidizing the
10
11
If you look at the blended rate, looking from
north, and then the north is benefitting from the south.
CHAIRMAN DROZDOFF:
That's really where I was
12
going because that's currently what we're sort of forcing
13
artificially.
14
were doing as part of this.
15
I just wanted to know whether that's what you
MR. LEATHERWOOD:
Yes, it's very similar to what
16
I think that's what the state currently does.
17
your north and south and blended the rates and basically in
18
our underwriting process, we've done the same, only we did it
19
for you based upon the blending of the plan.
20
21
CHAIRMAN DROZDOFF:
All right.
You've taken
Are there any
other questions?
22
MEMBER COCHRAN:
Leo?
23
CHAIRMAN DROZDOFF:
24
MEMBER COCHRAN: Leo, this is Chris Cochran.
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1
So just to close in on this, you know, when we've
2
looked at plans that looked at the north being an open
3
access, you know, HMO versus the south being a standard HMO
4
that goes through -- that goes through say a PCP, what we're
5
talking about, and I just to confirm what we're talking about
6
in a statewide plan, it would be the same plan utilization
7
regardless of whether you're in the north or in the south.
8
9
So let's say it's an open access plan in the
north, would it also be an open access plan in the south?
10
MR. LEATHERWOOD:
No, it would not.
It would be
11
open access in the north but it would be by referral in the
12
south.
13
MR. MILLER:
And the reason for that -- the
14
reason for that is it's our position our primary network in
15
the south which is Health Care Partners and they obviously
16
have been highly successful in managing cost, and I think it
17
will be in your best interest to keep that because that is
18
going to result in lower cost overall than what we have in an
19
open access unmanaged HMO, like we have in the north,
20
relatively unmanaged.
21
MEMBER COCHRAN:
And I agree with that concept.
22
The problem is selling that to members where folks in one
23
part of the state says, you know, I'm going to go through a
24
primary care provider to get the same kind of care that
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1
somebody up in the north is getting without having to go
2
through that extra step, and we're paying the same rate down
3
here than we are up in the north, and that's the difficulty
4
for me as a Board member in looking at all of these HMO
5
plans, but that's not your -- that's not your issue.
6
That's -- frankly, that's a Board issue.
7
MR. MILLER:
If I might add to this, I understand
8
that.
Our channel -- our channel approach in the north is we
9
believe that a member connected to a primary care physician
10
is absolutely essential.
11
to mandate in the north, we definitely are going to encourage
12
it, and we will continue to encourage it after we have most
13
of that done.
14
So while we're probably not going
The reality also is that even if you say it's
15
open access, most people go to the same physician anyway and
16
so while they have maybe not a designated PCP, primary care
17
physician, because they didn't put it on the normal form,
18
chances are they already have a primary care physician that
19
manages their care.
20
But if our direction will be to move to a primary
21
care, not away from it because that concept has to be proven
22
beneficial.
23
is not as a gatekeeper, like it is sometimes perceived or
24
being talked about. It's actually an enabler because how
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156
1
would somebody like me know to which specialist I should go
2
and when?
3
experience, so I don't know if that's helpful in terms of
4
which way we're going to head.
5
CHAIRMAN DROZDOFF:
6
MEMBER COCHRAN:
I probably would rely on somebody who knows from
Anything else?
I'm satisfied with your answer.
7
I -- you know, I do appreciate that.
8
get that PCP penetration further up north that, you know, we
9
apparently don't have, but I don't know how long that's going
10
to take.
11
Thank you very much.
12
CHAIRMAN DROZDOFF:
13
Okay.
14
MEMBER SAIZ:
15
How many employees do you guys have
in Nevada?
MR. MILLER:
17
MEMBER SAIZ:
Just the Prominence Health Plan?
Uh-huh, that would handle all of
this, how many employees?
19
MR. MILLER:
20
MEMBER SAIZ:
21
CHAIRMAN DROZDOFF:
22
Thanks.
Anything else?
16
18
You know, we need to
158.
Okay, Thanks.
All right.
We appreciate
your time very much.
23
MR. MILLER:
Thank you very much.
24
(Whereupon, a brief recess was taken.)
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CHAIRMAN DROZDOFF:
All right.
So we're going to
2
get started.
We will turn it over for the presentation and
3
for the most part, we'll ask questions at the end.
4
there's a clarifying one at the end, we'll ask it.
5
So, Ty.
6
MR. WINDFELDT:
Great.
If
Thank you, Mr. Chairman
7
and members of the Board.
8
know you have had a long day already and are only halfway
9
done, so we'll try to get through this presentation.
10
We appreciate the opportunity.
We
My name is Ty Windfeldt, vice president with
11
Renown Health and CEO of Hometown Health.
12
today is Hometown Health's chief medical officer, Dr.
13
Ash-Jackson and Renown's Health president and CEO Dr. Slonum.
14
15
Presenting with me
When we go on to the -- we are going to start
with a brief introduction video, if this works.
16
(Whereupon, a video was played.)
17
MR. WINDFELDT:
So thank you again for the
18
opportunity.
19
bit of an overview of Hometown Health.
20
partner of the State of Nevada Public Employees' Benefits
21
Program for many years, and we certainly appreciate the
22
partnership and working together.
23
24
Just real quick, I wanted to go into a little
I know we have been a
As the video alluded to, we are a non profit
company owned by Renown Health Company. Interestingly
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enough, we're actually the only domicile of the insurance
2
plan, health insurance plan in the state of Nevada, and we're
3
the only not for profit.
4
all the ones that will be here today are for profit status,
5
and we are not for profit.
6
Every one of our competitors and
We are very financially stable, and we are very
7
proud of the fact that all of the money we generate at
8
Hometown Health is reinvested back into this great state of
9
Nevada that we all call home.
10
We have a little over 600 employer groups.
We
11
serve over 130,000 people throughout the Northern Nevada
12
market, and Hometown Health is about 230 employees.
13
very proud of our comprehensive provider network.
14
very large network.
15
derivative of working with you.
16
your PPO plan, and so we have worked very hard in the rural
17
communities in order to develop a very comprehensive network
18
to meet all of the needs of the state of Nevada, including
19
those on the PPO and those on the HMO.
20
We are
We have a
A lot of that network has been a
We also have our network on
Last year Hometown Health or earlier this year,
21
I'm sorry, Hometown Health did receive a URAC accreditation.
22
We're very happy and proud of that.
23
URAC accreditation route.
24
could go.
We decided to go the
There's two different ways you
For a health plan you can go NCQA or you can go
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URAC.
2
something we achieved earlier this year.
3
We chose to go the URAC direction and that is
We have a lot of extensive experience and
4
knowledge of working with public sector employees.
5
has a number of clients throughout the state in all of the
6
rural markets, including Reno and Carson, as well as with
7
your group, the state of Nevada here in Carson City, but we
8
have worked with many of these local entities for many years
9
and have a long list of individual clients in which we serve
10
and understand, not only do we understand the benefits, that
11
Northern Nevada is very different and very unique, but we
12
also understand working with the public bodies and the
13
challenges you face, and we're happy to have had a
14
longstanding client list with individual companies we work
15
with.
16
Hometown
One of the interesting things that we looked at
17
when we were -- you know, we sit here through your PEBP
18
meetings and understand the challenges and participate
19
actively with you, and one of the interesting things we were
20
talking about when we were getting ready for this
21
presentation was the PEBP philosophies and the values, and we
22
know that you and this Board take a lot of pride in
23
developing these and standing by those, and we feel that we
24
too follow the same philosophy and same values.
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We feel we're an innovative company here to
2
protect the members in which we serve from catastrophic
3
expenses and be there when they need us most which is in the
4
time of need.
5
We also believe in personal responsibility and
6
want to continue to deliver that to the Public Employees'
7
Benefits program.
8
9
We also believe in transparency.
We're a very
transparent organization, and we feel we have demonstrated
10
that to the Public Employees' Benefits Program over the years
11
that we worked together, whether it's specific data request
12
that you have asked for, working with your consultant, Aon or
13
others, we've been very transparent, and we will continue to
14
be so into the future.
15
Very committed to communication.
We believe that
16
communication is the key, not only for the members that we
17
serve of the state of Nevada, also for the Board and PEBP
18
staff, and we also believe that we are best in class, and we
19
do have the management and the financial expertise to meet
20
your needs.
21
22
23
24
From here I want to turn it over to Dr. Slonum,
and he's going to speak a little bit about Renown.
DR. SLONUM:
I would like to echo my appreciation
for allowing us the opportunity to speak with you today.
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I
1
am honored and have been honored to lead Renown Health for
2
the last 18 months or so.
3
I'm new to Nevada and to Renown Health, but we
4
have over the period of that time embarked upon an aggressive
5
plan and a new mission and vision, which I think is important
6
to share with all of you because it does resinate through the
7
organization in a way which your values do as well.
8
Ty, if you wouldn't mind back on the slide.
For
9
our mission, our mission really gets to the heart of being a
10
healthy community, and for us a healthy community starts one
11
person at a time, and that's really important for us to
12
engage in a way that allows us to making a difference one
13
person.
14
and health care are changing and are not synonymous.
Notice I say person and not patients because health
15
We need to acknowledge that we want to be the
16
place that is there for people when they get sick, ill or
17
injured, but we also want to make sure that we're in a place
18
that is helping to guide people through living healthy lives.
19
That is a strategic investment that we believe will pay
20
dividends decades from now as we go about doing that work
21
together.
22
So our mission is to a make genuine health and
23
well being of people and communities, and I want to touch on
24
communities a little bit because we spent a lot of time
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thinking about who we serve and where and how that all comes
2
together.
3
reach is more northern than that.
4
people in the greater Washoe area, but we also go much
5
broader and serve another 400,000 in the rural environment.
6
We certainly are centered in Northern Nevada, our
We serve about 400,000
And for the 30 rural hospitals who we consider
7
our partners in providing care, about a third of all of their
8
care comes from Renown Health, which is important because we
9
want to make sure we are reaching out to the rural landscape
10
and we are in places where people need us regardless of how
11
much proximity they have to us, so it's very important as we
12
evolve our thoughts on what a healthy community is.
13
Next slide.
Thank you.
14
As part of our vision, you know, we realize,
15
first of all, it's more fun to do things with other people
16
than it is to do them by yourself.
17
differently with people.
18
Health.
19
in history, but we are taking a new stand on that and
20
actually making great roads into doing a few things with
21
others, not only because it's more fun but you get better
22
results.
23
24
We want to work
This is a new take for Renown
We haven't been known frankly as the best partners
And so but for a few examples, many of you may
have heard about our strategic relationship with University
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of Nevada.
2
in this school of medicine actually goes much broader to
3
include the entire university where there's programming going
4
on in the skilled nursing and the school of business and the
5
school of journalism and thinking together with the
6
university as partners, another state run organization really
7
does help us to provide value to the community and to the
8
people that we serve in Nevada.
9
That relationship while it's characterized often
More importantly I think or as importantly as a
10
new partnership that we've just engaged in with the
11
university, we call it the Child's Health Institute, and it
12
gets to that issue it's not only health care.
13
Health Institute as -- you know, as many of you may know, we
14
have a children's hospital.
15
actually use the services of a children's hospital a year.
16
That's good news.
17
The Child
Only about 17,000 or so kids
Most kids are healthy.
What our attempt in the Child Health Institute is
18
to make sure we reach every child.
So, you know, the fact
19
that we have high school dropout rates of 20 percent is
20
actually a bit of a problem.
21
are helping to drive enrollment in high school, making sure
22
that we're creating a more literate future because we know
23
people who are health literate actually enjoy a better health
24
status.
We want to make sure that we
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We know that kids who have obesity or start
2
smoking will have cardiovascular or neurological disease that
3
we need to combat decades from now.
4
prevent that child from starting to smoke or make sure they
5
don't get addicted to medication or drugs in a way that hurts
6
their long term success.
7
are often called the social determinative of health, and
8
we're taking a really strong role at how we can work with
9
projects in the community, including the sheriff's office,
What we want to do is
Those things that we talked about
10
the school system and others to make sure that we're
11
addressing the issues of poverty, education, obesity and
12
addiction in our community.
13
place to live, people will live healthier and enjoy better
14
status and that ultimately results in less health care for
15
our community over time.
16
Because if we have a better
We certainly have a number of other partners,
17
including the federally qualified health centers and the
18
Truckee Meadows Healthy Communities collaborate where we
19
pulled together a number of people to help us create a vision
20
for what being a healthy community might look like as we move
21
forward.
22
With leadership comes great responsibility.
As
23
Ty alluded to, we are not for profit.
24
we make gets reinvested in the community. This year it was
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It means every dollar
1
$64,000,000 that was reinvested in programming.
48,000,000
2
of that was in clinical programming, new radiation oncology
3
vaults.
4
going up.
There were -- there's a new clinical office building
5
Even more importantly are the infrastructure
6
investments, including technologies that allow us to reach
7
remote areas of the state and work with people in those
8
hospitals to drive better health and health care out in the
9
rural environment.
10
So imagine if we're sitting in a room like this
11
and video conference with a group of diabetics and connect
12
them to other people with diabetes, that's the future, and
13
that's how we're trying to do it, even remotely through the
14
use of technology so everyone can live a healthier life.
15
Here is some other examples of places where we've
16
invested.
17
for the indigent.
18
our university strategic planning efforts for school
19
professions programming, community not for profit
20
contributions and research round out the places where we
21
provide funding.
22
They certainly include subsidized health services
We've got several millions of dollars in
Finally, in the setting of health and population
23
based health, we are the only ACO in Northern Nevada, and
24
this slide is important because we put the patients and the
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family in the center of everything we do and manage that work
2
with their help through the disease management and care
3
coordination, not only for the people that are in the ACO but
4
we are investing heavily to the tunes of several tens of
5
millions of dollars to create a management office that allows
6
us to care for and navigate all people in the community
7
regardless of whether they happen to be a Renown Health
8
patient or not, and we are certainly elaborating on the
9
spectrum of services from primary care all the way up to what
10
I call the oh, my God program, when you need a trauma center,
11
you need it now.
12
When you need a children's hospital because your child is
13
critically ill, you need one now and you don't have time to
14
go look for one, so we provide that level of programming.
15
You don't have time to go look for one.
But we also want to be the place that people turn
16
when they have questions about their health, how to manage
17
their stress more effectively, how to eat right, how to maybe
18
get rid of that smoking addiction that they have had for
19
years and live a healthier life and maybe learn how to
20
exercise a little bit without overdoing it, that's Renown
21
health.
22
That's the new take, and we're sticking to it.
We're going to be moving forward with a variety
23
of partners, and we look forward to continuing our
24
partnership with you, and thank you again for the
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1
opportunity, and I'll turn it back to Ty.
2
MR. WINDFELDT:
Thank you, Dr. Slonum.
3
A little bit specifically about our proposal, we
4
know you have had an opportunity to review the binders and
5
all of the information.
6
first and foremost with Hometown you will definitely always
7
have access to Renown but also a number of other areas within
8
Northern Nevada.
9
Sparks, Carson.
A few things we wanted to highlight,
We really understand it's not just Reno,
The state of Nevada goes throughout the
10
entire state, and Northern Nevada we have a very robust
11
network.
12
providers directory.
13
individuals.
14
We really focus our energy in building this
You know, it's important to
And when you ask individuals what's most
15
important to them, often times the number one answer is going
16
to be I want to see my doctor, and we run into that often
17
when we do focus groups, and we ask them, you know, what's
18
most important for you?
19
know, that's all important to them, but they definitely want
20
to see their doctor.
21
provider network of these providers not only in the family
22
practice space because we know that's important but the
23
specialty space.
24
to specialists throughout the entire care that they may need.
CAPITOL REPORTERS (775)882-5322
Do you want benefits, premiums?
You
So we put together a very comprehensive
We continue to make sure they have access
168
1
In addition, you know, we all know that Northern
2
Nevada does have some limitations when it comes to providers
3
and access, and there are sometimes when individuals need to
4
go outside of the network, we have a number of contracts with
5
Centers of Excellence that we utilize, and we will continue
6
to utilize those.
7
not able to get access within the state and we have sent them
8
out, we have those contracts where we can send them out and
9
use those Centers of Excellence.
10
So when individuals on the HMO plan are
In addition to the proposal we have on the table
11
and the current HMO we have what is called current open
12
access, a little bit different philosophy, not that
13
individuals have the ability to go to any physician they want
14
to go to but they don't need a referral to go to those
15
specialists.
16
care physician would refer those individuals and under the
17
current structure and the proposal, one of the proposals
18
where we offer with no changes to the benefits, we continue
19
to offer that open access so individuals can self-refer into
20
those specialists.
21
So in the old model of the HMO, the primary
Looking at some of the benefits that we provide,
22
you know, one of the other areas we also understand the state
23
of Nevada is somewhat unique, and we're serving a number of
24
different individuals from a number of different preferences.
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1
We have individuals that still today don't have a cell phone
2
and we understand that and that's okay.
3
And then we have other individuals that are
4
carrying around smart phones and they don't want to talk to
5
anybody.
6
their computer, and so we want to be able to meet all of
7
those needs and we -- if you want to call us, we're here to
8
help.
9
They want to access everything on their phone or
We focus our energy within our call center.
10
of the areas that we look at on an hourly basis is our
11
average second to answer and we're very proud of the fact
12
that we answer the phone in less than 30 seconds.
13
One
We also want to make sure we're offering the
14
cutting edge benefits that others may want.
15
to have access to your benefits coverage on-line, you want to
16
look up all your information, your claims, your
17
authorizations, we have that available to you.
18
your ID card on your phone so you don't have to carry it
19
around in your wallet and you want to fax it or e-mail it
20
right from your phone to your provider, that's available to
21
you and all of the other tools that individuals are asking
22
for on-line, we do provide that as well.
23
24
So if you want
If you want
The current offering that we put together for
you, we're very proud that we were able to offer some reduced
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1
premiums from what you currently have.
2
understand the situation that PEBP continues to face, and we
3
understand you're trying to offer the best benefits that you
4
can with the most affordable prices.
5
We certainly
Over the last year, Hometown Health has been
6
successful in negotiating or renegotiating some significant
7
provider contracts in a number of different areas, a lot of
8
them in the hospital space.
9
Excellence, we've actually been able to renegotiate some of
Also in the Centers of
10
our Centers of Excellence contracts that significantly
11
reduced allowables which we are then able to pass that on to
12
the state.
13
So we have offered a proposal with reduced
14
premiums.
15
Board decides to continue with Hometown Health, those
16
individuals that are on the Hometown Health Plan would not
17
have any disruption, and there are almost significant --
18
there's almost about 100 percent crossover between the PPO
19
network and the HMO network.
20
decision to choose changing their plan at open enrollment,
21
they would not have any disruption.
22
Certainly there's no disruption.
If the PEBP
So even individuals that make a
With the reduced premiums, we felt we addressed
23
the Cadillac Tax concern the Board has been talking about.
24
Although, we understand there may be other changes from a
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1
federal and a legislative basis, as it stands today, we felt
2
we addressed those needs for you.
3
We provided options.
We know you want to look at
4
different options and a number of concepts that have been
5
discussed at the Board level, and we provided those, not to
6
get too complicated, not to get too lost in those options,
7
but a number of different options are available, whether it's
8
deductibles on HMO's, which some individuals like, some
9
individuals don't like or status quo, you know, we provided
10
11
everything in-between.
And we also think that we have the flexibility
12
for long term cost containment.
13
together with you through a new contract and continue to
14
provide a great benefits program for your enrollees.
15
16
17
We think that we can partner
I'll turn it over to Dr. Ash-Jackson, and she
will touch on a few other of the components of the proposal.
DR. ASH-JACKSON:
So, obviously, thank you for
18
allowing us to be here.
19
and a half years so and was here when PEBP and the HMO first
20
became effective, so I know most of the people who have
21
unfortunate illnesses in that population and as they come
22
across my desk.
23
better and some days aren't so happy.
24
I've been here at Hometown for ten
Some days are happy because they are doing
We have been managing your population.
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We have
1
been privileged to do that, as well as your PPO population
2
for the last couple of years.
3
currency.
4
coverage policies.
5
sure it's appropriate.
6
no when the answer should be yes.
7
no that it's validated because there isn't a better
8
alternative to that patient.
9
We try to maintain clinical
We use national standards for our evaluation and
We look at all new technology to make
We want to be sure that we don't say
And then if the answer is
My nurses are very active in patient advocacy and
10
care coordination.
11
patient is best served.
12
myself and my medical director Dr. Rosen to have peer to peer
13
conversations, some of which aren't too happy for the
14
physician at the other end of the phone, and some of which
15
are very happy for the physician at the other end of the
16
phone because we want to be sure the care is appropriate each
17
time for that patient.
18
They work very hard to be sure that the
There are numerous opportunities for
We're comfortable with what is available in the
19
region.
20
available, then we will go outside and we will look to see
21
what Center of Excellence does have the best opportunity for
22
the patients to do well.
23
24
And as Ty said, if we know that services aren't
We have a hotline that we get calls on for your
members, and we interact quite extensively. Anecdotally,
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last I think Thursday night, one of my nurses got a phone
2
call that from a patient's wife who said that they just
3
received a call that her husband had a CAT scan that day and
4
they just moved to the area and he had a subdermal hematoma,
5
and he didn't find his way to the hospital, and they didn't
6
know what to do, and she had night blindness so couldn't
7
drive.
8
So he wanted to wait until morning, so I got on
9
the phone with him and after a bunch of honey's and sweety's
10
on his part, he agreed to let me send an ambulance for him,
11
and he was on operated Friday morning and did very well.
12
That sort of the local hands-on day-to-day work is something
13
that I think you get from us and that is not as readily
14
available in some of our worthy competitors but don't have
15
that personal touch that we bring because we are local, and
16
we do believe that this is our mission.
17
We have a wellness program called Healthy Tracks
18
which would be available to all of the HMO members which I
19
think that you'll be pleased with.
20
Renown for years and it's forced many of us to get our acts
21
together, myself included, to be able to be healthier in
22
terms of our blood pressures and our cholesterol's, and we do
23
an aggressive job with prescription management to make sure
24
that all of the medication that is prescribed is appropriate
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We've been doing it at
1
and that we do the right thing when we provide the coverage
2
for the patient.
3
We heard you after sitting at the last meeting
4
and I need to tell you that we were -- we have superb
5
telemedicine at Renown.
6
telemedicines, as you know.
7
that primarily goes into the rurals and will let people in
8
some of the rural markets actually access subspecialty care
9
without leaving the market and then be able to come in and
It provides two different
There is a subspecialty program
10
have their surgeries.
It's really easy to determine if
11
somebody needs their gallbladder out when the imaging has
12
been done locally, and we can set that up with the physician.
13
And we have urgent care virtual visits that are
14
available for Renown providers, but we understand that that
15
is not going to satisfy 100 percent of the needs, and we have
16
been looking at the emergency room cost and the frequency in
17
Renown, outside of Renown in Northern Nevada compared to how
18
the urgent cares are available, particularly in the rurals.
19
So I have for me briefcase a contract from Doctor
20
On-Demand.
We have agreed on pricing.
21
credentialing issues, and we'll be signing that contract with
22
Doctor On-Demand, and we are certainly going to look to be
23
able to provide telemedicine and virtual visits to all
24
contract of providers at no co-pay for that -- for those
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We're working through
1
services for the membership and that will be part of the
2
benefit program.
3
We've been very happy with our findings with
4
Doctor On-Demand and their cooperation and as soon as Ty
5
blesses it and I review all of the information that I was
6
sent earlier today, we'll be active with that provider.
7
Thank you.
8
MR. WINDFELDT:
9
we appreciate your time.
So just in closing, once again,
We understand the differences that
10
Nevada has.
11
Nevada is even more unique.
12
Nevada.
13
of the different carriers that are offering.
14
continuing to be committed to your participants and to the
15
state, and we thank you for your time, and we would be happy
16
to answer any questions that you have.
17
18
19
20
We understand Nevada is unique, and Northern
Our heart is truly in Northern
We've been in this market for the longest out of all
CHAIRMAN DROZDOFF:
We're
Thank you very much, all
three of you.
Unless anyone is uncomfortable with it, I am
inclined to keep doing what we're doing.
21
Judy, are you okay with it?
22
MEMBER SAIZ:
23
CHAIRMAN DROZDOFF:
24
MEMBER SAIZ: Judy Saiz for the record.
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I'm okay with it.
All right.
176
1
MEMBER BAILEY:
Are you sure?
2
MEMBER SAIZ:
3
I just have a few questions.
I'm okay with.
I'm looking at your
4
rate sheet, and I've seen that you have like 832 renewal
5
proposed and it dropped to 728 for your renewal, and I'm
6
wondering did we all of a sudden get realty healthy?
7
-- you know, why now right before a proposal did the rates
8
drop, and why couldn't they have dropped prior to that is I
9
guess what I'm saying.
10
MR. WINDFELDT:
Did we
Great question, and I apologize
11
if I -- I was trying to answer that in the beginning because
12
I was sure that was going to be a question top of mind.
13
We've looked at a number of different areas
14
within our organization at Hometown Health to try to figure
15
out how we can control the cost.
16
this Board trying to understand the differences between the
17
cost in the north and south and why they are so drastic and
18
with that, Hometown Health continues to look at opportunities
19
for improvements.
20
We spent a lot of time with
One of the areas that we identified as an
21
opportunity was the amount that we were spending with some of
22
our providers in the hospital space and most significantly in
23
some of the Centers of Excellence, so we do have a number of
24
individuals.
You know, it used to be that 80/20 rule,
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1
20 percent, 80 percent of the cost.
2
95/5 rule.
3
It's probably now at the
You have a small percent of your individuals that
4
are driving so much of those costs, and so we have developed
5
some stronger partnerships with some of the Centers of
6
Excellence, including Stanford in the California market to
7
help us, and they have delivered to us that just was
8
effective on September 1st a new contract that has to be
9
substantial savings, and so our actuaries would be able to
10
use these contracts that are currently in place that we
11
negotiated and some other ones that we know are upcoming that
12
we've been able to come to an agreement on.
13
they were able to provide us with some modeling that we were
14
able to lower our cost.
15
MEMBER SAIZ:
Okay.
And with that,
Help me understand, we have
16
the active -- the actives and the retirees and we have the
17
non state actives and retirees.
18
state.
19
you've increased it for the non states automatically, and I
20
guess I just want to understand how a 56-year-old non state
21
compared to a 56-year-old state would be that much higher in
22
cost?
23
24
We have the state and non
Other carriers just mirror that and you, you know,
MR. WINDFELDT:
With the way we provide the
renewals is we kept them separate, so we used the experience
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1
of both of those populations separately.
2
on the experience, within our current experience at Hometown
3
on the HMO, the non state is running at a higher rate and,
4
therefore, the renewal premiums are higher.
5
And so just based
We could certainly blend that together, and I
6
know that's a conversation that you've had at the Board level
7
relative to your self-funded PPO plan and blending it
8
together.
9
very small impact to your state rates because there is so
We could blend those together, and it would have a
10
much more, state employees and non state, but the answer to
11
your question is we've kept them separate and the experience
12
unfortunately on the non state has been running at a higher
13
rate.
14
MEMBER SAIZ:
15
CHAIRMAN DROZDOFF:
16
Okay.
Because it's an older
population?
17
MR. WINDFELDT:
18
older.
It's a lot smaller.
19
to spread that across.
20
MEMBER SAIZ:
I don't necessarily think it's
You know, you don't have as much
Yeah.
I have a question for you.
21
Think fast.
22
product side by side with you in the north, would you be
23
opposed to that?
24
If another carrier came in and wanted to offer a
MR. WINDFELDT: We would definitely want to look
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1
at the specifics around that.
I mean, my initial answer
2
would be opposed to it, but we would want to -- we would have
3
to understand the differences in that.
4
things we want to make sure we protect ourselves against is
5
the adverse selection and, you know, where the benefits and
6
where the premiums, there's a lot of questions that go into
7
it.
I mean, one of the
8
At the end of your day, you're experience rated
9
100 percent experience rate so, you know, the experience of
10
your population, we run it through the model and we pass
11
those costs on or the savings, if there are, on to the state.
12
And so really for us, our objective is to find a long term
13
solution to becoming partners together, and I'm not sure that
14
wouldn't lead to that but we would -- unfortunately, I don't
15
have a yes or no answer.
16
MEMBER SAIZ:
It's a maybe.
Do you have -- okay.
So in the
17
north, I know you don't have Saint Mary's, we know that.
18
you ever get a contract with Banner, with Churchill?
19
MR. WINDFELDT:
So we have a contract with
20
Banner.
We always have had a contract with Banner.
21
Unfortunately, it's not a great contract.
22
MEMBER SAIZ:
Are they considered a --
23
MR. WINDFELDT:
24
MEMBER SAIZ: Just like a percentage off or
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In-network on the HMO.
180
Did
1
something like that?
2
MR. WINDFELDT:
Yeah, something like that.
It's
3
not a great contract, and we've continued to try to work with
4
them to get a better contract, but they are a contract
5
provider and your HMO participants currently have access as
6
in-network.
7
MEMBER SAIZ:
Okay.
Just a couple of more
8
questions.
When I saw your numbers up there and I see, you
9
know, you have 2,817 providers and you've combined specialty
10
and ancillaries and labs and all of that stuff, how many
11
specialists do you really have because you combined it into
12
one?
I would like to know how many specialists you have.
13
MR. WINDFELDT:
I don't know the number off the
14
top of my head.
15
easily.
16
we don't have a lot of ancillary that are -- we don't
17
contract with all of the ancillary providers just to make
18
that number look higher, so I don't know off the top of my
19
head, but I could certainly get that for you.
It's going to be a high number.
20
21
22
23
24
I can certainly get that for you very
MEMBER SAIZ:
I mean, we really
Yeah, I would like to get that just
so I know.
MR. WINDFELDT:
able to tell you.
We could query that easily and be
I just don't have that.
MEMBER SAIZ: Okay, yeah. Okay. So no
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1
referrals, we don't need any referrals from a primary care to
2
a specialist.
3
And reporting, I'm assuming you guys are getting
4
good reporting or you would have been complaining by now,
5
monthly reports and loss experience on a regular basis?
6
MR. WINDFELDT:
Yeah, we've worked and it's
7
changed.
8
transparent as you want us to be so we meet your needs.
9
the previous executive director, Mr. Wells, you know, he had
10
asked for some specific reports on a regular basis, monthly
11
or quarterly, and we can make those available to you.
12
You know, we have different generations.
We are as
And
The reality is any kind of report you want is
13
available.
We have data.
As long as it's data that you
14
have, if you want it, you can have it.
15
MEMBER SAIZ:
Okay.
16
MR. WINDFELDT:
We've also worked with your
17
consultant Aon to provide specific reports into their system
18
so they could do those reports -- that presentation back to
19
you on risk factors, so we're very transparent when it comes
20
to reporting.
21
MEMBER SAIZ:
Okay.
And so you are just now
22
getting to telemedicine, well, almost.
23
briefcase.
24
It's in your
DR. ASH-JACKSON: We've had telemedicine.
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We've
1
had virtual visits available for Renown providers.
2
MEMBER SAIZ:
For Renown providers but not I as a
3
member could call in and talk to a doctor and say I've got
4
this rash?
5
DR. ASH-JACKSON:
6
provider but not uniformly.
7
contract.
Well, you could to a Renown
So, yes, we are working that
8
MEMBER SAIZ:
But not yet, okay.
9
One more question.
What did you guys ever do
10
about the Tonopah issue, when the hospital closed in Tonopah?
11
How long did it take you to fix that problem?
12
MR. SLONUM:
So I can take that one because it
13
gets to the point of thinking more broadly about who our
14
community is, and so we were distressed when we heard the
15
2,500 people in Tonopah who had no access to health care.
16
MEMBER SAIZ:
17
MR. SLONUM:
There's 2,500 people there?
Yeah, so I'm not sure that they need
18
a hospital nor are they, but they certainly need a doctor or
19
a mid level or something that allows them to have access to
20
health care.
21
We have been aggressively working with both the
22
hospital and the county counsel down there to make sure we
23
can be a partner in figuring out what that looks like and how
24
we move forward. Actually, we've gone through several steps
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1
of that.
2
we've been selected as the partner.
3
have with the University of Nevada and the school of
4
medicine, it's also an important opportunity for us to make
5
sure that they have access to residents and other things that
6
they can practice in the rural environment.
7
that there's an opportunity for us to work with the people to
8
get service that they need.
9
We have another hearing coming up next week, and
And given the roots we
So we're excited
I don't know what that looks like at this point
10
or what, but we have a whole menu of options that were
11
provided to them, everything from having a primary care
12
person with emergency access to everything short of an urgent
13
care and perhaps even a small 24-hour observation unit, so --
14
MEMBER SAIZ:
15
MR. SLONUM:
Nothing yet?
It's going through the county
16
process, and we've been selected as the vendor for that
17
process.
18
MR. SLONUM:
Which I think the important part
19
about that I think is how we've first identified the partner
20
and second, identified the need to move outside of the walls
21
of our local geography to make sure that we're addressing the
22
needs of a broader community.
23
MEMBER SAIZ:
Okay.
24
CHAIRMAN DROZDOFF: Anna?
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That's it.
Thank you.
1
MEMBER ANDREWS:
Anna Andrews for the record.
2
I need to switch the order of my questions.
3
the wellness, the Healthy Tracks, is that part of the
4
contract or is that an additional fee?
5
MR. WINDFELDT:
6
MEMBER ANDREWS:
On
It's included in the price.
It is included, okay.
And then
7
you stated that you want to meet everybody's needs, and I've
8
been asking this question because, as you know, if you've
9
been present at the Board meetings, we've always had this
10
complaint that there are people who do not have access to
11
technology.
12
a computer, and at times they do feel like they are left out
13
out there, and they have to call, and they are on a long wait
14
on the phone.
15
you're making to your proposal -- in your proposal to be able
16
to provide just this good service to that population as those
17
of us who are technology savvy?
18
They don't have a smart phone.
They don't have
Is there any advance or any other changes that
MR. WINDFELDT:
Well, there's nothing in the
19
proposal that is outside of what you have today.
But with
20
that, we are very aware of individuals who may not prefer to
21
utilize technology.
22
number one area for us to communicate is the telephone, and
23
so we have our call center, and we are very aware of the need
24
to answer that phone quickly, and we do, and we watch it on
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And so as I alluded to, you know, the
185
1
the hour every hour what our call -- our tracking.
2
And so when individuals call in, there's a phone
3
tree, and in the state of Nevada individuals have an option
4
to push and the phone calls are answered in 30 seconds or
5
less, and we hold our team accountable to making sure we meet
6
those needs so we can answer those questions for your
7
participants.
8
9
MEMBER ANDREWS:
Okay.
One more follow-up, if I
may.
10
CHAIRMAN DROZDOFF:
11
MEMBER ANDREWS:
Sure.
Towards the end of your
12
presentation, you said that your heart is in Northern Nevada.
13
So basically what I understand is this proposal is to provide
14
the HMO services with all of the options for Northern Nevada
15
and the rurals only?
16
MR. WINDFELDT:
That's correct.
So we go --
17
yeah, so our market for HMO goes all through Washoe County,
18
Carson, Douglas, all the way through rural Nevada.
19
have an HMO license down in the Clark County, Esmeralda,
20
Lincoln and Nye County, so those individuals today are
21
serviced through your Southern Nevada HMO.
22
MEMBER ANDREWS:
23
CHAIRMAN DROZDOFF:
24
Nevada now.
Okay.
We do not
Thank you.
So we'll go to Southern
Rosalie? Chris?
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MEMBER COCHRAN:
I actually have just a couple of
2
questions.
One has to do with just some discussion again as
3
we've had in the past about the rates for Northern Nevada
4
compared to the rest of the state.
5
the rates are so much higher out there for the HMO than they
6
are for Southern Nevada?
Why would you say that
7
MR. WINDFELDT:
That's a great question,
8
Mr. Cochran, and we've addressed that.
9
address that on a number of fronts.
We have tried to
Based on your experience
10
that we have throughout the state of Nevada, what it really
11
comes down to is provider contracting, and more specifically
12
it's in the area of a specialist.
13
We feel that the provider contracting at the
14
hospital, inpatient hospital is a parody for the state.
15
when you look at the specialist and you look at what contract
16
the specialists are paid in Southern Nevada compared to what
17
they are paid in Northern Nevada, there's a significant
18
difference, and we know that because we have a network in the
19
Southern Nevada, Las Vegas market that we acquired earlier
20
this year, and we've been able to do a lot of analysis around
21
that.
22
But
And when you're looking at areas of these
23
specialties, whether it's a GI or a neurosurgeon, ear, nose
24
and throat, in the Northern Nevada market because there's
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1
such a smaller number and there's really a lack of
2
competition for a lot of these areas, the health plans are
3
challenged with trying to get contracts with those providers
4
that are competitive to the Southern Nevada market.
5
In Southern Nevada it's a different market.
You
6
have 2,000,000 people that are all based really close to each
7
other.
8
lot more providers that work in that area.
9
Nevada, not only is it spread out over many hundreds of miles
You have a larger area where the providers work, a
In Northern
10
but you have a significantly far less population and,
11
therefore, you don't have the quote, unquote, leverage in
12
Northern Nevada than you do in the Southern Nevada market.
13
MEMBER COCHRAN:
Okay.
In consideration of that,
14
has Hometown Health ever looked at expanding statewide?
15
know you mentioned some offices and clinics down here, but
16
have you ever looked at doing a statewide contract?
17
MR. WINDFELDT:
I
We've looked at that and that's
18
something in our strategic plan that we will continue to
19
evaluate.
20
network side and from the self-funded.
21
in the Southern Nevada market.
22
the fully insured space at this time, but it's something that
23
we will continue to consider.
24
We've looked at the Southern Nevada market from a
We're doing some work
We are not in that market in
MEMBER COCHRAN: Okay. And then just one final
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question, you know, relates to your mission and strategic
2
planning, and we're in a period now where we're seeing
3
consolidation of large companies coming in and purchasing
4
other companies health plans.
5
what's the -- I'm not saying that you have, I have no idea,
6
but is that something do you guys get approached by other
7
companies to buy out the Hometown Health practice?
8
MR. SLONUM:
Is -- has Hometown Health --
I can start with that, twice a week.
9
If you -- there's only 100 health systems in the country that
10
have their own health plan, so this is a rather unique setup.
11
Nonetheless, it is a place where everyone thinks that
12
population health is moving as we get more integrated, better
13
coordinated and better managed care at high levels of
14
efficiency and lower costs.
15
We're very happy to have Hometown, and we're
16
certainly not in the market for selling it.
17
that differentiates the Hometown Plan from other health
18
systems, large systems, in fact their own health plan is ours
19
is rather mature and very robust.
20
will, for a lot of money, but we're not in the market to
21
sell.
22
The nice thing
It would cash out, if you
Similarly, we have -- our strategic plan says
23
very specifically we will remain independent.
24
actually are operating in our revenue and continue to grow
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This year we
1
sale and scope to make sure that we have the programming
2
needed for the communities we serve.
3
MEMBER COCHRAN:
Okay.
I mean, I do applaud it.
4
It's kind of unique at least for us down here in the south to
5
see a non for profit organization running in Nevada.
6
something that is unique to me being down in the south.
7
not unique to me in my experience in health care, but
8
certainly at least I applaud you guys for maintaining that.
9
In the state of Nevada, people may have different terms of
10
It's
It's
views on that, but I don't think I have.
11
But in any event, I'm more curious about that
12
because obviously we have this discussion about rates and,
13
you know, if someone were to come in and say eventually offer
14
you a deal you couldn't refuse, that may set parameters in
15
place that cause us to have to think about, you know, our
16
future contracts as well, so but I don't have any other
17
questions.
18
CHAIRMAN DROZDOFF:
19
So, Chris, or, Rosalie, can you guys hear us?
20
21
We've lost video.
Rosalie?
So, Rosalie?
MEMBER COCHRAN:
Our mute -- yeah, our mute
22
button is very similar to the turn off the meeting button and
23
I hit the wrong button.
24
CHAIRMAN DROZDOFF: Well, you took it like a pro,
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Chris.
I appreciate that.
2
put that tape right across that, don't touch.
3
4
MEMBER COCHRAN:
CHAIRMAN DROZDOFF:
9
10
All right.
Rosalie, do you have any
questions?
7
8
We have a problem.
Thank you.
5
6
What was it, Appollo 13 where he
MEMBER GARCIA:
No, I do not.
Thank you very
much.
CHAIRMAN DROZDOFF:
MEMBER BAILEY:
Don?
Yeah, I just had one.
Can you
11
give us a little more information on Doctor On-Demand?
12
think that's just a terrific program for our rurals, and I
13
know you're in contract.
14
DR. ASH-JACKSON:
I
Right, I would be happy to give
15
you what the information that I've reviewed.
16
they have a program where they provide 15-minute urgent care
17
visits to patients that have a certain specified disease
18
process that they are comfortable treating.
19
they -- and they guarantee that there are physicians that are
20
licensed in the state that have the appropriate
21
qualifications to provide prescribing to local pharmacies so
22
that the patients, the members can get what they need.
23
24
I think it's not licensed.
So basically
Anything that
It's not available in
the Louisiana, Arkansas and in another state, I apologize, I
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1
can't remember which one, but from that, then they would be
2
able to do that.
3
provide, then they would refer that patient to a local
4
provider, particularly things like fractures or illnesses
5
that -- a seizure or things like that because people they
6
believe will reach out.
7
If there are services that they cannot
They charge a certain specified amount.
You
8
heard in the meeting it was $40 for that visit.
They also
9
have available mental health counselors with psychologists
10
that are not -- that are not prescribing physicians that they
11
have two different levels for that are for 25 minutes and
12
50 minutes.
13
would potentially be added to the network but covered under
14
the mental health benefit.
15
And those if, in fact, we work through that
Today in the rural market, we routinely see
16
Nevada rural health centers doing telemedicine for psychology
17
and psychiatric management because those claims have come
18
through my desk to verify that those patients are being seen
19
and that's the standard unfortunately in the rural market.
20
There's not a lot available, so that's how Doctor On-Demand
21
works.
22
On the Renown side, if you sign up with my chart,
23
then you can engage a Renown provider and get a telemedicine
24
or get a virtual visit on your phone or on your computer and
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that would be a similar benefit to you where you would be
2
able to go out and talk with that provider and then we verify
3
that those patients -- that those providers available
4
prescribed in the state of Nevada have all of the information
5
they need to, that's available to you today, but we haven't
6
done the best job publicizing it to everybody.
7
8
MEMBER BAILEY:
question.
9
That was going to be my next
I'm sorry, I got two questions.
CHAIRMAN DROZDOFF:
10
MEMBER BAILEY:
Oh, okay.
The second question would be what
11
are you doing to reach out to the at live members in the
12
rural areas and are you keeping it like Anna pointed out some
13
of our members have no knowledge of computers or anything
14
like that.
15
are you visiting the areas and selling the program?
16
Are you doing some mailing and some selling or
DR. ASH-JACKSON:
I think once we make a
17
determination about the scope of this new benefit because
18
it's a new benefit for us, then we'll be siting down with
19
people like John Hager and making him drive out to the
20
rurals.
21
will come up with a campaign because we want to be sure that
22
we take into account that everybody is served but our rural
23
-- but our hospital rural partners' needs are met as well
24
from the perspective that if someone can't use this level of
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No, I'm teasing you obviously, but I believe that we
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1
technology, that they have those -- they have services
2
available for them to be taken care of.
3
whole campaign and once we work through the benefit, we'll be
4
happy to bring that back here and share it with you.
5
MEMBER BAILEY:
6
MR. SLONUM:
So there will be a
Okay, great.
To answer your question a little bit
7
differently, on the health side, we have extensive reach outs
8
into the community and into the rural hospitals, mostly not
9
to the member themselves but through the hospitals from which
10
they are referred, just easier point of contact.
11
been out at 15 of the hospitals myself driving around,
12
forming relationships, establishing what we can do in
13
partnership and those kinds of things because the tighter we
14
become in the community, the better off and easier those
15
transition points are for the members that need them in
16
crisis.
17
MEMBER BAILEY:
I know I've
Right, and through your partners,
18
that's how you have got to reach our members because
19
otherwise you're not going to get to them.
20
you know, more than just they don't have computers and they
21
are not going to get it, and the call system may work, but I
22
think something in visitation format with your partners would
23
be great.
24
They need that,
MR. SLONUM: We know that care in the rural
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environment is very relationship oriented, very relationship
2
oriented.
3
MEMBER BAILEY:
Very good.
4
CHAIRMAN DROZDOFF:
Thank you.
So I really sort of just have
5
one line of questioning, and I'm a little bit surprised on
6
the lines of where Chris was.
7
Ty, you have certainly been -- well, you've been
8
here from the start, and so you've had the discussion or
9
heard the discussion about the blending of rates and the HMO
10
rates and the logic.
The logic of the time was, of course,
11
that there's, you know, you have one kind of -- you have one
12
state employee.
13
south, it's still arguably a more rich plan in the north.
14
But the one factor that always comes up about
And even though the rates are cheaper in the
15
your plan is that in the south there's, you know -- there's
16
whatever you want to call it, there's a permission that you
17
have to go through before you see somebody else and that
18
doesn't necessarily exist with you all.
19
discussion for this many years, maybe this is an unfair
20
question, is the blending of rates the best approach or is
21
there a better way to kind of strike at the equity issues
22
whether they are positive for the participant or negative for
23
the participant?
24
So being part of the
You know, what do you think is the best way to
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kind of get at this, trying to make the benefits mirror each
2
other, recognizing, you know, that they are two different
3
approaches?
4
MR. WINDFELDT:
It's a great question, certainly
5
a philosophical question.
6
often.
7
challenging areas that you face.
As for the Board, it's probably one of the most
8
9
I know it's one you grapple with
You know, from my perspective, the way I look at
it, it's no different than any one specific employer group.
10
Let's say there's an employer group at Renown Health, we have
11
6,000 employees.
12
premiums.
13
condition, we don't see, well, you had a bad year last year.
14
You caused a lot of expenses so we're going to rate you up,
15
but the rest of the individuals were not.
16
concept of the insurance.
17
We don't individually rate the employees'
So if somebody is diagnosed with a catastrophic
You know, it's the
So when you have those areas where you have
18
employers that offer coverage throughout the state, like the
19
state of Nevada, it's traditionally we see it's blended, and
20
we have a number of employers that we work with that have
21
north and south.
22
the north and the south.
23
north.
24
there's some good things in the Southern Nevada market.
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It's just the nature of doing business in
There's some good things about
There's some bad things about north, just like
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1
As this market grows and as the projections
2
continue to be, then we anticipate there's going to be some
3
evolved evolution and things will evolve in that space.
4
know, right now, we don't have too many people in which the
5
benefits that bring, but over time I think we will be able to
6
continue to work with Renown and with other providers that we
7
are partners with to continue to make that issue aware of the
8
differences and the cost.
9
You
We made substantial changes this year which is
10
why the premiums have been reduced, substantial changes that
11
we have made.
12
Nevada market is, but we do see the light at the end of the
13
tunnel, and we will continue to work with those providers to
14
get to where we need to get to have parody in the state, and
15
that will take time and that will take growth.
16
Albeit, we have a long way to go to where the
CHAIRMAN DROZDOFF:
That is a good point, that
17
the rates are less so arguably the blending is not as much.
18
Okay.
That's my question.
19
Is there anything else, anybody?
20
Any further questions down south?
21
MEMBER COCHRAN:
22
CHAIRMAN DROZDOFF:
23
24
No, no questions down here.
All right.
I appreciate your
time.
The way we've been doing this is we largely
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1
turned it over to you all.
I don't know who is going to
2
start but largely give your presentation, and then we've gone
3
pretty much member by member, giving them an opportunity to
4
ask questions if there's a question along the way, but for
5
the most part we have been waiting until the end.
6
MR. GIANCURSIO:
7
CHAIRMAN DROZDOFF:
8
MR. DOLAN:
9
of the Board.
Okay, fantastic.
Whenever you're ready.
Good after, Mr. Chairman and Members
For the record my name is Paul Dolan.
I'm the
10
assigned account manager for the PEBP's HMO plan offered in
11
the south by HPN, long term -- long term partner obviously
12
with PEBP, HPN.
13
Healthcare.
You all know me as the face of HPN United
14
I have come up monthly for your meetings, but
15
today I would like to introduce to you our subject matter
16
experts.
17
leadership team because they are the reason I'm able to be so
18
proactive and responsive to the PEBP staff's needs and the
19
participants.
I brought specific members from our senior
20
Joining me at the table on my left is Don
21
Giancursio, who is our CEO of the Nevada Market United
22
Healthcare.
23
graciously given us prior authorization to call her Dr. E.
24
And to my immediate right, Kim Sonerholm, vice president of
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On my far right, Dr. Rutu Ezhuthachan.
198
She's
1
sales and marketing.
2
he's the president of VHO and you know him from your PPO
3
network and he joins me at the monthly meetings.
4
Cassano, vice president of network development and
5
contracting, and down in the south at the Marilyn Parkway
6
video location Glenn Stevens is our general counsel.
7
attends the meetings with me, as well up here when he's not
8
at the DOI.
9
In the audience, as well, Gary Ramos,
Scott
He also
We've got a brief set of slides to go over with
10
you today to demonstrate why HPN is the best solution and
11
share with you the value HPN has provided over the years.
12
We've been partners with PEBP 25 plus years.
13
to say I wanted to point out I've been assigned as the
14
account manager for 21 of those years, and very proud to say
15
of that work and saw the changes over the years, saw the
16
improvements, saw the changes, but very glad to be with you
17
through that whole time.
18
I'm also proud
RFP submission consisted of two options.
Option
19
one was our statewide proposal for the six counties shown
20
here, that offered one plan design, one set of rates, single
21
billing, one reporting package, single clinical integration
22
and applying the same care management and expertise and
23
population health management to both the north and south of
24
PEBP populations within those counties.
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1
Option two is obviously our larger footprint in
2
infrastructure, the Southern Nevada counties that would
3
represent our current plan design, and also we propose an
4
additional little value added cost reduction option as well.
5
Down in the south, obviously our innovative
6
provider contracting strategy allows us to offer more
7
aggressive price point, but also we wanted to offer PEBP
8
maximum flexibility to allow in the state to offer different
9
plan options possibly in the surrounding counties.
10
What sets us apart from the competition is based
11
on four core competencies allows us to deliver what we know
12
is the best in class health care.
13
remaining slides, we'll touch on all of these, cost
14
management, clinical integration, technology and personalized
15
service.
16
structure, stable trends over the years of renewals with
17
PEBP, simple plan design that the participants like, the
18
co-pay structure.
As we go through the
We're an affordable plan with predictable cost
19
Clinical integration, that's one of our keys to
20
our success.
21
delivery model is what differentiates us from the rest of the
22
market.
23
from Dr. E.
24
We'll spend some time on that.
Our integrated
You'll hear about that, more of that in a moment
Innovation, we're going to go over the tools and
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1
resources that we're constantly growing and approving for the
2
PEBP participants.
3
Consumer engagement, it's important that the
4
participants become more engaged in the health care decisions
5
as the years progress.
6
We'll talk about HPN having the backing and resources through
7
our parent company and health group.
8
9
10
Patient center of care, we help participants
achieve a better health outcome, as well as we help the
physicians practice better medicine.
11
12
We'll talk about PEBP -- excuse me.
I now would like to turn it over to Dr. E who
will focus on the strengths of our integrated delivery model.
13
DR. EZHUTHACHAN:
14
CHAIRMAN DROZDOFF:
15
DR. EZHUTHACHAN:
16
Thank you.
It's fine.
So I want to share -- thank you
also for having me here as well.
17
I do want to share that I've been with the
18
company for over 12 years and at least a decade of that
19
providing direct inpatient clinical care so I'm very well
20
versed in terms of, you know, what that means between the
21
physician-patient relationship and what that means to the
22
patient as well in terms of their experience through health
23
care.
24
So clinical programs that we've developed over
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1
the past decade and more are really patient centered evidence
2
based and meant to create the right environment for the
3
patient.
4
one size fits all, so I would like to touch on some of the
5
pieces in the slide in front of you.
6
Patient care is meant to be personal and not just a
A medical home model where a patient has a
7
medical home has been well established since the 1950s.
8
People who have a medical home and are there where they are
9
well identified by their primary care provider do much better
10
in terms of chronic disease management and long term outcome.
11
So we always want to promote that kind of relationship for
12
our patients with their providers.
13
One of the examples that comes to mind when I'm
14
thinking about a patient care experience is a
15
hospitalization.
16
and when we look at our clinical care programs, we look at
17
several that can impact how that -- how that experience
18
translates out for that member.
19
have onsite case managers who are there.
20
That is a scary, overwhelming experience
Right from the onset, we
When a patient is having an acute episode of
21
anything and they are talking to their physician, there's a
22
lot of research out there that shows us that half of what is
23
happening in that dialogue between the doctor and the patient
24
and the family is getting missed because you're so worried
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1
about your loved one, you're so worried about what is
2
happening that you kind of need someone to translate the
3
Dr. E's that just happened.
4
realtime in the hospital.
5
Our onsite case managers do that
At discharge we have a Care For Me program where
6
we have specialized case managers to then for the next
7
30 days or longer if needed will follow the patient through
8
that discharge.
9
with the patient to help translate that Dr. E's to make sure
They will come to those follow-up visits
10
nothing is missed because it is very complicated.
11
frankly, I think a patient should be worrying about their own
12
health care and getting better and taking care of their
13
family and should be leaning on our clinical team to help
14
them maneuver the rest of that.
15
And quite
After that, we also have a complex case
16
management system, again, a very high touch also will come to
17
doctor visits with the patient, will also tele-visit in and
18
make sure all of those referrals and needs are taken care of,
19
help them remind them of things and coordinate care across
20
the variety of needs that they need and even plugging them
21
into social work, if needed, for transportation, other
22
resources, community resources that might be out there for
23
their needs.
24
Looking at health care isn't only about when you
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1
get sick though.
2
preventative health care, as well, and we have a variety of
3
wellness programs.
And the question is, you know, when does
4
health care begin?
Personally, as a pediatrician, I think it
5
begins very very early and actually preconception.
6
Really good health care is about
Our wellness programs offer prenatal classes.
7
The goal is really to engage people as early as possible in
8
their health care.
9
they are more likely to be on a correct trajectory for good
10
11
If we do it early, we engage them right,
health care all the way through.
We have also lactation support because
12
breastfeeding is one of the earliest health care
13
interventions that you can do.
14
It's valuable.
15
developmental outcomes for children.
16
risk for children.
17
it's very powerful, and we have trained our staff to be
18
lactation consultants in the north and in the south as well.
19
In quarter one, they will also be doing some bedside
20
lactation support.
21
are out there, from toddler nutrition and even some
22
specialized pieces.
23
24
It's simple.
It's important.
It can change the trajectory for neuro
It can change cancer
It can change cancer risk for mothers, so
There are other wellness programs that
Unfortunately, many of us have experienced a
family member or a loved one who has gone through cancer.
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We
1
have registered dieticians that have done nutrition programs
2
based around specific cancers and will give them one on one
3
consults.
4
ever experienced that beside a loved one, you know that it
5
can really take a lot out of them.
6
drain them, and we have a team of dieticians who have taken
7
special interest in this to help maximize nutrition, help
8
maximize that outcome in that experience as much as possible
9
and maximize the health outcome which is what we want.
When you're going through chemotherapy, if you've
10
Those treatments can
Linking to that medical home as a patient, I
11
think anyone would want to have immediate access to
12
information.
13
get it?
14
advice nurse that is a registered nurse who is using evidence
15
based medical protocols that are reviewed by regularly.
16
the advice is sound and standard of care.
17
If you're not the expert, where am I going to
How can I get it quickly?
And we have a 24-hour
So
And that telephone advice nurse also has access
18
to the member chart in terms of which hospitals and where to
19
direct the member and if the member needs urgent care, if the
20
member needs to go to the hospital and also if the member
21
needs just some home remedy guidance so that is at their
22
fingertips available for them as well.
23
24
Really good medicine is evidence based but also
customized to the personal needs of the patient.
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Another component of our care delivery is
2
pharmacy clinical programs.
We've also realized that during
3
that hospitalization, some members may be challenged with a
4
variety of medications and what is happening on all of these
5
new things, and we even have some bedside delivery models in
6
place, and we also have some home visits by pharmacists that
7
have happened so that you can go through someone's medicine
8
cabinet and take the time that's necessary to make the member
9
comfortable with their health care and ask all those
10
questions that sometimes in that short physician encounter
11
may not happen.
12
Really the way I view it and the way I think it
13
is meant to be is that the patient is in the center of a
14
patient center model and everything around it is to support
15
the patient, the participant, the member or their family
16
member as they are going through the health care continuum,
17
whether it be before they are even born, all the way to
18
having some acute need that needs immediate services.
19
Some of these things in the slide we already
20
touched on in terms of the wellness programs and the
21
importance of PCP, advice nurse.
22
In terms of utilization management, we have -- we
23
already talked about the onsite case managers who are doing
24
that and they are dialoguing with us the medical directors
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1
daily in terms of what a patient needs so we can coordinate
2
and get that care for them.
3
We also have a HEDIS Outreach and HEDIS, I think
4
probably many people have heard of it, but it's basically CMS
5
comes up with over 80 health quality indicators that they
6
benchmark insurance companies on, and we've taken a proactive
7
approach because I really felt that transparency all the way
8
down to the consumer was very important, and this year we
9
really looked at who were some high performing providers in
10
measures.
11
picked an adult member and we published in our member
12
newsletters some education about those specific quality
13
indicators so that the member would understand what we were
14
looking at.
15
We picked a pediatrics.
We picked an OBGYN.
We
And then we were transparent with the providers
16
and listed the top three providers who performed well because
17
I think the member needs to know who is doing it right and be
18
able to have that choice as well when they are looking at
19
that group.
20
Also --
21
CHAIRMAN DROZDOFF:
Sorry, I realize it probably
22
changed depending on what kind of doctor, but can you give us
23
some examples of what high performer, what variables?
24
DR. EZHUTHACHAN: It was the first year I piloted
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1
this because it was just an opportunity to be innovative and
2
try something new, and we looked at immunization rates for
3
pediatricians.
4
OBGYN's because there have been a movement for high elective
5
C-sections.
6
that can be associated with adverse outcomes later in life.
7
We looked at primary C-section rates for
However, on the downstream effects, sometimes
So for example, if you're born, most people think
8
full term is if you're over 37 weeks.
Traditionally, it's
9
40 weeks is full term but if 37 weeks is the definition, then
10
people think, oh, it should be okay if I just have my
11
C-section at 38 weeks.
12
studies looking at second grade math and reading scores and
13
if you are born even 37, 38 compared to 40, they are lower.
14
Well, what we found is that there are
So I don't think the average person, you know,
15
has had an opportunity.
16
and learn and know about but if that's something we know
17
about, I think it was our responsibility to share that having
18
a child at the right time when mother nature intended.
19
Obviously, there are emergencies that come up and we're there
20
for that too, but the elective C-section, that was sort of
21
the medical implication of why it didn't make sense to do
22
that electively.
23
diabetes control.
24
There's so much out there to read
And then for the adults, we looked at
CHAIRMAN DROZDOFF: Great. Thank you.
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1
DR. EZHUTHACHAN:
2
And the, you know, talking about urgent care, the
3
other thing that comes up for me as a medical director is the
4
complicated cases will percolate up to me and what is nice
5
is, you know, having been a practicing physician in Las Vegas
6
for over a decade, you know, I know what is available
7
resource wise and I've been able to route patients where they
8
need to go.
9
You're welcome.
But every now and then there's something here --
10
there's something we don't have here but because we are
11
linked to United Healthcare, we can access their countrywide
12
national network, and I've been able to get patients to some
13
specialty care.
14
something outside of Nevada, we can facilitate that.
If we need a Center of Excellence for
15
The most recent example that I can think of was a
16
baby was born with a condition where the lightest touch would
17
have eroded their skin.
18
genetic condition but it was -- it was comforting to know for
19
the family, also as well me, as you know, a pediatrician that
20
I can get them to a facility, a specialty center and they can
21
go for periodic visits to make sure this child is getting
22
exactly the care he needs to grow up to minimize any adverse
23
outcomes later.
24
Now, it's super rare.
It's a
Thank you.
MS. SONERHOLM: So what I think you hear from
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Dr. E and I think what you will hear from me is that we're --
2
we're here.
3
daughter.
4
like we want our family to be treated.
5
We're local.
I'm a mom.
I'm a granddaughter.
I'm a wife.
I'm a
We treat our members just
About two years ago, I was talking with a member
6
and she told me something that I found that was very profound
7
in the way that she thought of health insurance, and it's
8
really stuck with me, and it's something I share with a lot
9
of people in our organization.
10
She said that she thinks of
health insurance like she thinks of the fire department.
11
When she first said that, I really sat back and I
12
really didn't understand, and so I kind of pushed her a
13
little bit more.
14
associate health insurance with the fire department.
15
said I really don't go down to the fire station.
16
really know the firemen but if my house is on fire, I want to
17
know that they are going to show up and they are going to be
18
there when I need them, and that's what I want to know from
19
you.
20
that I can count on you, that I know that you're going to be
21
there when I need you.
22
from us in our presentation is that we want to be sure that
23
we're going to be there for your members, that we're going to
24
treat them like they are our family members.
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I said can you explain to me how do you
And she
I don't
I want to know that if I have something that goes on
And I think that is what you will see
210
1
I talk to members everyday.
I may be the vice
2
president of sales, but I was in network for 12 years and
3
that's part of why I'm going to go over the network slides
4
and tools in innovation that we have because I am very
5
passionate about the care that we deliver.
6
whether about on our plan or not on our plan.
7
calls me and they say they need assistance, I'm going to be
8
there to assist them because that's exactly what I would want
9
if somebody from my family was reaching out and they didn't
10
have a resource, I would want that person on the other side
11
of the line to be able to help the person that they were
12
calling.
13
I talk to members
If someone
So I'm going to talk to you a little bit about
14
our network.
15
It's the foundation of what we're providing.
16
Nevada we have a network that is proven.
17
deliver with our network, it's consistent.
18
In Southern Nevada, we have access to Southwest Medical.
19
have a whole slide on Southwest Medical.
20
to you a lot about that because we really believe that this
21
is something that is very unique to the model that we have
22
that we can provide to your members.
23
24
Our network has been in place for 30 years.
In Southern
The results that we
It's predictable.
I
I'm going to talk
We also have access to long term hospital
contracts.
We don't negotiate our hospital agreements for
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1
just one year.
2
That's why when we make proposals, we can say we know what
3
our future looks like.
4
arrangements.
5
providers, we don't want the providers to be unhappy.
6
want to have a relationship with our physicians and our
7
providers.
8
We want to be able to have predictability.
We want to have long term
The relationships that we have with our
We
When someone calls me and asks for assistance, I
9
can pick up the phone and call a provider and say I need your
10
assistance, and they will get on the phone with me and assist
11
me with that number because that's the kind of personal
12
relationships we want to have with our doctors and they
13
expect from us because we are all sitting there -- here in
14
Nevada working with the doctors and working with the
15
providers.
16
They are not processed somewhere else.
17
here.
18
The claims are processed in our offices here.
Everybody is working
I know we kind of skipped over it but we have
19
over 3,900 people who are working for our health plan here
20
locally here in Nevada.
21
health plan, they are also insured with our health plan.
22
cover our own employees with our own HMO plans.
23
that's something important that we -- the value that we
24
deliver, we deliver not just to clients, we also deliver it
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Not only are they working on our
212
We
So I think
1
2
to our own employees.
Our network, it is a capitated network.
There's
3
a lot of value to that outside of just the fact that it does
4
provide an affordable delivery system, but also there is a
5
lot of ease when the members go to access the plan, there's
6
not claim issues on the back end to provide a very simple
7
plan design that people seem to enjoy where there's co-pay
8
plans, where they know what the known cost is going to be
9
when they go to the providers.
That has been something that
10
a lot of the members have enjoyed and benefitted from our HMO
11
plan designs.
12
Our provider agreements today, we hold our
13
providers accountable.
14
don't want the providers just to provide care.
15
to provide quality care.
16
are tied to quality efficiency and satisfaction, so we're
17
linking their payment to these things.
18
We use value base contracts.
We
We want them
We have -- all of our agreements
In the north, we are contracted with both
19
hospital systems, Saint Mary's and Renown.
We have both
20
systems up here in the north.
21
have had an opportunity to review all of the responses in the
22
request for proposal, but 90 percent of our primary care
23
providers have open panels and are able to take patients and
24
new patients.
I don't know how many of you
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1
One of the areas where we did not have -- we did
2
not propose a network was in Carson City.
3
product file in Carson City, but we do have providers in
4
Carson City, so that was something that you were interested
5
in us doing.
6
We can also file a product and have that available in the
7
Carson area.
8
So those are things I just wanted to kind of touch and
9
highlight.
10
We do not have a
We could go and look and add providers there.
We also have providers out in the rural areas.
Dr. E did talk about our Centers of Excellence.
11
I think that is a very big value.
12
undermine that.
13
largest networks.
14
we are very strong in Nevada with what we are able to do with
15
our plans and our infrastructure here in Nevada, having the
16
ability to reach out into the united world accessing our
17
transplant and our Centers of Excellence, accessing, being
18
able to go to a national carrier and utilize their resources
19
and tools, it's invaluable.
20
more value that brings to the table for us.
21
I don't want to, you know,
The United Proprietary Network is one of the
While we do have a local presence here and
I cannot express to you how much
Southwest Medical, as I mentioned to you before,
22
I know access has been a concern.
Access is a concern in
23
Nevada.
24
something we are struggling with in the state of Nevada.
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No matter who talks to you, we know that access is
214
At
1
Southwest Medical, if you would have looked at us in 2014, at
2
the end of 2014, we had 248 providers.
3
We have hired over 100 providers.
4
makes us different.
5
We are also providing care.
6
doing things to try to make access easier and simpler for our
7
patients and more convenient for them.
Today we have 362.
That is a big part of what
We are not just an insurance company.
We're delivering care.
We are
8
When we first started Southwest Medical, we were
9
building just these giant clinics throughout the valley, and
10
we had these big clinics throughout the valley where there
11
were urgent cares and family practice and everything was
12
housed, and we realized that that wasn't as convenient for
13
everybody as it could have been.
14
over the last two years and build more retail type
15
facilities.
16
So we started to branch out
We started to add convenient care facilities
17
throughout the valley, where people could come in and have
18
walk-in visits.
19
ability for same day access, the ability to call and get
20
right in if they had a flu symptom or something.
21
That's what people were looking for, the
We introduced telemedicine.
We've been doing
22
telemedicine for the last two years with our commercial
23
population.
24
that staff our telemedicine. They have access to members'
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Our Southwest Medical physicians are the ones
215
1
medical records.
2
they are on the phone with the person if they identify a gap
3
in care.
4
not a network provider.
5
with.
6
They are able to close gaps in care when
It's available 24 hours seven days a week.
It's
It's not somebody that we contract
These are our physicians that are hired.
They
7
are dedicated to telemedicine.
8
telemedicine visits than any other practice in the United
9
States because of the volume we've been able to drive through
10
our telemedicine.
11
Clinic.
12
here with me.
13
me I'm not text savvy.
14
They have completed more
That telemedicine app is called the Now
I have it on my phone.
I don't have my phone up
It's very simple to use.
People have said to
I go out and I meet with people all of the time.
15
I meet with members.
I'm in front of our patients and
16
members all of the time.
17
it.
18
long on to the Now Clinic.
19
you've ever -- if you have teenagers, which I do, it's Face
20
Timing with somebody, and it's a very easy way to have a
21
visit.
22
go down to where people are potentially sick and get exposed
23
to other things.
24
able to provide through Southwest Medical has been a
CAPITOL REPORTERS (775)882-5322
They say I don't know how to use
I pull my phone up and show them in two minutes how to
It is like doing a Face Time.
You don't have to leave your home.
If
You don't have to
So the telemedicine Now Clinic app, being
216
1
fantastic addition to what we're doing at Southwest.
2
Our urgent care facilities, I'm not sure if
3
anybody here has had the opportunity to see them or be able
4
to understand what they do, but the level of care that we're
5
providing at our urgent cares, it's a much higher acuity
6
level than you see in a lot of urgent cares.
7
triage.
8
are able to stay -- we have one facility that has a 23-hour
9
observation unit.
We're able to
We're able to stabilize, avoid ER visits.
Patients
These are things that we've been adding to
10
the system in order to make care more convenient at access
11
points.
12
identified is we're here.
13
we know that are challenges for us here in Nevada.
14
These are the things that we know that we've
Our Southwest Medical, we are one of the only
15
NCQA accredited.
16
medical home.
17
accreditation.
18
through.
19
We have people accessing care that
We have level three accreditation for our
No one else in the state has that
It's a very onerous process that we have gone
Over the last year, we launched an app, something
20
that you don't see with any other medical practice.
21
to just mention this to you because this portal we have with
22
Southwest allows people the access and availability to
23
schedule their appointment, renew their medication, have an
24
e-visit, use the point of Now Clinic, have their records on
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I wanted
1
an app.
Ever since we lunched this, the adoption rate of
2
people utilizing this has been incredible from our seniors to
3
our commercial population.
4
You would think that it wouldn't be as well
5
adapted with certain demographics but we have found that this
6
app and the utilization of it has made it so much simpler for
7
people to be able to access services and access their records
8
and be able to schedule appointments and cancel appointments
9
and manage their own care.
10
Really quickly, I'm going to touch on some
11
innovation.
12
Group, outside of us being local, there are a lot tools and
13
resources that we've been able to add having as far as
14
innovation.
15
trying to make the health care system better and simpler.
16
Having United Healthcare and United Health
We're constantly innovating.
We have a symptom checker.
We are constantly
It's a mobile app
17
that you put on your phone.
18
nurse.
19
you can also map yourself to the closest current urgent care
20
connected to the telephone advice nurse that Dr. E talked
21
about.
22
It's like a telephone advice
Not only can you look up symptoms by palm remedies,
Urgent care home waiting, it's been a very great
23
-- something we just introduced here in the last couple of
24
months.
If you want to put yourself in line for an urgent
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1
care visit, you can go on, see how long the wait is, put
2
yourself in line and it will let you know when it's your turn
3
to go down to the clinic so you don't have to sit in the
4
waiting room to wait for your visit, very well received.
5
Rally Wellness, it's something United has
6
launched nationally.
7
upon.
8
the wellness concepts that we all want the patients in order
9
to be healthy to live healthier lives.
10
11
It's a wellness tool.
It's founded
It gives people the ability to do challenges and adopt
And I've already kind
of talked to you about the Now Clinic and the E-visits.
The last thing I just wanted to kind of bring to
12
your attention, I know reporting analytics in the past have
13
not been something that Health Plan of Nevada has been
14
something necessarily we've been known for.
15
the least three or four years we have put a lot of effort
16
into becoming stronger in our analytics.
17
However, over
We've used our resources that we have with
18
United, the national reporting team.
They have been able to
19
assist us in pulling analytics together, having access to
20
national peer data.
21
better reports for you, I think you've seen some of those
22
reports here with what we've been able to come here with as
23
far as our health plan performance reviews.
24
able to produce better reports and analytics out to our
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Not only does that help us produce
219
We've also been
1
providers to help them understand in how to manage their
2
patients.
3
MR. GIANCURSIO:
Okay.
I guess the last slide up
4
and we're right around the end to the finish line, so it's
5
been a long day I'm sure for all of you, as well it has been
6
for us, but it was well worth our trip to have the
7
opportunity to sit here and talk with you about our proposal.
8
9
10
11
Let me start by saying thank you to the PEBP
Board and the staff for selecting Health Plan of Nevada to
participate in today's finalist meeting for the HMO services.
You know, Paul made mention of his tenure as the
12
face of the company, but hopefully what you'll take away is
13
that all of us have been involved in the PEBP program for
14
many many years behind the scenes.
15
the meetings, our schedules typically don't allow us to,
16
that's why we have an account manager assigned to the team.
17
He's typically accompanied by either Garren or Glenn, who I
18
believe is in the Grant Sawyer building observing the
19
broadcast today, but the point is that we're all here to
20
support PEBP, have been and will continue to be.
21
We don't always get up to
I'm probably next to Dr. E the next least tenured
22
employee at 20 years.
The other two, three employees that
23
represent the continuum of leadership here today are north of
24
20 employees with the company, and that's very important to
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us as we do have a sense of history with PEBP.
2
have gone through challenging times but all in all, I think
3
our relationship continues to grow.
4
We certainly
Hopefully in this brief opportunity to talk
5
today, a chance to look at our material, our RFP, we've been
6
able to impress upon you what that slide says that we really
7
are more than just a health plan.
8
to characterize our organization as probably a true advocate
9
for the Nevadans.
10
I probably think it's best
When I think about my responsibility as the
11
health plan president and the multitude of programs that
12
we're entrusted to serve Nevadans with and through, when we
13
tally that up, it's almost a million members that depend upon
14
us for services, whether it's health plan, underwriting of
15
insurances or the delivery of care through Southwest which is
16
part of our optimum business unit, and that array of
17
membership spans all types of coverages, certainly our
18
commercial business which includes accounts like PEBP but our
19
Medicaid program which we've been proudly part of since day
20
one with the state.
21
program in the state of Nevada and continue to grow with it.
22
18 years we've been part of the Medicaid
We're a major player in the Medicare advantage
23
space for our seniors.
We've been part of that program for
24
30 years, and this region is part of the military and
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1
veterans program that United Healthcare manages.
2
that's United Healthcare's contract, our team here locally is
3
involved here managing it.
4
responsibility to continue to advocate for Nevadans and
5
what's best for Nevada.
6
Even though
So we have a tremendous sense of
We are a major employer.
We are local.
We have
7
3,000, almost 4,000 employees in the state, and we continue
8
to grow.
9
we have the benefit of probably the largest and most well
10
capitalized national if not soon to be global company in
11
health care and in that health group.
12
We continue to invest.
We're a local company, but
When I think about the transaction of our
13
acquisition back in '07 which was Sierra Health Services, I
14
think about how difficult it would have been for Sierra
15
Health Services to endure the recession that we went through
16
in this state.
17
Having had United Health Group as our parent,
18
having had access to Capital to allow us to invest in our
19
political infrastructure, in our technology systems, most
20
importantly our people was a blessing, and they have been
21
truly a great partner in allowing us to run our Nevada
22
business model the way we know how to run it, quite candidly
23
without any interference.
24
So when we talk about a local company, we do
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1
everything here for our members, specifically in the PEBP
2
account.
3
in Las Vegas at our corporate campus.
4
been there or haven't had the chance to see our facilities,
5
we welcome the opportunity to extend an invite to invite any
6
or and all of you.
7
There is no business offshore.
Everything we do is
If any of you have
Paul mentioned real briefly that we responded to
8
a couple of different options.
You know, ultimately the
9
Board and the leadership will pick which one hopefully they
10
think fits best in terms of leveraging our many strengths to
11
the benefit of your plan.
12
You heard Dr. E talk briefly about kind of the
13
focus on quality evidence based medicine and that's really
14
been the hallmark of our program for basically 30 years since
15
we've been -- since we've launched Health Plan of Nevada
16
business.
17
You know -- and you know, I want to stop and say
18
we are not perfect.
We do make mistakes but as any -- what I
19
would like to say and what I remind my leadership team about
20
regularly is it's not that you make the mistakes, it's what
21
you do to resolve it.
22
do it in a prompt courteous professional fashion?
23
believe we do because we aren't perfect, and we have made
24
mistakes, but I'm pleased with the leadership team that I'm
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Do you do the right thing and do you
223
I like to
1
given the responsibilities to direct our business with.
2
Kim shared some highlights, you know, real
3
briefly.
4
value story, the collection of network attributes and assets
5
that we have that they don't just allow for distribution or
6
differentiation because of the exclusive nature of them, but
7
they allow for us to achieve best in class cost structures,
8
and basically we pass them on to PEBP on both sides through
9
our HMO plan, as well as through our show plan which you have
10
11
Some of our core competencies, what I call our
the benefit of engaging for your ASA plan.
She talked about SMA and its clinical footprint,
12
the services it provides, technology and how we're continuing
13
to expand, that is our exclusive delivery system.
14
exclusive to us.
15
-- while we have broader network choices, doctors and
16
facilities, they depend upon us and we put a high degree of
17
pressure on them to deliver the highest level of quality of
18
service that is available for our members.
19
they are a critical part of our delivery system.
20
They are
They are not a multi paver model.
And we
And they are --
She talked real briefly about innovation and in
21
the past several years we employed Capital to invest in
22
technology to engage people, to help engage people in their
23
health care and doing it in fashions that are more conducive,
24
more desired on their part. Let's face it, it is a change in
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1
demographic, and technology is changing how people interact
2
in transact commerce.
3
It's no different in health care.
In fact, we're going through a major transition
4
as a system as a Eco system nationally in health care, and I
5
think you have the benefit of leveraging the assets of the
6
strongest company in that space.
7
closing slide says, we are more than a health plan, and we're
8
going to continue to engage in ways to advocate for Nevada.
9
You know, again, as this
Access to care is a passion that we have.
How do
10
we grow it?
11
south is challenged in terms of access.
12
Act did a lot to expand coverage to millions of Americans.
13
Here in Nevada, about a quarter of a million Americans today,
14
Nevadans have health insurance coverage they didn't have two
15
years ago.
16
You know, we know that Nevada certainly in the
The Affordable Care
While that's tremendous and I applaud the
17
Governor for the decisions he made for Medicaid expansion and
18
taking control of the state based exchange, the reality is
19
Affordable Care Act did nothing to expand access to care.
20
That's a huge challenge that we have to deal with as a state.
21
Certainly, we're doing everything we can in the southern part
22
to address that need.
23
24
You know, it's things like that that get us
excited about collaboration, collaboration for example with
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1
the school of medicine, the local universities, through their
2
various health care administration programs, internships,
3
whatever we can do to increase the supply of resources for
4
our community, we are engaged and focused on doing that.
5
Kim mentioned Now Clinic, that was a project that
6
I really latched onto at the beginning of 2013.
I said we
7
have got to -- we have got to utilize this technology.
8
got to make it available for our members, and we launched it
9
January 1 of '14 for our commercial population, about 350,000
We've
10
members at the time.
11
tremendous asset.
12
20 to 25,000 consults this year.
13
growing quickly and we're pleased to tell you, we launched it
14
last Tuesday for the Medicaid population, so there's another
15
200,000 Medicaid beneficiaries in the state that we have --
16
we have made tele-help available to.
17
We went live January 1 and has been a
We're probably doing about, on page to do
The adoption rate is
We would love to talk to PEBP about utilizing
18
that technology for your ASO plans.
19
to do that, we certainly have the capability.
20
scaleable resource, and I would tell you it's dramatically
21
different than anything that you may otherwise see in the
22
market place.
23
very integrated to try to close gaps in care at the time we
24
have a patient.
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It's very integrated.
226
If there's an appetite
It's a very
It's designed to be
1
And even if a member, whether they are in the
2
PEBP plan or the HPN plan in the south is using SMA or not
3
using SMA, there still could be a record of that visit
4
transmitted to that physician so that that physician can know
5
this individual did have an episode of care and can follow-up
6
on that.
7
We're going to continue to recruit physicians as
8
part of our optimum businesses.
We like to talk about
9
organic growth, not acquisition growth when we talk about the
10
physician capacity that we have in Southern Nevada and
11
that's, as she pointed out, if you would have looked at that
12
map four or five years ago, it would have had probably half
13
of the amount of facilities, certainly less than half of the
14
doctors that we have today.
15
The last piece, I'll tell you what you see there
16
in the bottom left of the screen, we've invested in a mobile
17
clinic that arrives in our state here scheduled for the
18
second to third week of January.
19
clinic on wheels.
It has two exam rooms.
20
radiology suite.
It's got a draw station.
21
it's going to be fully staffed.
22
This is a state-of-the-art
It's got a
It's fully --
This was launched primarily as a solution for our
23
Medicaid population because of their challenges with
24
transportation, excuse me, and we also are going to use it in
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1
the area of the Head Start programs in the school systems to
2
try to get early immunization.
3
screenings, early immunization for the children in the Head
4
Start programs, but we also see a crossover opportunity for
5
our commercial population, and we're going to be piloting it,
6
and we would love to talk about doing something potentially
7
with PEBP.
8
9
Dr. E mentioned early
We have a couple of community organizations up
here in Reno that we've already begun talking to about
10
frequency, running that mobile clinic up here.
11
expensive, but my goal is to have not just this one
12
operational early '16 but an order in for the second one by
13
the end of '16, going into '17 to serve our population.
14
My goal, very
So, you know, that kind of concludes our prepared
15
remarks.
16
you've given us today, and we certainly want to open it up
17
and be glad to attempt to answer any questions you might
18
have.
19
I certainly, again, want to thank you for the time
CHAIRMAN DROZDOFF:
Okay.
Well, we appreciate
20
your time, as well, in bearing with us for what was a long
21
day.
22
As I said, what we've done is we've just kind of
23
gone person -- Board member by Board member.
24
continue with that practice. If you're up for it one last
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I think we'll
1
time, Judy.
2
3
MEMBER SAIZ:
I'm up for it.
Judy Saiz for the
record.
4
CHAIRMAN DROZDOFF:
5
MEMBER SAIZ:
All right.
I have a few questions.
I've been
6
asking the majority of the questions, I think, so we might as
7
well just follow that pattern.
8
9
If you're chosen -- okay.
So I just want to make
this clear, you have applied, of course, for the south and
10
then for statewide network also, statewide HMO.
11
chosen for the statewide HMO, just a few things, I know you
12
have an office up here, and how would you deal with customer
13
service?
14
back and forth if he would be our true representative.
15
would you do if you were chosen as a statewide HMO as far as
16
customer service for the north?
17
If you're
Paul would just get so many airline miles going
MR. GIANCURSIO:
What
Again, all of our call claim
18
operations are headquartered out of Las Vegas.
19
our core campus is, but we certainly have the flexibility to
20
add dedicated staff to the north if there was a demand as
21
part of that decision to add staff to service the members up
22
here, that would be something we certainly would entertain.
23
MEMBER SAIZ:
24
MR. GIANCURSIO: In Las Vegas?
CAPITOL REPORTERS (775)882-5322
That's where
How many do you have up here now?
229
1
MEMBER SAIZ:
The north?
2
MR. GIANCURSIO:
3
MEMBER SAIZ:
We have 13.
13, okay, good.
A couple of
4
difficult questions here, if you're chosen for either the
5
south or for statewide, would you consider allowing another
6
carrier to be side by side with you as an HMO?
7
were -- if you were chosen as the south, would you allow
8
another southern carrier and if you are chosen statewide,
9
would you allow another one for statewide next to you side by
10
So if you
side?
11
MR. GIANCURSIO:
Our pricing wasn't -- was
12
contingent upon a different parameter.
13
open to considering doing that.
14
the opportunity to look at our pricing to see if we felt that
15
we -- we would be willing to do that, but I would be open to
16
considering it.
I would certainly be
I would respectfully request
17
MEMBER SAIZ:
You would be open to it, okay.
18
Another difficult question, if you're chosen as
19
the HMO, whether it's the south or whether it is statewide, I
20
read someplace in there under the contract, under the
21
assumptions that you may not allow PEBP to continue with the
22
show network.
23
24
Can you clarify that, expand on that?
MR. GIANCURSIO:
Sure.
Access to our show
delivery system.
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1
MEMBER SAIZ:
The PPO network.
2
MR. GIANCURSIO:
In the south has always been a
3
condition of our offer that, you know, if the -- if the state
4
wants to access our show assets that we would require that
5
our HPN HMO be offered as well.
6
standard practice with any employer, and we have several in
7
the south that choose to do that, but that's been our
8
arrangement for as many years as we've done it.
9
MEMBER SAIZ:
Okay.
Honestly, that's been our
So if you weren't selected,
10
we wouldn't have access to your Sierra Health and Life
11
Network, PPO network?
12
MR. GIANCURSIO:
13
MEMBER SAIZ:
Okay.
14
reports?
15
or quarterly loss reports?
MR. DOLAN:
17
MEMBER SAIZ:
18
MR. DOLAN:
Quarterly.
I know we see reports come through.
I was sharing them previously with
Mr. Wells and will certainly continue that.
20
MEMBER SAIZ:
21
MR. DOLAN:
22
MEMBER SAIZ:
23
24
Do you guys get monthly
Do you offer monthly like loss experience reports
16
19
That's correct.
Okay.
Loss experience stuff?
And utilization.
Utilization up to the minute, well,
within reason, yeah, okay.
MR. DOLAN: There's a three-month lag in the
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1
reporting.
2
MEMBER SAIZ:
3
MR. DOLAN:
4
MS. SONERHOLM:
incurred data.
7
8
The quarters will be quarter to
quarter.
5
6
Three-month?
It's based on incurred, so it's
It's typically it's a three-month delay.
MR. DOLAN:
The report is reflecting everything
that's come in as in a certain date.
9
MR. GIANCURSIO:
The short answer is yes, I think
10
the level of analytics and transparency in data is higher
11
today than it's ever been with our reporting packages, and
12
we're going to continue to refine those, you know, going
13
forward.
14
MEMBER SAIZ:
15
right, on-line.
16
that?
17
I know your members have access,
They can look at their claims and all of
MS. SONERHOLM:
Yeah, they can look at their
18
claims.
They can get their card.
19
prior auth, and we're working to develop actually a way for
20
clients to be able to run their own reports on-line so that
21
you would have realtime access to do that, and so we're
22
working towards that so that we can offer that in the future,
23
but we do have the ability to produce the quarterly reports
24
and it's a dash forward that provides loss ratio data.
CAPITOL REPORTERS (775)882-5322
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They can get their PCP
1
MEMBER SAIZ:
Okay.
So just really quick about
2
referrals, do you guys acquire referrals, PCP and then
3
referred to a specialist?
4
MS. SONERHOLM:
5
MEMBER SAIZ:
Yes.
Okay.
If you have -- how do we
6
handle it if you have a student out of state, you don't have
7
coverage for that student out of state if the parents left
8
the HMO?
9
10
MS. SONERHOLM:
services.
11
12
MEMBER SAIZ:
Okay.
MR. DOLAN:
14
MEMBER SAIZ:
No, we do.
You do have Carson-Tahoe?
When did
that happen?
16
MR. DOLAN:
17
MEMBER SAIZ:
18
You don't have Carson-Tahoe
Hospital in your network, right?
13
15
Correct, if it's HMO and emergent
I don't know the exact date.
So you have the hospital itself for
HPN?
19
MR. GIANCURSIO:
And Sierra Health and Life
20
Company, two down in the south regulated and headquartered in
21
Nevada.
22
MEMBER SAIZ:
Okay.
Any hospitals you don't have
23
in the state?
I could look through it, but I can't remember
24
if you don't have any.
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1
MR. GIANCURSIO:
2
MR. CASSANO:
3
Scott Cassano.
4
5
I'll defer to Scott.
If you don't mind, so my name is
I'm the vice president --
CHAIRMAN DROZDOFF:
Well, we've got folks down
south.
6
MR. CASSANO:
Again, my name is Scott Cassano,
7
and I'm the vice president for network development for United
8
Healthcare, and I'm responsible for Nevada.
9
blaring facilities that would not be contracted would be HCA
10
in Las Vegas, so the three HCA facilities are not contracted.
11
So the most
There are some rural hospitals that are not HPN
12
contracted.
However, they are Sierra Health and Life
13
contracted, and we do have access to those contracts, so we
14
could access those contracts via our Sierra Health and Life
15
HPN.
16
MEMBER SAIZ:
Do you know what they are?
17
MR. CASSANO:
Which hospitals?
18
MEMBER SAIZ:
Yes, in the rural areas?
19
MR. CASSANO:
Yes.
21
MEMBER SAIZ:
The ones that are not HPN, yeah.
22
MR. CASSANO:
So not HPN would be North Eastern
20
23
24
Which ones are SHL and not
HPN?
Regional Hospital, so that's Elko.
MEMBER SAIZ: You don't have Elko?
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1
MR. CASSANO:
I don't have it.
I have it on
2
Sierra Health and Life, so I could access that contract for
3
Health and Life of Nevada.
4
MEMBER SAIZ:
Okay.
5
MR. CASSANO:
Battle Mountain, I have that,
6
again, on Sierra Health and Life.
7
on Sierra Health and Life, as well.
8
also Sierra Health and Life.
9
out.
10
11
12
MEMBER SAIZ:
Humboldt General, that's
Pershing General, that's
Those are the ones that stand
So when you say you can contract
them, what do you mean?
MR. CASSANO:
So our contract with Sierra Health
13
and Life even though it's not a separate and distinct health
14
contract of Nevada, our contract has a dynamic called
15
reciprocity so I could access that contract.
16
have a lot of utilization in these areas so we don't list
17
them as Health Plan of Nevada.
18
19
20
MEMBER SAIZ:
We just don't
But if you're statewide HMO, you
would access them?
MR. CASSANO:
If we are statewide, yes.
So in
21
essence, we have accessed them, but we haven't had a lot of
22
the utilization there.
That's transparency.
23
MEMBER SAIZ:
Okay.
24
CHAIRMAN DROZDOFF: Well, maybe I'll just -- I've
CAPITOL REPORTERS (775)882-5322
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I think that's it for me.
1
been letting everybody go.
2
curious then, was it because you ran out of space, but on
3
your proposal when you had option one statewide, you only
4
listed a handful of counties.
5
MR. CASSANO:
Just a related question, I'm
Is that just because it was --
So I'll answer from a provider
6
standpoint.
I have a lot of contracted facilities and
7
providers outside of counties that I may offer product in
8
because the pattern of care is to those counties or is to
9
those providers.
So I have people, for instance, contracting
10
in Southern Utah because a lot of people in a town called
11
Mesquite keep going to Southern Nevada.
12
limited to the -- necessarily to the same geographic service
13
area as what we have filed I guess.
14
counties and the network configuration are not apples to
15
apples comparison.
16
CHAIRMAN DROZDOFF:
So my network is not
So the service area
I mean, I guess that's what
17
we're trying to figure out.
We're very familiar with your --
18
we're very familiar with your -- what you do in Southern
19
Nevada.
20
years.
21
statewide option, you know, really an option?
22
know, is it a robust option or is it that you've tried to,
23
you know, provide us with other alternatives, but it's not
24
necessarily something that is as strong as robust, and that's
CAPITOL REPORTERS (775)882-5322
Your option two, I mean, that's what we've had for
I guess what I'm trying to figure out is the
236
Is it -- you
1
really what we're trying to figure out.
2
exclude you.
3
MR. CASSANO:
I don't want to
We have a lot of commercial product
4
in Washoe County, and we have both hospital systems and
5
affiliated provider systems in Washoe County.
6
a robust network outside.
7
outside.
Although, we do have providers
8
CHAIRMAN DROZDOFF:
9
MEMBER EWING-TAYLOR:
All right.
Thank you.
CHAIRMAN DROZDOFF:
11
MEMBER EWING-TAYLOR:
Can I follow-up on that?
10
12
We don't have
Yeah.
Thank you.
So let's just
say Elko.
13
MR. CASSANO:
Okay.
14
MEMBER EWING-TAYLOR:
There's a fairly large
15
population in Elko, 35, 40,000, something like that, so you
16
don't have an HPN contract with that hospital.
17
MR. CASSANO:
Correct.
18
MEMBER EWING-TAYLOR:
19
MR. CASSANO:
20
MEMBER EWING-TAYLOR:
But you have --
A PPO contract.
-- a PPO contract.
So what
21
does that look like for our employees out there who might
22
want to have an HMO?
23
24
MR. CASSANO:
So we could access it.
It's really
going to be -- we could access the contract. So if you -- if
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1
we're offering a product in that area, we could access the
2
contract and they would be considered as in plan, receiving
3
in plan benefits.
4
MEMBER EWING-TAYLOR:
Okay.
So in your
5
terminology, accessing the contract means it could
6
effectively be transparent for our employee?
7
MR. CASSANO:
8
We would list them in the directory.
9
MEMBER SAIZ:
Why don't you just state that then
MR. CASSANO:
Well, we are getting lost in
10
We wouldn't know the difference.
as having --
11
12
terminology because the reason we don't have an HPN contract
13
is we really don't have any HPN business out there.
14
that's just when we ran the query and said who is
15
specifically HPN contracted, it just didn't show up on our
16
query, but the -- we do have a Sierra Health Life contract
17
that would allow us access to that facility.
18
it.
19
facility.
20
really existed.
So
So I am stating
It's not been a highly utilized Health Plan of Nevada
So it's just been a pattern of care that hasn't
21
CHAIRMAN DROZDOFF:
22
MEMBER ANDREWS:
23
To follow-up on those questions, I just want to
24
Okay.
Anna?
Anna Andrews for the record.
make sure I understand. Earlier you said that you don't have
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1
anything in Carson, but just a little while ago you said that
2
you have Carson-Tahoe.
3
MR. CASSANO:
4
MEMBER ANDREWS:
5
6
Yeah, we do.
So if we were to go statewide,
how would we take care of the Carson people?
MS. SONERHOLM:
We have providers in Carson.
7
What I said was we have providers in Carson City.
8
submitted the filing, we didn't put Carson as one of the
9
counties that we listed in.
10
We can add that county as a
filed product -- as a county for our product.
11
MEMBER ANDREWS:
12
MS. SONERHOLM:
Okay.
We do have providers.
13
HPN providers.
14
contracted with the hospital there.
15
we currently have filed under HPN.
16
easiest for us to add it.
17
When we
We have contract providers.
MR. CASSANO:
We have
We are
It is not a county that
We confirmed it is
So I think that's the confusion
18
here that when we bid it and you're observing it, we didn't
19
bid these counties.
20
That's the confusion.
21
It doesn't mean we don't have providers.
MEMBER SAIZ:
I think when you would submit a
22
proposal, if you're submitting it for a statewide, you would
23
include the ones you knew you had in those counties.
24
that's what we're saying. You know, it just got confusing
CAPITOL REPORTERS (775)882-5322
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I guess
1
for us because they weren't -- they weren't outlined.
2
MS. BURCHETT:
3
record, state purchasing.
4
5
So this is Gail Burchett for the
Would you clarify that.
In your proposal, do you
or do you not have Carson City submitted in your proposal?
6
MR. GIANCURSIO:
7
MS. SONERHOLM:
8
MS. BURCHETT:
9
MS. SONERHOLM:
I don't believe it is.
In the actual RFP?
Yes.
No in the RFP.
10
MEMBER SAIZ:
Yeah, that's what I thought I saw.
11
CHAIRMAN DROZDOFF:
12
MEMBER ANDREWS:
13
were talking about access and outreach.
14
how to take care of a very small population that is not
15
technology savvy.
16
calling a number and being on hold, is there any other
17
program that you have in place or that you can talk about?
18
Because telemedicine -- okay, telemedicine, you have to do it
19
off a computer, right?
MR. CASSANO:
21
MEMBER ANDREWS:
23
24
I have one more question.
You
I'm concerned about
So other than being on the phone and
20
22
Go ahead, Anna.
You do it over your smart phone.
Right, exactly, but we have a
population that doesn't have a smart phone.
MS. SONERHOLM:
You know what, actually it
doesn't require that we have a face-to-face visual with you
CAPITOL REPORTERS (775)882-5322
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1
to do a -- to do a Now Clinic visit.
You have a conversation
2
with a provider and have the same visit.
3
have to see you to diagnose you in order to diagnose you.
4
you were able to describe your symptoms and explain to the
5
provider what is going on, they can care for you that way so
6
you do not actually have to connect with a web camera or with
7
a face time to have that same experience.
He doesn't actually
If
8
We also have telephonic advice nurse.
We have
9
the mobile clinic which we're piloting to see how that works,
10
so that's another avenue for people to access services.
11
have e-visits which is, it's like an e-mail with a physician
12
where you're e-mailing with your provider.
13
there are many different ways.
14
We
So, you know,
And we understand that sometimes people are not
15
always text savvy.
My husband wasn't text savvy.
16
he's 43-years-old.
He wasn't text savvy to be able to get a
17
webcam to work, but he was able to get on the phone and have
18
a Now Clinic visit with a provider by just talking to him and
19
they were able to fill a prescription too.
20
kill me if he hears this.
21
22
23
24
CHAIRMAN DROZDOFF:
You know,
He probably will
We're going to send him those
minutes.
MS. SONERHOLM:
Please don't.
He had an actual
phone conversation with the provider and they were able to
CAPITOL REPORTERS (775)882-5322
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1
diagnose him by him describing his symptoms and they send the
2
prescription for him.
3
without having the technology there.
4
So, I mean, it can still be done
MEMBER ANDREWS:
As a follow-up, could we
5
potentially assume or think about having that mobile clinic
6
that's described in that slide go to the rural areas and be
7
able to offer medical services that way as well?
8
9
MR. GIANCURSIO:
We could.
I think to the extent
that as we build our calendar and we're in the process of
10
doing that now, building the calendar of where we're going to
11
be to services that will be offered on the clinic, we would
12
need to know that sooner than later obviously so that we can
13
publish a schedule so that these various areas will know or
14
so that our members would know when the clinic is going to be
15
in an area that is convenient for them.
16
MS. SONERHOLM:
I mean, honestly, a part of the
17
mobile clinic, it's new.
18
We have looked at near-site.
19
tried these things.
20
to provide convenient services.
21
and see are we able to get people to go.
22
-- you know, are they willing to access services in this type
23
of mobile environment.
24
Where is this like our answer to?
We've looked at on-site.
We've
This is a different approach to trying
So we're going to pilot this
Are they -- do they
And before -- you know, I think we need to
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1
understand how receptive are people to this clinic?
2
very high tech.
3
mobile clinic.
4
It's a very high level clinic, but we don't know if people
5
will actually go and utilize the service and get their X-ray,
6
have a mammogram, have their labs done until we actually try
7
and set them up and see what kind of the people's adoption
8
rate is.
9
hard to say whether or not it will be successful.
It's very -- it's not what you think about
It's not this RV thing.
It's very nice.
Yeah, that's the word I was looking for.
10
MEMBER ANDREWS:
11
CHAIRMAN DROZDOFF:
12
Rosalie, Chris, what do you guys got?
13
MEMBER GARCIA:
14
This is Rosalie Garcia.
15
It's
All right.
It's very
Thank you.
So we'll go down south now.
I'm pushing the correct button.
I do have some questions.
What means would you use to communicate the
16
available service innovations, such as your mobile unit, how
17
-- how far are you planning on going to reach out to your
18
clients, customers?
19
services?
20
How are you going to communicate those
MR. GIANCURSIO:
The initial thought right now is
21
the mobile clinic will have its own website.
22
communicate the normal way we do information to our members.
23
We use technology to the extent that we have e-mail addresses
24
and the ability to do that. But, you know, the most
CAPITOL REPORTERS (775)882-5322
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We are going to
1
rudimentary would be simple mail, to let them know about a
2
new service that's available.
3
clinics.
4
organizations that -- that we're engaged in with our Medicaid
5
population.
6
We'll be promoting it in our
We'll, obviously, be working with a lot of the
But the -- at a high level of thought, it will
7
have its own website with its own schedule and its own
8
definition and description of services that are available.
9
So we're -- we're working through that right now in terms of
10
the -- building the calendar, building the services, building
11
the marketing piece of it, and we hope -- as I said, we hope
12
to launch that here at the first part of the year.
13
MEMBER GARCIA:
Not only -- I wasn't speaking
14
only with regard to the mobile unit but also the urgent care
15
Home Waiting Room, I notice the Rally Wellness, those other
16
items, are those already out?
17
them?
18
MS. SONERHOLM:
People already know about
So the Home Waiting Room, that's
19
something we're advertising in our newsletters.
20
it on billboards.
21
It's any time that we have an opportunity to educate people
22
on it, we're educating them about it because it's a great --
23
it's something that we've -- it's only been in place since
24
October, but the adoption rate so far has been very -- has
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It's in our clinics.
244
You'll see
It's on our website.
1
been very well received.
2
I would -- I don't know if you've been -- you
3
know, it was something like the DMV had, where you go and put
4
yourself in line and it will text you you are close.
5
-- the adoption with the Home Waiting Room was very quick.
6
People started to understand how to work it.
7
MEMBER GARCIA:
I'm sorry.
Quickly
Would you be willing
8
to share a link for different websites, for NCHE on the
9
website or something you would be willing to consider?
10
MS. SONERHOLM:
Yes, absolutely, and Paul said we
11
do have a link today but, absolutely, we would be willing to
12
what other links we can put out there for you guys to
13
recognize these tools, we're willing to do that.
14
15
16
MEMBER GARCIA:
question.
Thank you.
I also have another
How is your doctor retention rate lately?
MR. CASSANO:
It's been good.
I mean, the
17
retention rate, when you measure it in terms of the overall
18
providers has been very good.
19
Vegas is the transient nature provider.
20
one group to another group, but generally we maintain the
21
relationship with the provider within -- it's been as good as
22
it's ever been.
What's kind of endemic to Las
So they move from
23
MR. GIANCURSIO:
They are up over 100 providers.
24
MEMBER GARCIA: I'm sorry, what was that?
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MR. GIANCURSIO:
As it relates to SMA, they are
2
actually up over 100 providers additionally in the last two
3
years.
4
5
MEMBER GARCIA:
Okay, great.
I think that was
all I had.
6
Chris?
7
MEMBER COCHRAN:
Just a couple of quick
8
questions.
You talked about the relationship with United
9
Healthcare and availability of services on other states.
Are
10
members able to access -- it's been a long day, so I'm just
11
trying to remember so many people have used so many terms.
12
Are there Centers of Excellence you can refer or that PEBP
13
members would be eligible for in other states or if there are
14
specialty areas that members are unable to obtain say in
15
Southern Nevada or in Nevada in general that they can be
16
referred to out of state without being considered going out
17
of network?
18
MR. CASSANO:
The answer to that is yes.
We have
19
a very robust transplant network that is nationwide, as well
20
as a non-transplant, what I'll consider treasury.
21
many facilities that are very high level facilities that we
22
have education with those facilities in terms of the NCHE
23
services that they offer that are not offered in Las Vegas.
24
So we have
And, as you know, and I've been in Las Vegas for
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1
decades.
2
town have really shrunk over the years as more subspecialists
3
that come to Las Vegas.
4
we're use to seeing, but we do still see that specialized
5
care leave.
6
7
So we're not seeing as much leave as
MEMBER COCHRAN:
What about prescription -- go
MR. GIANCURSIO:
I apologize.
ahead.
8
9
You know, the services that are sent out of that
I was going to add
to what Scott said that, and we do coordinate that, and it is
10
considered a plan benefit.
11
management team.
12
needs and that service is available at a UCLA or USC or
13
University of Utah or wherever it might, that's the role of
14
medical management and contracting is to facilitate that,
15
bring it together and it's viewed as a plan benefit.
16
It's gone through our medical
If there's a specialized case that a member
MEMBER COCHRAN:
Could that be expanded oncology
17
or any of those services that might not be available or do we
18
have all of the oncology services that we need in Nevada?
19
MR. CASSANO:
You get some stuff out of town.
20
Some complex bone malignancies that are still sent out of
21
town.
22
sent out of town.
23
early 90s, there was one pediatric oncologist.
24
probably eight pediatric oncologists in Las Vegas, but we
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Some complex pediatric malignancies that are still
So we have -- when I came to town in the
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There's
1
still send a lot of stuff out of town.
2
MEMBER COCHRAN:
3
Okay.
Rosalie has one more question.
4
MEMBER GARCIA:
All right.
Thank you.
I think
That's it for me.
I wanted to go back to the Carson
5
coverage, and specifically I needed to know whether the
6
rights that were provided on the RFP would need to be
7
reviewed if you were to include Carson or would the rates
8
just be perfect the way they are?
9
CHAIRMAN DROZDOFF:
Yeah, Rosalie, I don't know
10
that anybody has any ranks other than us, so that's for us to
11
talk about.
12
MEMBER GARCIA:
No, rates, rates.
13
CHAIRMAN DROZDOFF:
14
MR. GIANCURSIO:
15
MEMBER GARCIA:
16
MR. GIANCURSIO:
Oh, rates.
May I take a stab?
Costs.
The proposal that we issued
17
would include whatever provider groups in contracted
18
hospitals that we have today.
19
example, if the decision was to make a statewide selection on
20
our bid, Carson, as Scott mentioned, Carson-Tahoe is
21
contracted with us.
22
They are contracted under another one of our regulated
23
entities in which we would use the reciprocity provision so
24
it would be transparent to the members, but we would be able
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So my answer would be, for
Elko General is contracted with us.
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1
to access the discount.
So, therefore, we wouldn't have any
2
exposure that we wouldn't have otherwise.
3
MEMBER GARCIA:
4
MEMBER SAIZ:
5
CHAIRMAN DROZDOFF:
6
MEMBER SAIZ:
7
right?
8
that to the DOI?
9
Thank you very much.
Mr. Chair?
Go ahead, Judy.
You have to take that to the DOI,
For any changes to your plan, you would have to take
MR. GIANCURSIO:
10
MEMBER SAIZ:
11
MR. GIANCURSIO:
No.
You can add -Any -- so with Health Plan of
12
Nevada, our license is referred to certificate of authority.
13
Our certificate of authority outlines the service areas by
14
zip code that we are licensed to transact business in.
15
MEMBER SAIZ:
You wouldn't have to take it?
16
MR. GIANCURSIO:
If one of those zip codes is not
17
included, we would have to do that.
18
MEMBER SAIZ:
19
MR. GIANCURSIO:
20
process for us to do.
21
order.
22
23
24
You would have to.
And that's a fairly ministerial
We can do that relatively in short
MEMBER SAIZ:
You don't think they would deny
you?
MR. GIANCURSIO: I don't believe they would.
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1
They may have some requirements they would want to see.
2
know, what -- you know, some satisfaction of network
3
adequacy, but the answer is I doubt that they would.
4
MEMBER SAIZ:
You
Another quick question, Centers of
5
Excellence, do you offer anything for those families that are
6
going out of -- you know, somebody has to have a liver
7
transplant or whatever it might be and the families are going
8
to -- you know, I know some carriers offer a monetary amount.
9
Do you guys offer that?
10
MR. CASSANO:
Travel money for the family?
11
MEMBER SAIZ:
Travel money for family, you know,
12
some carriers do that.
13
14
MR. GIANCURSIO:
I think we have done that.
Most
of that --
15
MEMBER SAIZ:
Just curious.
16
MR. GIANCURSIO:
Most of the times when those
17
occur, they are managed through our medical management team
18
and through the physicians, and they have the flexibility to
19
make decisions that they think are in the best interest of
20
patient care.
21
it may be in the best interest of the member and the member
22
service to have the spouse or the partner or whomever it is
23
with them as they go through that episode of care.
24
So the contract may not provide a benefit, but
MS. SONERHOLM: I can give you an example of
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250
1
where we made an exception where it was a kid with a
2
pediatric heart problem.
3
place in Minnesota.
4
the kid went together, and we arranged for that.
5
it's not like Don said something in the benefit plan, but it
6
made sense.
7
happen because that was the only place we could get that kid
8
to be seen.
We had to send him to a special
Their HPN, we made sure that the mom and
I mean,
We knew the kid would do better, so we made that
9
So I think that we are, kind of like what I
10
talked about, we're going to do the right thing for the
11
patient because that's what we would want somebody to do for
12
us and our family.
13
14
CHAIRMAN DROZDOFF:
All right.
We'll bring it
back up here.
15
So, Don, do you have anything?
16
MEMBER BAILEY:
Yeah, on the mobile unit that you
17
showed on the screen, do you have that already in existence?
18
Is it created?
19
MR. GIANCURSIO:
It's been built just outside of
20
Dallas, Texas.
21
It's scheduled to be delivered the second to third week of
22
January 2016.
23
24
It's an organization that built it for us.
MEMBER BAILEY:
And is the plan of your
organization to after you do all of your testing, I know you
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251
1
were going to do -- get a feel for how that's, whether the
2
members are going to use it or not, I think they will, my
3
personal opinion, but then are you going to move that around
4
the entire state of Nevada?
5
MR. GIANCURSIO:
The initial thought was to use
6
it predominantly in the Southern Nevada area where we have --
7
and initially for predominantly our Medicaid population
8
because they are a challenged population.
9
have transportation.
Many of them don't
They will make an appointment but the
10
no show rate 40 to 50 percent.
11
we brought the service to them?
12
convenient by creating a schedule where they knew we were
13
going to be at certain community centers, shelters, religious
14
organizations that allow us to park the vehicle there and
15
render the services.
16
So we thought about what if
What if we make it more
If it's as successful as we think it will be, my
17
goal would be to try to push it nationally or push it
18
statewide and look to purchase one by the end of '16.
19
are very expensive.
20
MEMBER BAILEY:
21
MR. GIANCURSIO:
They
I'm sure they are.
It's an investment that I made a
22
decision to make for the membership predominantly starting
23
with our Medicaid.
24
crossover to our commercial customer base as well.
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But we think, as I said, we think there's
252
1
And quite simply, if it happens to be parked in
2
the parking lot in the north in one of our larger property,
3
customer casino properties in the north part of Las Vegas,
4
that doesn't mean any of our commercial customers couldn't go
5
there and get service.
6
So to -- to the Board member in the south who
7
asked the question how are we going to market it, how are we
8
going to communicate it, it would be our intention to make
9
sure members knew it was at a location so that they could use
10
it if it was convenient for them that day, that week to go
11
get services rendered.
12
13
MEMBER BAILEY:
MR. GIANCURSIO:
15
MEMBER BAILEY:
17
All I would ask you if you
would keep this Board in the loop on how successful that is.
14
16
Okay.
Sure.
Because I think that could also
be applied to the north.
MR. GIANCURSIO:
Absolutely.
Just -- and I
18
appreciate the Board member who said not everyone is text
19
savvy but we want -- we are going to push the telehealth
20
services out into the rurals.
21
And, quite frankly, I've had the conversation
22
with my peer at Southwest Medical who they manage it for us.
23
They built it for us.
24
it into the rurals and into areas and make it available for
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We pay for it, but we do want to push
253
1
members that today don't have access, readily convenient
2
access.
3
We talked to the Governor's office about that two
4
legislative sessions ago when we collaboratively worked on
5
the language to allow telehealth to be a benefit and that's
6
why we launched it in '14.
7
session with the various constituents to get them all
8
comfortable to launch it for our Medicaid population, and we
9
did that last week, so we will.
We worked through the last
We will make a note to keep
10
the Board -- you know, maybe we can include that as part of
11
our quarterly reports on information.
12
MEMBER BAILEY:
13
CHAIRMAN DROZDOFF:
14
All right.
15
Thank you, Mr. Chair.
Jacque?
Is there any other questions from the
Board?
16
I appreciate your time.
17
MR. GIANCURSIO:
18
No?
Thank you all.
We appreciate
it.
19
CHAIRMAN DROZDOFF:
20
MEMBER COCHRAN:
21
CHAIRMAN DROZDOFF:
22
MEMBER COCHRAN:
So thank you very much.
Mr. Chair?
Yes, Chris?
This is Chris in Southern
23
Nevada.
We had somebody from NCHE stick their head into our
24
meeting, saying that they are closing up the building.
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1
There's one person left in the building, FYI.
2
if we constitute a quorum, if we're being asked to leave.
3
They said they just wanted us to know.
4
CHAIRMAN DROZDOFF:
I don't know
Well, let me try to just --
5
let me see -- for a lot of reasons, it's been a long day.
6
Our poor court reporter is beat.
7
consider.
8
9
I think we have got lots to
Here's what I'm thinking very briefly.
Obviously, I know we're in a position to have any meaningful
10
discussion within short order for the rest of today about
11
picking HMO vendors.
12
say earlier that we really don't have a great deal of time,
13
but I think we have some time, so I do think we're going to
14
have to come back.
15
I'm very cognizant of what Tina had to
I guess I'll probably ask Kari to do a doodle
16
poll maybe the first week -- first or second week in January
17
but here's what I would like the Board members right now to
18
think about in advance of that because what I don't want to
19
do is come back to it and purchasing is what's the process
20
and I'm like, well, I don't know.
21
So I think what we have to figure out is what
22
exactly have we not heard yet and do we want to know in
23
advance of whenever we get together next so that we can make
24
a decision so that we can rank these applicants.
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1
I can tell you from my perspective, I think we
2
have to decide -- I think there's -- I think there's some
3
value, if you would, some bonus value in one statewide
4
system.
5
decades, and people seem to like what they have.
6
married to that idea, but I do think we have to -- we have to
7
try to figure out, you know, do we -- do we want to have a
8
statewide system?
9
would, extra in terms of how we evaluate these things.
10
At the same point, that's not what we've had for
So I'm not
Is that something that is worth, if you
And regardless of that, how then do we want to
11
look at these four very unique proposals that we received and
12
figure out how we -- how we're going to make our selection
13
and I think -- because I really don't want to come back and
14
have a free for all when we get together two weeks from now.
15
So whether it's providing that information in
16
advance, I mean, Judy, you spent a lot of time today grilling
17
these folks, good for you.
18
there are specific issues that you think the group should be
19
aware of or have questions asked, I would ask that you
20
provide that to the Board so they can be distributed, that
21
works, you know, through -- you know, through the staff.
22
can't discuss that in advance of the meeting but you can
23
certainly, and that goes for any of the Board members, you
24
can certainly, and I would encourage to provide what
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I think, you know, you're -- if
256
We
1
additional information or answers that you want so that we
2
can have -- so that we really can come to a decision and
3
provide a process in early January, that's what I'm thinking.
4
Gail?
5
MS. BURCHETT:
6
press the magic button.
7
before we leave today.
I need to make a couple of -I need to make a couple of points
8
CHAIRMAN DROZDOFF:
9
MS. BURCHETT:
Okay.
First point is HPN, though they
10
gave a lovely speech, they cannot change their proposals, as
11
long as we all understand that.
12
not offer all of the things that they offered in their
13
discussion today.
14
They did in their proposal
They cannot change their proposal.
We can ask if you want to proceed with them to
15
become your vendor for the north and statewide, you can
16
certainly ask for clarification.
17
they cannot change their proposal in their presentation.
18
CHAIRMAN DROZDOFF:
19
MS. BURCHETT:
We can go that way, but
Yep.
The second point I need to make is
20
I need to collect those scores of what you've seen today.
21
What I'm going to suggest, rather than have everybody read
22
them to me because it's late today, if you would just e-mail
23
the scores to Megan Sloan.
24
contact for everybody, e-mail the scores to Megan Sloan for
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She seems to be the point of
257
1
the presentations today, and then she can get them to me.
2
3
CHAIRMAN DROZDOFF:
Can I ask you a question
about the scores?
4
MS. BURCHETT:
Yes.
5
CHAIRMAN DROZDOFF:
Because I know I can see
6
people.
So I think we can do that based on what we heard
7
today.
I guess the question I'm sure the Board will ask is
8
but what if after we get together and two or three weeks from
9
now those scores change?
10
11
12
MS. BURCHETT:
I don't see how the presentation
scores are going to change.
CHAIRMAN DROZDOFF:
But, okay, if the
13
presentation scores -- so does the presentation scores
14
determine the Board action?
15
are tallied today or tallied as soon as Megan gets them, is
16
that our -- is that it?
17
MS. BURCHETT:
So if the presentation scores
No, that's only ten percent.
18
That's only ten percent.
19
percent of the Board decision on the actual technical --
20
21
MEMBER SAIZ:
What we're waiting on is the 45
So you're saying we just need to
submit this --
22
MS. BURCHETT:
23
percent of the presentations of that.
24
You just need to give me your ten
MEMBER SAIZ: I'm cool with that.
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1
2
CHAIRMAN DROZDOFF:
Okay.
Everybody good with
that?
3
MS. BURCHETT:
I don't need the other because
4
that is -- you need another couple or three weeks to go
5
through that.
6
e-mailed to Megan.
7
So I need your ten percent presentation scores
CHAIRMAN DROZDOFF:
Is there any problem -- is
8
there any concern the 45 percent is the unknown at this
9
point?
10
MEMBER SAIZ:
Just ten percent.
11
MEMBER BAILEY:
12
CHAIRMAN DROZDOFF:
13
MEMBER BAILEY:
14
MR. HAYCOCK:
15
CHAIRMAN DROZDOFF:
16
MR. HAYCOCK:
I got it.
I'm done.
Is that okay, Don?
Yes, that's fine.
Can I make a suggestion -Okay.
-- Mr. Chair?
So Damon Haycock for
17
the record.
18
possible, obviously, everyone is going to turn in their
19
scores to the presentations.
20
process, ten percent.
21
Just to kind of frame it a little bit, if
That's a pretty cut and dry
Because there was some apparent miscommunication,
22
I think for the next, and it appears to be about a month
23
before we'll be able to come back and meet first or second
24
week in January, you have been provided all -- the Board has
CAPITOL REPORTERS (775)882-5322
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1
been provided all of the RFP's and all of the presentations
2
and in that time, the Board can similarly or like a pseudo
3
RFP committee go through and take your time and read them
4
over the next month and get more in depth about those type of
5
presentations because there's definitely policy decisions
6
that the staff at PEBP will need to know when it's time to
7
award.
8
9
Do we want to -- does the Board want us to pursue
open access versus closed access.
You heard from HPN today
10
about a capitation model versus a different series of models.
11
We have statewide versus regional, and I know you all are
12
going to do this at the next meeting.
13
But as you review or hopefully you got the
14
opportunity to review these proposals, you can show up armed
15
with score RFP's as a deliberation trying to share with the
16
staff or directing staff which direction you want us to go
17
through negotiation and then that can help us expedite the
18
process so we don't truly lose anymore time than necessary.
19
It's just a lot of suggestion on my part.
20
line with purchasing.
21
MEMBER SAIZ:
I think it's in
Well, it seems like we need to
22
score -- when we're scoring, I think we need to score
23
Hometown --
24
CHAIRMAN DROZDOFF: Turn your mike on.
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MEMBER SAIZ:
Judy Saiz.
I think when we're
2
scoring, we would need to score Hometown just for the north.
3
We would have to have a separate sheet for Health Plan Nevada
4
for statewide Health Nevada Plan for south and a separate
5
score sheet form Anthem north and Anthem south and Anthem
6
statewide and a separate score sheet for Prominence north,
7
south and statewide, am I correct?
8
9
10
CHAIRMAN DROZDOFF:
correct.
I'm not sold on HPN statewide but other than that,
I agree with you.
11
12
I think you're mostly
MEMBER SAIZ:
Yeah.
So we would have several --
several score sheets for each one to bring to them?
13
CHAIRMAN DROZDOFF:
Yeah, right, that way we come
14
back and say, okay, and that kind of works with what I'm
15
trying to do too which is, you know, that will get us -- what
16
is the matter?
17
MEMBER SAIZ:
18
MS. BURCHETT:
How do we do this then?
You don't need separate score
19
sheets.
You need one score sheet for each company and that
20
score that you give them would be good for the south or in
21
the north or for statewide.
22
CHAIRMAN DROZDOFF:
23
MS. BURCHETT:
24
But I think the problem --
Because that's the way we did it
for putting an evaluation committee, so we need to be
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1
2
consistent.
CHAIRMAN DROZDOFF:
But I think the problem with
3
that is the rates are different.
4
rates may be better in the south than they are in the north.
5
MEMBER SAIZ:
6
CHAIRMAN DROZDOFF:
Like there's company X's
Yeah.
So that's the problem or a
7
problem, and I think -- candidly, I think there's issues
8
with, you know, strength of network that may be better
9
regionally, so.
10
11
12
MEMBER SAIZ:
Maybe the evaluation committee
needs to get together and separate theirs too.
CHAIRMAN DROZDOFF:
Like I said, I think -- look,
13
I think we can figure out using one score or many scores.
14
think what for me it comes down to when you take a look at is
15
there any value to a statewide as opposed to two regionals?
16
That's a fundamental question for me.
17
at strength in network, and we have to take a look at rates.
18
We have to take a look
And there's probably other factors, like
19
experience and the like.
For me, those are the biggest
20
things that we need to try to get around in short order.
21
Does anybody see that?
22
MEMBER ANDREWS:
23
CHAIRMAN DROZDOFF:
24
MEMBER ANDREWS: I hate to throw a wrinkle in
CAPITOL REPORTERS (775)882-5322
Do we see the -Anna?
262
I
1
this, but I am out of country December 24th through
2
January 7th.
3
CHAIRMAN DROZDOFF:
4
MEMBER ANDREWS:
Okay.
Okay.
That's fine.
So that second week in
5
January.
I don't know, as far as the committee meeting
6
again, I don't think it's going to happen.
7
CHAIRMAN DROZDOFF:
8
the committee has done enough.
9
nobody is going to be available.
No, I don't either.
We'll do a poll.
I think
Look,
We'll do the best,
10
including my own schedule.
11
people over the next two weeks, wherever that is we'll do and
12
if happens to be that first week, that would be unfortunate
13
because you were on that committee but, you know, if it's a
14
date that I can't make it but nine out of ten or eight out of
15
ten can, however many, then that's what we'll do.
16
MEMBER ANDREWS:
17
MR. HAYCOCK:
We'll do the best with the most
That's fine.
Can I?
So real quick, I know
18
everyone is trying to get home.
Damon Haycock for the
19
record.
20
rating of the -- if the Board rates the ten percent
21
presentations to agree with the 45 percent of the evaluation
22
committee, that 55 percent takes the day and you come back
23
and want to change everything but recognize -- unless, Gail,
24
you tell me differently from purchasing, that's your 55
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percent and you may have it right there.
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MS. BURCHETT:
3
MR. HAYCOCK:
That makes sense.
So I don't know if there's a
4
process that needs to be redeveloped or changed on the fly
5
but I would be cognizant of your ten percent evaluation when
6
you send it to Megan because if you choose the same things
7
that the evaluation committee does, you need no additional
8
meeting.
9
agree with the evaluation committee and those are your HMO's.
10
11
The Board has decided to do that ten percent to
MEMBER EWING-TAYLOR:
Then how do you decide
which of the options in each one?
12
MR. HAYCOCK:
And thank you for asking that
13
question, Madam Chair.
14
I believe that becomes the next discussion that we want a
15
statewide or we want a region wide.
16
At the direction of the Board, and so
MEMBER EWING-TAYLOR:
So there does need to be
17
another meeting pretty quickly in order to get the contract
18
done?
19
MR. HAYCOCK:
The negotiations done, correct.
20
MEMBER COCHRAN:
21
CHAIRMAN DROZDOFF:
22
MEMBER COCHRAN:
May I have a question, please?
Go ahead.
In response to what Damon just
23
said, if we're looking at a rating as a committee, as a Board
24
or as a whole or at least those of us that have been in
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1
attendance at this meeting and we have different ratings for
2
different organizations, I don't see how that means that
3
whatever we decide on the presentation is going to affect the
4
overall -- you know, is going to be, well, we're choosing
5
that organization.
6
Because if our ratings are different here and we
7
rate an organization say significantly lower than the
8
committee rated them, that could change their overall rating.
9
If it's 45, 45 and ten, that ten shouldn't change what the
10
overall ratings.
11
influence.
12
I mean, you know, shouldn't be the major
Let's say for example, Health Plan of Nevada was
13
rated a five by the committee but a three by the Board,
14
that's going to bring them down to a four.
15
don't know how the rates are going to be done.
16
going to be done each individual member's rate is going to
17
calculate into the overall rating or are we doing this based
18
on two meetings?
19
know, with the committee and one that took place with the
20
Board.
21
to whether or not that should change.
22
read that.
I'm assuming -- I
If they are
There's one meeting that took place, you
You know, so it depends on the number on your end as
That's the way I would
23
MR. HAYCOCK:
For the record --
24
MEMBER COCHRAN: I know I have you all confused.
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1
MR. HAYCOCK:
For the record, Damon Haycock.
2
Maybe this will clear things up, when it doubt, look at the
3
statute.
4
Dennis Belcourt today.
5
that the Board is not bound by the recommendation of the
6
administrator of the purchasing division or the committee
7
appointed to evaluate the proposal, and that they can award
8
the contract based upon the best interest of the state.
9
Unless someone clarifies that for me otherwise, I believe the
10
Board has ultimate authority to choose who they want as their
11
HMO's regardless of these score sheets.
So thank you, Mr. Stockton, our standing DAG for
NRS 287.04345 specifically states
12
CHAIRMAN DROZDOFF:
13
MEMBER COCHRAN:
14
15
Good.
I withdraw my statistical
calculations.
CHAIRMAN DROZDOFF:
Well, regardless, I think
16
what we need to do is we need to come back in short order,
17
early January and make a decision, that's it.
18
19
20
MEMBER SAIZ:
How are we going to do that,
separate score sheets?
CHAIRMAN DROZDOFF:
Well, so view is -- you know,
21
and I understand what Gail said.
22
statewide bids that are also competing regionally, and then
23
we have two just regional bids.
24
My view is that we have two
MEMBER SAIZ: You don't count HPN and Statewide?
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1
CHAIRMAN DROZDOFF:
I don't, I really don't.
I
2
just don't see that.
3
going to be looking at HPN in the south.
4
looking at HHP in the north, and then we're going to be
5
looking at the other two, north and south separately and then
6
statewide, that's what I think we're looking at, and we can
7
pick -- arguably we can pick any combination thereof.
8
pick one statewide vendor.
9
two incumbents, two new -- two new regionals.
10
So, basically, we're going to -- we're
We're going to be
We can
We can pick -- we can pick the
I think that's
what we'll look at.
11
MR. HAYCOCK:
For the record, Damon Haycock.
My
12
only additional suggestion is that when a motion is
13
eventually submitted that it includes direction that the HMO
14
plans are available statewide, and so we have to go back and
15
have conversations with the HMO vendors that we're not
16
leaving pockets of Nevada without HMO coverage unless that is
17
the direction of the Board.
18
19
CHAIRMAN DROZDOFF:
I don't understand what
you're saying.
20
MR. HAYCOCK:
Based on the presentations that we
21
heard today, there are certain vendors that have proposed to
22
only offer certain services as part of their statewide
23
offering.
24
CHAIRMAN DROZDOFF: Yeah, well, that was HPN,
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1
that's what I'm saying, I don't think that is a viable
2
option.
3
the other two, Prominence and Anthem, did offer complete, if
4
you would, statewide proposals because if we don't see it
5
that way, then correct me because that's the way I'm looking
6
at it like Anthem and --
I think the other two though -- do you agree that
7
MEMBER ANDREWS:
8
CHAIRMAN DROZDOFF:
9
Prominence.
Anthem and Prominence have
submitted viable statewide bids, and so we can look at them.
10
But if -- if by viable, I mean, that we're not leaving
11
anybody out.
12
somebody needs to correct that assumption.
13
14
If that's not the case, then, yeah, you know,
MR. HAYCOCK:
So this is Damon for the record
again.
15
I will make sure and send out a confirmation to
16
the Board.
17
presentations you heard today, which actual companies are
18
offering true statewide services, and that way you can use
19
that to help you develop your decision and solutions.
20
21
CHAIRMAN DROZDOFF:
those two.
22
23
24
I'll push something out that says each of these
Like I said, I think it's
If it's something different -MR. HAYCOCK:
I think you're right but I haven't
seen -CHAIRMAN DROZDOFF: That's fine. Between now and
CAPITOL REPORTERS (775)882-5322
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1
then, you let us know.
2
MEMBER GARCIA:
Excuse me?
3
CHAIRMAN DROZDOFF:
4
MEMBER GARCIA:
Yeah.
Excuse me, this is Rosalie
5
Garcia.
6
presentation and, of course, I'll review the packets
7
extensively, but I missed the part where HPN is not
8
comparably providing services or offering to provide services
9
to the north.
10
I do not -- I must have missed something in the
And my other statement is that I believe that in
11
our best and final negotiations, those type of issues might
12
be able to be remedied.
That's all I had to say.
13
CHAIRMAN DROZDOFF:
14
Anything else?
15
MEMBER SAIZ:
16
CHAIRMAN DROZDOFF:
Okay.
Fair enough.
Eight.
People should come, do their
17
homework, and people should come with what they want to do
18
and make your best case.
19
MEMBER SAIZ:
Probably to get a disruption report
20
would probably be cumbersome.
21
even asking for that.
22
Okay.
Never mind.
I'm not
I know how the networks are.
CHAIRMAN DROZDOFF:
All right.
Are there any
23
questions with regard to Agenda Item Four and Five?
24
didn't even get to five. So we're going to push five to
CAPITOL REPORTERS (775)882-5322
269
We
1
January.
2
Any other questions there?
3
Let's go to public comment.
If you guys -- we
4
don't need a quorum for public comment, Chris.
5
Rosalie -- the folks in Vegas, let me start with them.
6
have two members of the public.
7
MEMBER GARCIA:
8
CHAIRMAN DROZDOFF:
9
MEMBER GARCIA:
So if you and
We
No comment.
No, okay.
Thank you.
10
CHAIRMAN DROZDOFF:
11
MS. BOWEN:
All right.
Peggy Lear Bowen.
My name and words
12
for the record, P-e-g-g-y L-e-a-r B-o-w-e-n.
13
much.
14
your ten percent today and with so many questions left
15
unanswered, and it seems like it was more than one group that
16
said, no, we can also do this because of that, but it was
17
listed, Judy, you said, I believe but you have a zero here in
18
the report that you got back.
19
Thank you very
I am still concerned that you're being asked to give
It seems to me almost as if there was a
20
misinterpretation about how or what they should have
21
submitted in their report because to describe their agency in
22
its completeness, they obviously were shocked and they had a
23
zero and, no, that's not true.
24
And my biggest concern is that the committee who
CAPITOL REPORTERS (775)882-5322
270
1
worked so hard to do such a good job this may have made a
2
different ranking or rating of the proposal had that not, I'm
3
just going to pick that one item, zero been there, it had
4
been, in fact, yes, we did this or in another one to they
5
provide different types of services, had they put in their
6
proposal that they did supply those services and it may have
7
been by my understanding what the question was or how the RFP
8
was actually worded.
9
the committee awarded to -- in their response to where they
10
were coming from that those 45 points may not be reflective
11
of the actual proposals if those were submitting the
12
proposals had understood the question, and I don't want
13
mistakes or errors made even for ten percent, even for ten
14
percent.
15
So that in effect your 45 points that
My question to you today is can the ten percent
16
be also awarded at your meeting in early January or whenever
17
you have it rather than being submitted between now and then
18
with not enough accurate information based on the information
19
that was submitted -- that may have been submitted
20
incorrectly because of confusion about the question.
21
Other than that, you've done a marvelous,
22
wonderful job, and thank you for all your time, energy and
23
effort and if you have any questions about that for me.
24
CHAIRMAN DROZDOFF: Any questions?
CAPITOL REPORTERS (775)882-5322
271
1
MEMBER SAIZ:
You know, I do have a question.
2
We're not allowed to see the evaluation committee scores
3
ahead of time?
4
5
Could we see their scores on --
MS. BURCHETT:
I would rather than share them
because I don't want them to sway your scores in any way.
6
MEMBER SAIZ:
7
MS. BOWEN:
There isn't a protocol.
You guys have done such a marvelous
8
job at being so transparent, and I don't want to it to appear
9
some of the most important decisions you're ever going to
10
make that they were made with this professional
11
misunderstanding that could have been rectified except for
12
you were told that you had to submit something before the
13
next meeting regarding your ten percent or presentations of
14
bells and whistles on presentation and actual meat and
15
content of each program has to offer.
16
presentations than others, and that concerns me greatly when
17
you put so much work into this and so much effort and you
18
want it to be so good that I share that desire with you, and
19
I would like to help you if it's at all possible that suggest
20
that and I get a head shaking over there.
Some people do better
21
But as a public comment as one who knows how hard
22
you've worked and to make it so right for the state of Nevada
23
and the employees that you err on the side of knowledge and
24
scores based on what you know and not with unanswered
CAPITOL REPORTERS (775)882-5322
272
1
questions.
2
Thank you very much and have a safe journey home.
3
CHAIRMAN DROZDOFF:
4
All right.
5
6
7
Thank you.
Any other public comments?
Seeing
none, we'll call the meeting.
Keep an eye out for the doodle poll and have a
great holiday.
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
CAPITOL REPORTERS (775)882-5322
273
1
STATE OF NEVADA,
2
CARSON CITY.
)
)
)
ss.
3
4
I, KATHY JACKSON, Official Court Reporter for the
5
State of Nevada, Public Employees' Benefits Program Board, do
6
hereby certify:
7
That on Monday, the 7th day of December, 2015, I was
8
present at the Legislative Counsel Bureau, Carson City,
9
Nevada, for the purpose of reporting in verbatim stenotype
10
11
notes the within-entitled public meeting;
That the foregoing transcript, consisting of pages 1
12
through 272, is a full, true and correct transcription of my
13
stenotype notes of said public meeting.
14
15
16
Dated at Carson City, Nevada, this 7th day
of January, 2016.
17
18
19
20
KATHY JACKSON, CCR
Nevada CCR #402
21
22
23
24
CAPITOL REPORTERS (775)882-5322
274
1
2
3
Kathy Jackson
Capitol Reporters
123 W. Nye Lane Suite 107
Carson City, Nevada 89703
(775) 882-5322
4
STATE OF NEVADA
5
PUBLIC EMPLOYEES' BENEFITS PROGRAM
6
7
AFFIRMATION
8
Pursuant to NRS 239B.030
9
The undersigned does hereby affirm that the following
document DOES NOT contain the social security number of any
person:
10
11
1) Public Employees' Benefits Program Board
Regular Meeting, 12/7/15
12
13
14
15
16
17
KATHY JACKSON
DATE
18
19
20
21
22
23
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CAPITOL REPORTERS (775)882-5322
275
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
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Monday
December 7, 2015
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Monday
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Public Employees' Benefits Program Board
Videoconferenced Open Meeting
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19:16;22:14;31:2;
35:15;39:23;41:9;
46:4,11;47:3;49:20;
50:21;53:13;55:12;
58:21;63:2,4;66:6;
67:20;68:18;69:21;
70:8;73:1,22;74:16;
79:11,15;81:24;
83:19;87:15;93:17;
98:22;102:23;
103:21;105:22;
123:1;124:15,22;
128:1;141:23;142:5;
148:3,12;151:12;
158:17;167:24;
176:8;187:2;203:16;
225:6;228:15;
229:17;234:6;235:6;
263:6;268:14
against (3)
33:5;135:5;180:4
age (1)
74:19
agency (1)
270:21
Agenda (6)
26:11;27:2,4;28:7;
108:5;269:23
aggressive (3)
162:4;174:23;
200:7
aggressively (1)
183:21
ago (10)
7:13;36:9;42:4;
85:1;116:22;210:5;
225:15;227:12;
239:1;254:4
agree (12)
32:5;40:4,12,12;
101:16;106:17;
Min-U-Script®
107:4;155:21;
261:10;263:21;
264:9;268:2
agreed (4)
31:8;39:21;174:10;
175:20
agreement (5)
45:2;80:19,20,21;
178:12
agreements (3)
211:24;213:12,15
ahead (16)
14:24;19:23;21:16;
28:9;30:8;41:21;
44:12;84:3;98:13;
119:6;136:7;240:11;
247:7;249:5;264:21;
272:3
aim (2)
121:14;123:6
airline (1)
229:13
Albeit (1)
197:11
alcohol (1)
73:17
allow (15)
25:13;47:15;
152:17;166:6;200:8;
220:15;222:18;
224:5,7;230:7,9,21;
238:17;252:14;254:5
allowables (1)
171:11
allowed (2)
28:22;272:2
allowing (5)
50:19;161:24;
172:18;222:21;230:5
allows (8)
75:21;90:8;162:12;
167:5;183:19;200:6,
11;217:22
alluded (3)
158:23;165:23;
185:21
almost (11)
22:2;37:20;47:15;
80:12;118:22;
171:17,18;182:22;
221:13;222:7;270:19
along (7)
51:9;79:13;110:19;
123:21;139:21;
140:3;198:4
alternative (1)
173:8
alternatives (2)
141:21;236:23
although (4)
29:17;49:21;
171:24;237:6
always (11)
72:7;79:6;106:11;
168:6;180:20;185:9;
195:14;202:11;
220:14;231:2;241:15
Amanda (1)
95:5
amazing (1)
57:19
Amazon (1)
119:22
ambulance (3)
122:21;131:11;
174:10
ambulances (1)
122:23
amended (1)
48:7
Ameri (1)
52:21
Americans (3)
51:22;225:12,13
among (1)
101:21
amount (5)
35:4;177:21;192:7;
227:13;250:8
analysis (2)
42:17;187:20
analytic (1)
125:6
analytics (10)
71:10;73:11,19,21;
105:9;219:12,16,19,
24;232:10
analyzation (1)
33:9
ancillaries (1)
181:10
ancillary (3)
69:8;181:16,17
and/or (3)
76:6;88:12;135:14
Andrews (32)
5:9,10;39:5,5,8;
40:10;84:23,23;
130:15,15;131:15;
132:24;133:4;185:1,
1,6;186:8,11,22;
238:22,22;239:4,11;
240:12,21;242:4;
243:10;262:22,24;
263:4,16;268:7
Anecdotally (1)
173:24
angst (2)
40:23;46:21
Anna (17)
5:9;39:4,5;45:15;
46:12;83:24;84:21,
23;130:14,15;
184:24;185:1;
193:12;238:21,22;
240:11;262:23
Capitol Reporters
775-882-5322
Anna's (1)
133:6
announce (1)
30:1
answered (1)
186:4
Anthem (27)
27:5;32:13;43:15;
50:4,4,24;51:21,23;
55:13;56:6,9,15;59:4,
12;60:19;66:21;
67:18;69:9,14;74:16;
98:14;261:5,5,5;
268:3,6,8
Anthemcom (3)
60:18;64:2;85:19
Anthem's (1)
90:7
Anthencom (1)
61:18
antibiotics (1)
62:22
anticipate (1)
197:2
anticipated (2)
36:14,18
anxiety (1)
63:15
anymore (3)
45:5;92:17;260:18
Aon (3)
42:13;161:12;
182:17
apart (4)
66:22;89:12;112:5;
200:10
apologies (1)
50:1
apologize (4)
49:18;177:10;
191:24;247:8
app (8)
61:17,22;216:10,
23;217:19;218:1,6,16
apparent (1)
259:21
apparently (2)
35:22;157:9
appear (2)
139:6;272:8
appears (1)
259:22
appetite (1)
226:18
applaud (3)
190:3,8;225:16
apples (2)
236:14,15
applicable (1)
145:5
applicants (2)
126:12;255:24
application (5)
14:17,18;15:4;
16:9,22
applied (2)
229:9;253:16
applies (2)
145:5,9
apply (1)
149:14
applying (1)
199:22
appointed (1)
266:7
appointment (7)
12:12,12;14:21;
15:1;118:12;217:23;
252:9
appointments (2)
218:8,8
Appollo (1)
191:1
appreciate (27)
9:22;17:12;18:11,
16;20:9;50:11,13;
76:13,19;84:16;
91:17;106:7;124:17;
150:8;152:24;153:1;
157:7,21;158:7,21;
176:9;191:1;197:22;
228:19;253:18;
254:16,17
appreciation (1)
161:23
approach (17)
56:19,22;57:7;
65:9,21;75:8;111:23;
112:8;113:19;
120:21;125:13;
151:10;153:2;156:8;
195:20;207:7;242:19
approached (2)
8:2;189:6
approaches (1)
196:3
appropriate (12)
34:24;43:24;82:3,
9;89:7,7,8,8;173:5,
16;174:24;191:20
approval (1)
26:12
approve (1)
26:15
approving (1)
201:1
apps (1)
60:3
April (1)
44:8
area (38)
22:11,12;29:10;
42:14;51:2;56:3;
78:20;81:17;82:4,5,7,
17;83:2;94:18;
103:12;119:23;
(2) affect - area
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
128:12,15;140:6;
148:8;150:23;
151:16;153:3,4;
154:5;163:4;174:4;
185:22;187:12;
188:7,8;214:7;228:1;
236:13,13;238:1;
242:15;252:6
areas (52)
11:8;21:1;25:14;
51:11;52:13,13;
53:12;55:5;73:24;
77:8;92:24;93:2,4,
24;100:1,3,4,5;101:3;
102:3,16;122:13,16,
19;123:1;130:17;
131:2,6,12,17;166:7;
168:7;169:22;
170:10;171:7;
177:13,20;187:22;
188:2;193:12,15;
196:7,17;214:1,7;
234:18;235:16;
242:6,13;246:14;
249:13;253:24
arguably (3)
195:13;197:17;
267:7
argue (1)
154:8
Arizona (3)
121:2;127:3;
134:21
Arkansas (1)
191:24
armed (1)
260:14
around (24)
12:17;36:3;58:21;
61:5;82:1;83:12;
92:9;96:13;100:10;
112:12;118:5;121:1;
129:23,24;170:4,19;
180:1;187:20;
194:11;205:2;
206:14;220:4;252:3;
262:20
arranged (1)
251:4
arrangement (2)
82:8;231:8
arrangements (1)
212:4
array (1)
221:16
arrived (2)
5:23;47:19
arrives (1)
227:17
art (1)
75:3
artificially (1)
154:13
Min-U-Script®
ASA (1)
224:10
Ash-Jackson (7)
158:13;172:15,17;
182:24;183:5;
191:14;193:16
ASO (1)
226:18
aspects (1)
122:8
assessments (2)
43:3;59:1
asset (1)
226:11
assets (3)
224:4;225:5;231:4
assigned (8)
71:14;72:1,24;
88:11;121:13;
198:10;199:13;
220:16
assist (3)
211:8;212:10;
219:19
assistance (5)
113:8;123:8;211:7;
212:8,10
assistant (12)
112:19;113:11;
114:5,13;118:15,22;
119:2,8,12;120:11;
121:12;127:13
assistants (3)
115:19;126:3,21
assisted (3)
16:11,12,13
associate (1)
210:14
associated (3)
120:3;122:17;
208:6
associates (1)
58:18
association (1)
17:24
assume (3)
137:16,20;242:5
assumed (1)
41:2
assuming (6)
21:3;111:19;116:7;
138:10;182:3;265:14
assumption (2)
87:5;268:12
assumptions (2)
154:7;230:21
assure (1)
39:15
assured (1)
49:23
asthma (2)
71:3,3
attach (1)
20:5
attempt (2)
164:17;228:17
attend (1)
7:10
attendance (1)
265:1
attends (1)
199:7
attention (3)
39:19;104:4;
219:12
attest (1)
22:19
attracts (1)
135:20
attributes (1)
224:4
audience (3)
27:9;85:2;199:1
audits (1)
7:6
auth (1)
232:19
authority (3)
249:12,13;266:10
authorization (1)
198:23
authorizations (2)
121:22;170:17
auths (4)
98:11,12,12,14
auto (1)
19:18
automatic (1)
19:11
automatically (1)
178:19
availability (9)
29:6;49:10;63:20;
121:24;125:5;
130:17;140:2;
217:22;246:9
available (57)
8:23,23;22:7;
23:10;40:19;43:22;
60:8;62:9;66:18;
88:3;110:1;120:16,
17;123:2,3;127:15;
130:9;132:7;135:23;
141:9;148:10,10;
154:3,4;170:17,20;
172:7;173:18,20;
174:14,18;175:14,18;
182:11,13;183:1;
191:23;192:9,20;
193:3,5;194:2;
205:22;209:6;214:6;
216:3;224:18;226:8,
16;243:16;244:2,8;
247:12,17;253:24;
263:9;267:14
avenue (1)
Capitol Reporters
775-882-5322
241:10
average (3)
124:7;170:11;
208:14
avoid (2)
45:19;217:7
award (3)
111:9;260:7;266:7
awarded (6)
48:23;78:24;98:1;
100:9;271:9,16
aware (10)
12:6;40:17;58:3;
77:17;94:16;149:23;
185:20,23;197:7;
256:19
away (10)
14:9,10;39:20;
40:5;42:22;57:5;
121:2;141:11;
156:21;220:12
awesome (1)
70:5
aye (1)
26:21
18;32:19,20;37:8,8;
45:7,9,9,14;47:4;
92:22;93:22;94:20;
95:10,17;96:5,9;
139:18;177:1;
191:10;193:7,10;
194:5,17;195:3;
251:16,23;252:20;
253:12,15;254:12;
259:11,13
BAILY (1)
37:6
balance (8)
101:19,20;102:8,
19;103:6,18;116:20;
137:7
balanced (1)
20:11
bands (1)
150:15
Bank (1)
55:1
Banner (3)
180:18,20,20
barriers (1)
109:22
Barton (3)
B
134:2,3,5
base (7)
baby (1)
58:20;139:6,7,9;
209:16
152:5;213:13;252:24
back (70)
based (38)
8:21;10:3;11:2,2;
32:3;42:24;48:11;
13:7,10,18,22;15:21;
56:21;57:5,6;59:18;
16:5;22:17;23:15,18;
65:23;66:5,16,17;
25:8;35:4;36:12;
70:18;74:8;103:23;
37:11;38:1,20;40:7;
104:3;135:1;144:11,
44:6;50:21;53:3,4;
22;146:8;154:19;
63:18;67:23;70:1,9,
166:23;179:1;187:9;
19;71:1,6;73:20;
188:6;200:10;202:2;
79:9;84:15;86:4;
205:2,15,23;223:13;
87:3,18;92:23;95:6;
225:18;232:5;258:6;
103:12;107:5,8,10;
265:17;266:8;
113:10;118:3;
267:20;271:18;
125:11;127:9;139:5;
272:24
151:6;153:1;159:8;
162:8;168:1;182:18; basic (2)
125:23;131:3
194:4;210:11;213:6;
basically (19)
222:13;229:14;
8:16;9:20;45:17;
248:4;251:14;
56:14;57:4;59:24;
255:14,19;256:13;
74:24;90:8,13;95:20;
259:23;261:14;
108:23;131:1;
263:22;266:16;
154:17;186:13;
267:14;270:18
191:15;207:4;
backed (2)
223:14;224:8;267:2
118:15;126:18
basis (11)
backgrounds (1)
47:14;65:24;105:3;
126:4
125:2;137:23;
backing (1)
142:18,21;170:10;
201:6
172:1;182:5,10
bad (2)
Battle (1)
196:13,23
235:5
Bailey (37)
bearing (2)
5:11,12;26:17,17,
(3) areas - bearing
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
50:11;228:20
beat (1)
255:6
beautiful (1)
21:19
became (2)
22:24;172:20
become (8)
18:10;113:3,3,24;
141:9;194:14;201:4;
257:15
becomes (1)
264:14
becoming (2)
180:13;219:16
bedside (2)
204:19;206:5
beefed (1)
60:1
began (1)
28:17
begin (1)
204:4
beginning (3)
134:13;177:11;
226:6
begins (1)
204:5
begun (1)
228:9
behalf (1)
20:10
behavioral (5)
73:14,15;108:24;
120:15;133:21
behaviors (3)
65:3;66:9;71:11
behavorial (1)
86:4
behind (3)
108:2;109:20;
220:14
Belcourt (1)
266:4
belive (1)
135:16
bells (1)
272:14
benchmark (1)
207:6
benchmarking (2)
70:10,14
beneficial (2)
10:21;156:22
beneficiaries (1)
226:15
benefit (41)
13:14;15:12;27:16;
53:20,23;63:23;
69:12;74:22;78:2;
92:2;100:12;102:11;
103:3,9;104:14,16,
16;123:18,19;137:9;
Min-U-Script®
146:24;149:2;151:9,
15;152:8;153:13;
176:2;192:14;193:1,
17,18;194:3;222:9;
223:11;224:10;
225:5;247:10,15;
250:20;251:5;254:5
benefits (33)
7:20;20:3;22:3;
24:2;48:1;68:13;
90:11;91:8,9,10;
93:18;111:17;113:2;
114:12;115:5,6;
116:11;146:20;
158:20;160:10;
161:7,10;168:18;
169:18,21;170:14,15;
171:3;172:14;180:5;
196:1;197:5;238:3
benefitted (1)
213:10
benefitting (1)
154:10
beside (1)
205:4
best (39)
12:24;13:13;38:13;
41:21;42:23;44:15;
46:6;61:4;65:23;
66:3;94:15;99:20;
100:6;130:6;150:19,
24;151:7;155:17;
161:18;163:18;
171:3;173:11,21;
193:6;195:20,24;
199:10;200:12;
221:7;222:5;223:10;
224:7;250:19,21;
263:9,10;266:8;
269:11,18
better (44)
9:15;22:8;23:20;
43:17;51:15,15;60:8;
66:2;83:6;92:7;
101:21;111:3;113:3,
4,4;137:9;147:8;
149:4;151:1,3,4;
163:21;164:23;
165:12,13;166:8;
172:23;173:7;181:4;
189:12,13;194:14;
195:21;201:9,10;
202:9;203:12;
218:15;219:21,24;
251:6;262:4,8;
272:15
beyond (5)
87:5,9;123:5;
139:5;148:1
bid (4)
111:9;239:18,19;
248:20
bids (3)
266:22,23;268:9
big (9)
11:23;58:7;72:20,
22,22;124:10;
214:11;215:3,10
bigger (1)
23:20
biggest (2)
262:19;270:24
bill (1)
13:15
billboard (1)
94:9
billboards (1)
244:20
billing (4)
72:20;73:3;112:1;
199:21
binders (5)
37:23,24;39:10;
49:24;168:4
Bishop (2)
132:9;133:1
bit (30)
12:15;33:7;36:21;
51:20;53:3,17;55:4,9,
15;58:23;63:20;
76:14;81:13;82:9;
101:9;110:11;143:4;
146:10;158:19;
161:22;162:24;
164:20;167:20;
168:3;169:12;194:6;
195:5;210:13;
211:13;259:17
blaring (1)
234:9
blend (2)
179:5,8
blended (10)
111:15;152:7;
153:2,7,19;154:6,7,9,
17;196:19
blending (5)
154:19;179:7;
195:9,20;197:17
blesses (1)
176:5
blessing (1)
222:20
blindness (1)
174:6
blood (3)
64:10;95:22;
174:22
Blue (35)
50:24,24;51:22,23;
52:2,2;55:14,14;59:4,
4,11;60:24;67:10,12,
12,14,18,22;68:2,15;
76:2;87:1,2,17,20,23;
88:15;90:6,7,10,14;
93:2,5;112:15,15
Capitol Reporters
775-882-5322
Blues (2)
51:20;52:14
Board (97)
5:4;6:15,21;15:11;
28:7;30:11,13,16;
31:3,9,20;32:5,18;
33:5,7,8,17;35:15,17,
24,24;36:6,20;38:10,
17;39:3,6,8,22;40:3,
6;41:6;42:24;43:5;
44:18;45:12,19,21,
23,24;46:2;47:2,8,9,
16,20;70:7;71:17;
74:20;77:17;97:13,
17;100:24;106:12,
24;124:20;156:4,6;
158:7;160:22;
161:17;171:15,23;
172:5;177:16;179:6;
185:9;196:6;198:9;
220:9;223:9;228:23,
23;253:6,13,18;
254:10,15;255:17;
256:20,23;258:7,14,
19;259:24;260:2,8;
263:20;264:8,13,23;
265:13,20;266:5,10;
267:17;268:16
boards (1)
46:8
Board's (5)
29:19,21;40:24;
46:8,15
Bob (14)
5:13;116:5,5,17;
117:4,10,11,15,16,18,
20,21;118:2;119:16
Bob's (2)
116:11;117:23
Bodies (2)
127:22;160:12
BOE (4)
43:10,24;44:2,7
bone (1)
247:20
bones (1)
104:5
bonus (2)
14:7;256:3
book (2)
34:20;39:16
books (1)
40:8
border (6)
52:3,3,4,4;99:24,24
born (4)
206:17;208:7,13;
209:16
both (28)
52:19;53:1;54:19;
56:2,9;77:8;96:18;
109:23;110:17;
111:10,15;112:9;
122:16;125:16;
129:21;135:14;
139:3;141:19;
143:13;149:2;152:8;
179:1;183:21;
199:23;213:18,19;
224:8;237:4
bottom (4)
52:14;73:7;74:12;
227:16
bounced (1)
16:5
bound (1)
266:5
boundaries (2)
75:15;102:10
BOWEN (9)
21:17,18;25:23;
26:1,3;60:11;270:11,
11;272:7
B-o-w-e-n (2)
21:19;270:12
Brad (1)
7:24
branch (1)
215:13
brand (5)
52:21;70:13;74:17;
97:6,9
brands (1)
52:20
break (2)
94:12;107:5
breastfeeding (1)
204:12
bridge (4)
44:24;45:1;85:3;
86:12
brief (6)
28:5;107:7;157:24;
158:15;199:9;221:4
briefcase (2)
175:19;182:23
briefly (7)
129:4;146:4;223:7,
12;224:3,20;255:8
bring (23)
10:4;11:2;23:14,
17;36:11;39:18;
54:16;74:20;94:17;
111:15;118:17;
122:19;123:2;
131:12;149:12;
174:15;194:4;197:5;
219:11;247:15;
251:13;261:12;
265:14
bringing (2)
41:19;142:22
brings (1)
214:20
broadcast (1)
220:19
(4) beat - broadcast
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
broader (5)
22:12;163:5;164:2;
184:22;224:15
broadly (1)
183:13
broken (1)
117:24
broker (1)
27:14
brought (9)
9:2;24:11,12;25:7;
50:8;54:15;104:3;
198:16;252:11
budgetary (1)
66:17
build (5)
83:19;86:16;
112:20;215:14;242:9
building (12)
7:15;51:17;166:3;
168:11;215:9;
220:18;242:10;
244:10,10,10;254:24;
255:1
built (5)
80:6;116:15;
251:19,20;253:23
bullet (1)
68:16
bunch (2)
71:9;174:9
Burchett (30)
28:3,3,4;30:19;
31:10;32:1;43:7;
49:1,1;50:6;106:13,
15,21;107:1,11;
240:2,2,8;257:5,9,19;
258:4,10,17,22;
259:3;261:18,23;
264:2;272:4
B-u-r-c-h-e-t-t (1)
28:4
burn (1)
126:22
business (20)
8:20;11:19,24;
25:9;34:17;53:14;
71:13;98:2;100:9;
123:15;164:4;
196:21;221:16,18;
222:22;223:2,16;
224:1;238:13;249:14
businesses (1)
227:8
busy (2)
14:13;18:4
button (7)
6:10;107:17;
190:22,22,23;243:13;
257:6
buttoned (1)
79:18
Buy (3)
Min-U-Script®
61:4,4;189:7
108:16;179:21;
247:22
camera (1)
C
241:6
campaign (2)
cabinet (1)
193:21;194:3
206:8
campus (2)
Cadillac (1)
223:3;229:19
171:23
can (270)
calculate (2)
9:21;14:22,23;
29:24;265:17
16:1,6;17:9,21,23;
calculations (1)
18:6,7,22;20:2;
266:14
22:19;24:9;34:21;
calendar (5)
35:3;37:6,24;38:1,1;
12:18,19;242:9,10;
43:17;44:14;47:5;
244:10
49:20;50:3,14;52:7;
California (8)
53:9;54:3,4,9;59:23;
68:1;88:9,13;
60:20,21,23;61:4,6,
102:6;121:2;133:1;
18,20,22,22;62:4,7,8,
134:21;178:6
9,16,18,19;63:1,5,16,
call (71)
17;64:7,10,10,16,20;
5:3;15:12,13,13,20,
65:20,22;66:2,3,5,13,
24;16:7,16;40:1;
14,16,18;67:4,6,22;
54:2;57:3;60:19;
68:7;69:17;71:11;
62:13;67:23;68:8;
74:4,20;77:9,12;
69:22;80:1;85:6,13;
80:19;85:12,14,15,
87:18;90:6,8,9;
17,18,19,23;86:3;
93:15;96:23;113:9,
87:20;89:20;90:9,10;
15;114:4,5;115:13,
92:13,23;93:14,15;
15,16,19,20;116:3,4;
97:9,10,12,21;98:11,
117:8,9,22;118:6,9,
12,15,17,18;99:4;
10;119:1;124:5,9;
102:17;103:1,12,19;
127:2,6,7,12;137:2;
104:3,16,17,18;
146:13;159:9;
105:21,22;108:18;
164:11;167:10;
110:18;112:22,24;
170:7,9;174:2,3;
113:21;114:16,17,18,
183:3;185:13,23;
19;117:8,19;121:3,
186:1,2;194:21;
13;122:19;124:4;
195:16;198:23;
125:10,10,11;126:23;
212:9;215:19;224:3;
127:5,8,18;129:4,13;
229:17;273:5
130:22;131:1,6,7;
called (20)
132:13;133:12;
14:9,9;15:14;17:5;
135:13,13;136:5,11;
56:22;57:5;95:20;
137:7;138:2,3;141:6,
96:5,6;98:5;108:15;
8,9,19;143:4;144:4;
114:6;116:9;125:6;
146:3,10;147:10;
165:7;169:11;
149:9;150:24;
174:17;216:10;
151:13;152:13,14;
235:14;236:10
153:17;159:24,24;
calling (5)
165:8;166:14;169:8,
26:20;116:4;
19;171:4;172:12;
117:13;211:12;
175:12;177:15;
240:16
181:14;182:11,14;
calls (15)
183:12,23;184:6;
17:5;55:19;94:11;
186:6;189:8;190:19;
113:15;115:23;
191:10,22;192:23;
117:9;119:17,18;
194:12;202:17;
124:6;126:13;127:8;
204:13,14,15,16;
173:23;186:4;211:7;
205:5,5,13;206:7;
212:8
207:1,22;208:6;
came (15)
209:11,14,15,20,20;
7:2,4;8:21;13:7,18,
210:13,20;211:22;
22;15:11;32:2;34:2;
212:2,9;214:6;
37:10;41:6;42:21;
Capitol Reporters
775-882-5322
218:18,19;219:1;
225:21;226:3;227:4,
5;230:22;232:15,17,
18,18,22;235:10;
237:9;239:9;240:17;
241:5;242:2,12;
245:12;246:12,15;
249:10,20;250:24;
254:10;255:23,24;
256:1,20,22,24;
257:2,2,14,15,16;
258:1,2,5,6;259:14;
260:2,14,17;262:13;
263:15,17;266:7;
267:6,7,7,8,8;268:9,
18;270:16;271:15
cancel (1)
218:8
cancer (4)
126:14;204:15,16,
24
cancers (1)
205:2
candidly (4)
33:5;38:12;222:22;
262:7
capability (1)
226:19
capacity (1)
227:10
Capital (2)
222:18;224:21
capitalized (1)
222:10
capitated (1)
213:2
capitation (1)
260:10
Card (33)
60:24;61:20,22,22;
63:10;67:10,12,12,
19,22,24;68:11,12,
15;76:2;86:4;87:17,
18,23;88:15;90:6,7,
15;93:3,5;114:7,9,15,
22;115:2,15;170:18;
232:18
cardiologist (3)
67:6;89:20;95:21
cardiovascular (1)
165:2
cards (2)
68:10;126:23
care (232)
7:11;14:2,17;
16:21;21:23;22:11,
13;23:23,23;24:16;
25:12;51:11;52:22;
54:15,22;55:6;56:15,
21,23,23;57:4,9,12,
15;58:10,11,13,24;
59:6,8,15,16;60:7,23;
61:6;62:20;64:24;
65:5;67:23,24;69:6,
21,23;70:16,17;
75:10;76:1,7,9;79:5,
8,14,17;80:2;82:24;
83:20;84:6,10;86:7,
17;88:14,18;89:7;
90:2,2;92:1;98:9,10,
23,24;99:11;108:9,
23;112:23;113:2,23;
114:2;115:23;117:5;
119:4,9;120:4;121:7,
9,12,16,18;122:2,4,5,
10,11,12,14,24;
123:4,5,6,8,9,13;
125:11,12,16,17,17;
130:11,11,23;132:12;
133:8,24;134:15;
135:21;141:12,17;
143:21;145:16;
146:23;147:3,7,23;
148:3,9,13,17,22;
152:18;155:15,24,24;
156:9,16,18,19,21,
22;162:14;163:7,8;
164:12;165:14;
166:8;167:2,6,9;
168:24;169:16;
173:10,16;175:8,13;
182:1;183:15,20;
184:11,13;189:13;
190:7;191:16;194:2,
24;199:22;200:12;
201:4,8,19,23;202:3,
9,14,16;203:5,12,12,
18,19,24;204:1,2,4,8,
10,12;205:16,19;
206:1,9,16;207:2;
209:2,13,22;211:5;
213:14,15,22;215:5,
5,16;216:1,3;217:2,4,
10,12;218:9,15,19,
22;219:1;221:15;
222:11;224:23;
225:2,4,9,11,19,19;
226:2,23;227:5;
236:8;238:19;239:5;
240:14;241:5;
244:14;247:5;
250:20,23
careful (2)
35:8;38:14
cares (5)
57:13;175:18;
215:11;217:5,6
carrier (14)
22:16;53:11,12;
69:1;80:3;98:18;
110:19;111:9,20;
113:18;179:21;
214:18;230:6,8
carriers (7)
94:8;110:23;
126:17;176:13;
(5) broader - carriers
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
178:18;250:8,12
carrier's (2)
138:4;152:15
carries (1)
27:1
carry (1)
170:18
carrying (1)
170:4
CARSON (28)
5:1;6:8;20:22;
78:20;84:10;132:6;
133:11,12;134:1,4;
150:21;160:6,7;
168:9;186:18;214:2,
3,4,7;239:1,5,6,7,8;
240:5;248:4,7,20
Carson-Tahoe (10)
78:7;84:13;109:3;
129:8;133:18;134:2;
233:11,14;239:2;
248:20
case (17)
15:1;35:21;56:18;
79:4,20;85:12;88:11;
123:19;143:23;
202:19;203:3,6,15;
206:23;247:11;
268:11;269:18
cases (2)
79:19;209:4
cash (1)
189:19
casino (1)
253:3
Cassano (27)
199:4;234:2,3,6,6,
17,19,22;235:1,5,12,
20;236:5;237:3,13,
17,19,23;238:7,11;
239:3,17;240:20;
245:16;246:18;
247:19;250:10
CAT (1)
174:3
cataract (1)
13:14
catastrophic (2)
161:2;196:12
catch (4)
104:3,3,17,17
Catholic (1)
109:24
cause (1)
190:15
caused (1)
196:14
cautionary (1)
22:14
CDHP (1)
54:1
Celestena (1)
43:13
Min-U-Script®
cell (2)
116:7;170:1
center (26)
56:21;57:3;59:15;
68:17;94:3;109:1;
114:6;115:14;124:6,
10;127:2;133:14;
134:20;150:13,14;
153:8;167:1,10;
170:9;173:21;
185:23;201:8;
206:13,14;209:13,20
centered (4)
129:23,24;163:2;
202:1
centers (19)
113:15;118:5;
121:1,4;122:24;
134:17;165:17;
169:5,9;171:8,10;
177:23;178:5;
192:16;214:10,17;
246:12;250:4;252:13
centric (2)
65:1;112:8
CEO (4)
107:19;158:11,13;
198:21
certain (12)
12:20;22:11;73:24;
79:3;121:3;191:17;
192:7;218:5;232:8;
252:13;267:21,22
Certainly (35)
76:19;82:18;
110:21;149:9;
158:21;163:2;
165:16;166:16;
167:8;171:1,14;
175:22;179:5;
181:14,19;183:18;
189:16;190:8;195:7;
196:4;221:1,17;
225:10,21;226:19;
227:13;228:15,16;
229:19,22;230:12;
231:19;256:23,24;
257:16
certificate (2)
249:12,13
cetera (1)
130:24
chain (1)
98:21
chains (1)
98:19
Chair (19)
6:4;21:10;26:14;
32:19;41:24;48:4;
86:22;91:18;96:9;
107:9,11;132:13;
133:4;142:21;249:4;
254:12,20;259:16;
264:13
CHAIRMAN (213)
5:3,24;6:3,5,11,13,
15;7:14;18:18;19:15,
23;20:7;21:2,6,8,11,
14;25:22;26:1,4,9,11,
16,18,24;27:20,23;
28:1;30:6;33:3,23;
34:3,5,12;35:7,10,14;
36:2,5,16;37:4,7,17;
38:5,7;39:7;40:9,11,
20,21;42:1;43:6,11;
44:4,11,20;45:8,13,
15;47:3,6,11,13;
48:17,21;50:3,9,16;
76:18;77:13;80:5;
81:2;83:23;84:3,4,
21;86:20;92:15,20;
96:10,11;99:16;
100:2,17,20;101:5;
103:21;105:1;106:3,
6,9,17,23;107:3,8,13,
17;124:17;128:22;
130:14;132:15;
133:5;134:9;136:4,
12;138:16;139:19,
20;144:3;145:2,18,
24;147:21;148:5,14,
20;149:5,15,20;
150:8;151:1,13,15,
21,24;152:3,9,23;
153:21,24;154:11,20,
23;157:5,12,21;
158:1,6;176:17,23;
179:15;184:24;
186:10,23;190:18,24;
191:5,9;193:9;195:4;
197:16,22;198:7,8;
201:14;207:21;
208:24;228:19;
229:4;234:4;235:24;
236:16;237:8,10;
238:21;240:11;
241:21;243:11;
248:9,13;249:5;
251:13;254:13,19,21;
255:4;257:8,18;
258:2,5,12;259:1,7,
12,15;260:24;261:8,
13,22;262:2,6,12,23;
263:3,7;264:21;
266:12,15,20;267:1,
18,24;268:8,20,24;
269:3,13,16,22;
270:8,10;271:24;
273:3
chairs (1)
71:2
challenge (1)
225:20
challenged (4)
188:3;206:3;
225:11;252:8
Capitol Reporters
775-882-5322
challenges (5)
160:13,18;217:13;
219:7;227:23
challenging (2)
196:7;221:2
Challis (1)
108:2
chance (4)
83:24;127:1;221:5;
223:4
chances (1)
156:18
change (24)
14:8;18:3;19:20;
92:13;103:15,15;
119:14;121:8;141:3,
8;142:13;204:14,15,
16;224:24;257:10,13,
17;258:9,11;263:23;
265:8,9,21
changed (6)
75:19;109:17;
114:13;182:7;
207:22;264:4
changeover (1)
97:23
changes (13)
55:23,24;75:10;
96:19;121:8;169:18;
171:24;185:14;
197:9,10;199:15,16;
249:7
changing (9)
23:9,23;24:1;
104:20,21;142:24;
162:14;171:20;225:1
channel (2)
156:8,8
characterize (1)
221:8
characterized (1)
164:1
charge (5)
24:6;107:22,24;
147:3;192:7
charged (2)
63:10;136:21
charging (1)
24:6
chart (2)
192:22;205:18
chat (2)
15:19,20
chatter (1)
136:9
cheaper (1)
195:12
check (7)
13:22,23;84:14;
116:18;118:3,12;
146:21
checker (1)
218:16
checking (1)
145:19
chemo (1)
148:23
chemotherapy (2)
148:19;205:3
chief (3)
108:1,2;158:12
Child (7)
164:12,17,18;
165:4;167:12;
208:18;209:21
children (3)
204:15,16;228:3
children's (3)
164:14,15;167:12
Child's (1)
164:11
choice (6)
56:11;102:12,16;
110:14,20;207:18
choices (4)
102:13;113:5;
120:20;224:15
cholesterol's (1)
174:22
choose (14)
31:23;43:14;45:22;
49:10;56:8;62:7;
74:15;87:12;111:16;
153:14;171:20;
231:7;264:6;266:10
choosing (1)
265:4
chose (2)
78:1;160:1
chosen (7)
229:8,11,15;230:4,
7,8,18
Chris (29)
5:17,22;6:7;9:23;
21:13,14;43:17;81:4;
86:20,22;92:15,16;
134:10;135:3;136:4,
4,7,7;154:23,24;
186:24;190:19;
191:1;195:6;243:12;
246:6;254:21,22;
270:4
chronic (2)
119:17;202:10
chronically (1)
56:17
Churchill (1)
180:18
circle (1)
75:11
circles (1)
7:22
circumstances (2)
99:8;101:18
cities (1)
150:1
(6) carrier's - cities
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
citizens (1)
11:22
CITY (14)
5:1;6:8;14:19;
15:17;20:22;84:11;
134:21;150:2;160:7;
214:2,3,4;239:7;
240:5
claim (5)
73:24;85:18;
126:23;213:6;229:17
claims (12)
60:21;71:23,24;
72:1,4;73:15;112:1;
170:16;192:17;
212:15;232:15,18
clarification (9)
9:12;84:1;86:24;
90:17;91:6,17;
134:13;145:14;
257:16
clarifies (1)
266:9
clarify (9)
30:22;41:14;
132:17,22;140:9,22;
145:21;230:22;240:4
clarifying (1)
158:4
Clark (4)
78:12;140:5,7;
186:19
class (4)
41:5;161:18;
200:12;224:7
classes (2)
142:21;204:6
clear (4)
41:9,11;229:9;
266:2
Clearly (1)
38:10
clicks (1)
115:10
client (15)
42:7;70:4,5;71:9;
100:7;104:9;111:2;
116:14;118:11;
119:19;120:2,6;
128:7;151:7;160:14
clientele (1)
22:9
clients (27)
24:9,20;42:5;
53:22;67:8;80:8,13,
14;81:8;82:11;94:8;
102:20;104:9,13;
115:20,21,24;116:2;
125:24;127:19;
128:3;132:19;160:5,
9;212:24;232:20;
243:18
clinic (22)
Min-U-Script®
147:7;216:11,18,
23;217:24;219:3,10;
226:5;227:17,19;
228:10;241:1,9,18;
242:5,11,14,17;
243:1,3,4,21
clinical (17)
56:19;71:5,5;
72:14;118:15;166:2,
3;173:2;199:21;
200:14,19;201:19,24;
202:16;203:13;
206:2;224:11
clinics (5)
188:15;215:9,10;
244:3,20
clock (3)
58:22;118:8,9
close (7)
80:15;102:11;
155:1;188:6;216:1;
226:23;245:4
closed (4)
81:15;128:24;
183:10;260:9
closely (1)
132:6
closer (1)
111:15
closest (1)
218:19
closing (6)
17:11;23:8;123:11;
176:8;225:7;254:24
CMS (1)
207:4
coaches (1)
129:20
Cochran (46)
5:17;21:12,13;
86:22,23;88:2,20;
89:11;90:16,22;
91:14;92:17;129:3;
135:3,3,8;136:3,11,
13;137:15,19;138:10,
15;154:22,24,24;
155:21;157:6;187:1,
8;188:13,24;190:3,
21;191:3;197:21;
246:7;247:6,16;
248:2;254:20,22;
264:20,22;265:24;
266:13
code (3)
13:17,18;249:14
codes (1)
249:16
cognizant (2)
255:11;264:5
coined (2)
23:3,5
co-insurance (1)
143:22
collaborate (3)
92:11;103:1;
165:18
collaboration (8)
51:12;54:13,24;
55:10;83:1;149:4;
225:24,24
collaborative (4)
74:19;75:8,16,17
collaboratively (2)
66:3;254:4
collaboratives (1)
58:1
collateral (1)
74:4
collaterals (1)
74:5
collect (1)
257:20
collection (1)
224:4
collectively (3)
30:17;31:4;59:5
college (1)
68:5
colorectal (1)
57:21
combat (1)
165:3
combination (2)
137:8;267:7
combined (2)
181:9,11
Comcast (1)
112:15
comfortable (6)
38:18;48:16;
173:18;191:18;
206:9;254:8
comforting (1)
209:18
coming (13)
6:21;9:8;11:12;
24:1;58:16;70:9;
94:10;105:10;
121:20;148:11;
184:1;189:3;271:10
comment (16)
6:8;7:18;20:9;
21:9;26:5,8;38:20;
40:22,22;42:20;
46:24;84:24;270:3,4,
7;272:21
commented (1)
39:14
comments (5)
7:14;21:8;26:7,19;
273:4
commerce (1)
225:2
commercial (9)
94:8;215:22;218:3;
221:18;226:9;228:5;
Capitol Reporters
775-882-5322
237:3;252:24;253:4
commission (2)
27:17,18
commitments (1)
109:20
committed (2)
161:15;176:14
committee (44)
7:20;28:24;29:17;
30:12;31:11,18,24;
32:2,15;33:16;34:17;
35:2;37:9,16;39:9,
13;40:6;41:4,5,6;
45:23;47:1;48:8;
49:15,23;50:19;
142:20;260:3;
261:24;262:10;
263:5,8,13,22;264:7,
9,23;265:8,13,19;
266:6;270:24;271:9;
272:2
committees (4)
34:19;45:22;46:14,
14
commonly (1)
108:22
communicate (8)
94:21;95:8;96:20;
185:22;243:15,18,22;
253:8
communication (10)
23:6;55:21;95:9,
19;97:11,18;104:21;
149:4;161:15,16
communications (3)
95:2,3,7
communities (14)
11:7,15;12:16;
110:7,21;112:4;
131:4;142:22;
149:12;159:17;
162:23,24;165:18;
190:2
community (28)
11:18,21;12:17;
54:18;75:17,20;
83:16,20;131:3;
162:10,10;163:12;
164:7;165:9,12,15,
20,24;166:19;167:6;
183:14;184:22;
194:8,14;203:22;
226:4;228:8;252:13
companies (10)
8:20;27:10;30:3;
119:22;160:14;
189:3,4,7;207:6;
268:17
company (25)
22:17;28:19;50:16;
87:1;112:12;114:7;
123:14;124:11;
146:6;149:18;
158:24,24;161:1;
201:7,18;215:4;
220:12,24;222:8,10,
24;225:6;233:20;
261:19;262:3
comparable (2)
29:5;91:4
comparably (1)
269:8
compare (1)
34:21
compared (7)
35:18;120:10;
175:17;178:21;
187:4,16;208:13
comparing (1)
39:11
comparison (1)
236:15
competence (1)
29:5
competencies (2)
200:11;224:3
competing (1)
266:22
competition (6)
110:7,15;111:2,6;
188:2;200:10
competitions (1)
110:5
competitive (2)
111:7;188:4
competitor (1)
52:16
competitors (2)
159:3;174:14
complaining (1)
182:4
complaint (1)
185:10
complete (5)
18:23;22:13;43:4;
90:8;268:3
completed (4)
33:15;34:1,5;216:7
completely (4)
31:15;40:19;124:4,
7
completeness (1)
270:22
completing (1)
122:22
complex (5)
58:14;112:24;
203:15;247:20,21
complicated (4)
118:16;172:6;
203:10;209:4
complications (1)
25:7
compliment (2)
17:1;21:19
component (3)
(7) citizens - component
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
58:18;72:20;206:1
components (2)
94:17;172:16
comprehend (1)
37:21
comprehensive (4)
70:8;159:13,17;
168:20
computer (13)
14:16;38:2;86:11,
18;94:22;108:5;
116:10;130:24;
147:11;170:6;
185:12;192:24;
240:19
computers (2)
193:13;194:20
concept (4)
146:13;155:21;
156:21;196:16
concepts (2)
172:4;219:8
concern (11)
10:4,19;17:2;18:5;
33:13;80:18;171:23;
214:22,22;259:8;
270:24
concerned (5)
77:14;97:24;104:9;
240:13;270:13
concerns (8)
7:11,21,21;17:15,
17,20,23;272:16
concludes (1)
228:14
concur (2)
33:9;44:14
concussion (1)
22:20
condition (6)
67:6;95:21;196:13;
209:16,18;231:3
conditions (1)
119:17
conducive (2)
34:24;224:23
conference (3)
5:5;83:8;166:11
confident (1)
77:9
configuration (1)
236:14
confirm (2)
16:11;155:5
confirmation (3)
16:21,23;268:15
confirmed (2)
16:14;239:15
confirms (1)
145:24
conflict (2)
27:23,24
conformance (1)
Min-U-Script®
29:3
confused (1)
265:24
confusing (4)
9:1,8;10:2;239:24
confusion (3)
239:17,20;271:20
conjunction (3)
138:7;152:14,15
connect (9)
60:6;69:15,15,23;
115:9;125:16;
127:12;166:11;241:6
connected (3)
70:3;156:9;218:20
connection (5)
68:24;69:7,10,22;
109:15
connects (1)
115:11
consider (12)
22:15;23:17;55:18;
120:23;140:8;149:1;
163:6;188:23;230:5;
245:9;246:20;255:7
consideration (4)
53:21;153:19;
154:2;188:13
considerations (1)
21:21
considered (7)
29:11,14;133:24;
180:22;238:2;
246:16;247:10
considering (2)
230:13,16
consisted (1)
199:18
consistency (1)
6:21
consistent (3)
152:8;211:17;
262:1
consolidation (1)
189:3
constant (4)
121:7,8;141:9;
149:11
constantly (4)
142:19;201:1;
218:14,14
constituents (1)
254:7
constitute (1)
255:2
constraints (2)
82:2,2
consult (2)
25:15;64:15
consultant (3)
70:7;161:12;
182:17
consultants (1)
204:18
consultative (1)
65:21
consults (2)
205:3;226:12
consumer (10)
51:12;59:21,23;
60:5;65:1;75:3;
111:3;112:8;201:3;
207:8
consuming (1)
15:8
contact (10)
9:24;14:11;55:20;
112:21;118:21;
122:23;125:15,15;
194:10;257:24
contacted (1)
25:14
contacts (2)
119:3,16
containment (2)
152:21;172:12
content (1)
272:15
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7:4
contingent (1)
230:12
continual (1)
53:9
Continuation (2)
148:17,22
continue (32)
19:8,14;41:8;
77:12;79:13;80:2;
156:12;161:6,13;
168:23;169:5,18;
171:15;172:13;
188:18,23;189:24;
197:2,6,7,13;220:20;
221:21;222:4,7,8;
225:8;227:7;228:24;
230:21;231:19;
232:12
continued (3)
7:22;79:23;181:3
continues (4)
19:19;171:2;
177:18;221:3
continuing (5)
109:9;139:21;
167:23;176:14;
224:12
continuity (8)
79:5,8,17;98:9,10;
99:11;104:21,22
continuously (1)
7:5
continuum (4)
59:16;61:8;206:16;
220:23
contract (52)
Capitol Reporters
775-882-5322
28:13,14;30:2;
42:14;46:14;48:23;
50:2;77:19,21,23,24;
87:7;107:23;172:13;
175:19,21,24;178:8;
180:18,19,20,21;
181:3,4,4,17;183:7;
185:4;187:15;
188:16;191:13;
216:4;222:2;230:20;
235:2,10,12,14,14,
15;237:16,19,20,24;
238:2,5,12,16;
239:13;250:20;
264:17;266:8
contracted (23)
56:7;80:11;84:12;
94:3,5;120:24;
131:23;132:8,10;
136:22;138:12;
213:18;234:9,10,12,
13;236:6;238:15;
239:14;248:17,21,21,
22
contracting (9)
34:9;43:8;51:2;
187:11,13;199:5;
200:6;236:9;247:14
contracts (21)
28:9,12;35:17;
39:2;43:9;44:6;
47:10;84:6;87:10;
90:18;169:4,8;171:7,
10;178:10;188:3;
190:16;211:24;
213:13;234:13,14
contributions (1)
166:20
control (7)
56:24;57:10;91:22;
120:8;177:15;
208:23;225:18
controlling (1)
31:16
controls (1)
111:5
conundrum (1)
48:12
convenient (12)
62:3;63:6,14;
215:7,12,16;217:10;
242:15,20;252:12;
253:10;254:1
conversation (6)
7:17;9:21;179:6;
241:1,24;253:21
conversations (7)
99:4,5;116:13;
118:16;127:1;
173:13;267:15
cool (2)
94:7;258:24
cooperation (1)
176:4
coordinate (5)
57:13;113:23;
203:19;207:1;247:9
coordinated (1)
189:13
coordinating (1)
123:7
coordination (4)
58:21;121:22;
167:3;173:10
coordinator (1)
71:23
co-pay (15)
63:8,9,23;67:1;
68:2,13;89:13;
136:16;146:23;
147:13,13;153:13;
175:24;200:18;213:7
co-payment (4)
144:18;145:5,9,10
COPD's (1)
71:2
copy (3)
34:18;35:3;93:14
core (16)
71:20;74:10;
136:19,19;138:23,24;
139:2,2,3,3,14,15,16;
200:11;224:3;229:19
corporate (2)
111:24;223:3
correctly (2)
25:8;78:11
cost (61)
13:15;18:7;24:3;
29:7,22;51:11;53:20;
54:4;58:5,7;61:2,3,8,
10;63:22;66:11;
75:23;81:13,20;
82:10,20;91:22;98:4,
6;103:2,7;105:10;
111:5;112:9;119:13;
120:3,7,12,19;125:9;
129:17,20;137:16;
138:11;139:4;
143:10;145:8;
152:21,21;153:13,20;
155:16,18;172:12;
175:16;177:15,17;
178:1,14,22;197:8;
200:4,13,15;213:8;
224:7
Costello (1)
16:4
costly (1)
82:7
costs (16)
53:23;56:23;58:6;
64:8;76:7,11;80:23;
83:5;102:12;119:9;
121:3;152:18;178:4;
180:11;189:14;
(8) components - costs
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
248:15
cough (1)
58:16
counsel (2)
183:22;199:6
counseling (2)
73:16;115:7
counselor (4)
115:1,9,11,13
counselors (1)
192:9
count (2)
210:20;266:24
counted (1)
133:9
counties (18)
94:21;130:18;
131:18;132:2,4,23;
133:9;199:19,24;
200:2,9;236:4,7,8,14;
239:9,19,23
country (18)
40:3;51:13,18,21;
52:4,8;53:18;54:8;
59:7;65:16;67:14;
82:12;87:21;102:2;
147:16,18;189:9;
263:1
countrywide (1)
209:11
County (22)
78:12;131:17,18,
21,21;132:5,16;
133:8;140:5,20;
149:24;150:1;
183:22;184:15;
186:17,19,20;237:4,
5;239:9,10,14
couple (38)
14:10;27:7;30:6;
43:2;50:12;64:1;
66:23;67:11;75:6;
76:21;81:1,3;86:23;
96:12;99:17;109:13;
113:15;116:22;
118:3,20;123:12;
125:19;127:5;
128:17;130:16;
139:22;147:22;
173:2;181:7;187:1;
218:23;223:8;228:8;
230:3;246:7;257:5,6;
259:4
course (12)
37:7;65:6;66:16;
69:14;71:17;73:7;
88:15;109:22;136:1;
195:10;229:9;269:6
Court (2)
139:15;255:6
courteous (1)
223:22
cover (6)
Min-U-Script®
28:7;93:2;95:1;
134:19;147:17;
212:22
coverage (14)
19:3;67:17;90:4;
132:23;143:5;
170:15;173:4;175:1;
196:18;225:12,14;
233:7;248:5;267:16
coverages (1)
221:17
covered (14)
14:7;51:22;92:22;
93:12;95:16;143:4,6,
17;144:7,8,9;145:7;
153:16;192:13
craft (1)
95:6
create (6)
58:13;74:5;125:9;
165:19;167:5;202:2
created (1)
251:18
creating (2)
164:22;252:12
credentialing (1)
175:21
credit (2)
48:13;63:10
crisis (1)
194:16
criteria (3)
29:3,18,19
critical (4)
88:20;91:6,12;
224:19
critically (1)
167:13
CRM (1)
127:10
cross (13)
44:24;45:1;50:24;
51:23;52:2;55:14;
59:4;67:14;68:2;
87:2,21;90:10;
112:15
crossed (1)
95:8
crossover (3)
171:18;228:4;
252:24
C-section (3)
208:3,11,20
C-sections (1)
208:5
CT (1)
22:22
cubes (1)
126:17
cubicle (2)
64:10;82:8
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269:20
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105:21,21,22,22
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135:4;190:11;
236:2;250:15
currency (3)
122:1,2;173:3
current (17)
33:5,7,16;35:23;
48:8;78:24;110:2;
139:10;141:2;142:2;
169:11,11,17;170:23;
179:2;200:3;218:19
currently (12)
28:9;43:15;53:5;
150:5,7;152:5;
154:12,16;171:1;
178:10;181:5;239:15
customer (45)
8:1;9:18,21,22;
10:3,4,5,12,12;12:5,
6;17:16,16;51:16;
65:7;81:6,7;85:11,13,
19;86:5;92:23;93:12,
16,17,20;96:2;
109:16;110:4;112:1;
113:19;115:14;
117:22;118:5;119:1,
18,21;120:1,21;
124:2;125:13;
229:12,16;252:24;
253:3
customers (7)
53:16;82:15;86:9;
112:14;113:11;
243:18;253:4
customizable (1)
70:8
customized (1)
205:24
cut (2)
24:3;259:19
cutting (1)
170:14
D
DAG (2)
27:16;266:3
daily (2)
55:21;207:1
Dallas (1)
251:20
Damon (12)
28:8;31:12,13;
47:7;49:5;144:4;
259:16;263:18;
264:22;266:1;
267:11;268:13
dangers (1)
41:3
dash (1)
232:24
Capitol Reporters
775-882-5322
data (10)
73:19;92:12;
105:19;161:11;
182:13,13;219:20;
232:6,10,24
date (6)
23:7;80:2,3;232:8;
233:16;263:14
daughter (2)
126:14;210:3
Dave (1)
108:2
day (27)
8:10,12;9:6;16:2;
17:5;23:8;36:22;
49:16;55:22;66:10;
71:23,23;74:18;
104:14;116:1;
123:12;158:8;174:3;
180:8;215:19;220:5;
221:19;228:21;
246:10;253:10;
255:5;263:22
days (14)
12:20;16:21,22,23;
63:18;67:20;68:6;
114:9;148:4,13;
172:22,23;203:7;
216:3
day-to-day (1)
174:12
dead (2)
22:2,3
deal (11)
22:8;23:21;24:11;
49:9;100:24;103:24;
113:10;190:14;
225:20;229:12;
255:12
dealing (5)
17:13,14;101:19;
116:19;119:13
dealings (1)
22:8
deals (1)
110:6
Debra (1)
13:10
decade (3)
201:18;202:1;
209:6
decades (4)
162:20;165:3;
247:1;256:5
DECEMBER (7)
5:1,4;14:12;19:6;
23:7;32:18;263:1
decide (7)
31:4;38:18;97:14;
111:8;256:2;264:10;
265:3
decided (3)
146:22;159:22;
264:8
decides (2)
42:24;171:15
deciding (1)
152:16
decision (16)
30:18;42:16,24;
43:8;48:16;110:18;
112:12;171:20;
229:21;248:19;
252:22;255:24;
257:2;258:19;
266:17;268:19
decisions (8)
44:10;110:24;
113:22;201:4;
225:17;250:19;
260:5;272:9
decrease (1)
141:6
dedicated (6)
81:7;85:9,11;
128:6;216:7;229:20
deductible (34)
110:17;123:21;
135:4,9,15,17,19,24;
136:17,19,22,24;
137:1,2,3,3,10,11,13,
21,24;138:2,7,18,20,
23;139:8,12,12,16;
151:10;152:13,17,21
deductibles (1)
172:8
deductions (1)
19:11
deep (1)
73:20
defer (4)
32:1;49:12;149:21;
234:1
definitely (8)
64:20;101:7;
152:24;156:11;
168:6,19;179:24;
260:5
definition (2)
208:9;244:8
degree (1)
224:16
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232:6
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31:23
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260:15
deliver (10)
51:19;123:16;
161:6;200:11;211:5,
17;212:24,24,24;
224:17
delivered (4)
25:12,13;178:7;
251:21
(9) cough - delivered
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
delivering (1)
215:5
delivery (12)
59:8,15;110:22;
200:21;201:12;
206:1,5;213:4;
221:15;224:13,19;
230:24
demand (2)
122:2;229:20
demographic (1)
225:1
demographics (1)
218:5
demonstrate (1)
199:10
demonstrated (2)
29:5;161:9
Dennis (2)
27:16;266:4
dental (3)
14:4,6;69:1
dentist (1)
69:4
deny (1)
249:22
department (3)
34:9;210:10,14
depend (3)
24:17;221:13;
224:16
dependents (1)
124:1
depending (7)
79:12,12;97:16;
101:12;104:8;
146:24;207:22
depends (3)
82:15;154:2;
265:20
depression (1)
63:15
depth (1)
260:4
derivative (1)
159:15
describe (2)
241:4;270:21
described (2)
92:5;242:6
describing (1)
242:1
description (1)
244:8
design (13)
78:2;100:12;103:3;
105:15,15;123:18,19;
144:12;145:4;
199:20;200:3,17;
213:7
designated (1)
156:16
designed (3)
Min-U-Script®
87:12;111:11;
226:22
designs (3)
53:22,23;213:11
desire (3)
36:7;47:17;272:18
desired (1)
224:24
desk (4)
86:10;116:10;
172:22;192:18
details (1)
36:7
detect (1)
69:17
determination (1)
193:17
determinative (1)
165:7
determine (3)
24:16;175:10;
258:14
determined (2)
44:18;109:18
determines (1)
24:17
develop (8)
53:6,21;76:12;
83:1;129:22;159:17;
232:19;268:19
developed (3)
126:8;178:4;
201:24
developing (5)
53:8;86:13;123:7;
130:4;160:23
development (2)
199:4;234:7
developmental (1)
204:15
diabetes (4)
69:17,18;166:12;
208:23
diabetic (1)
24:10
diabetics (1)
166:11
diagnose (3)
241:3,3;242:1
diagnosed (1)
196:12
dialogue (1)
202:23
dialoguing (1)
206:24
dials (1)
116:5
dietary (1)
130:7
dieticians (3)
129:20;205:1,6
difference (6)
89:13;90:12;91:12;
162:12;187:18;238:7
differences (5)
138:10;176:9;
177:16;180:3;197:8
different (89)
12:15;14:10;16:18;
21:24;33:7;46:8;
52:10;60:1;61:9,10,
12;64:8,8;66:15,21;
67:1;69:7;76:6;78:2,
3;80:16;82:14,14;
85:16,17;94:17;
97:15,16;100:1,5,8;
101:3,10,12,15,18;
102:3,12;103:9,13;
104:8;110:22,23;
113:16;114:4;
116:15;124:4,7;
125:21;126:4;
128:16;149:12;
153:5,5,7;159:23;
160:11;169:12,24,24;
171:7;172:4,7;175:5;
176:13;177:13;
182:7;188:5;190:9;
192:11;196:2,9;
200:8;215:4;223:8;
225:2;226:21;
230:12;241:13;
242:19;245:8;
260:10;262:3;265:1,
2,6;268:21;271:2,5
differentials (2)
103:2;105:17
differentiate (1)
111:22
differentiates (2)
189:17;200:21
differentiation (1)
224:6
differently (4)
100:10;163:17;
194:7;263:24
difficult (13)
65:13;66:7;101:9;
102:9;103:14,16,17;
126:9,10,24;222:14;
230:4,18
difficulty (3)
46:3;92:24;156:3
dig (1)
36:7
digging (1)
42:11
digits (1)
66:1
direct (6)
7:17;67:24;120:16;
201:19;205:19;224:1
directing (1)
260:16
direction (11)
31:10;34:8;36:12;
Capitol Reporters
775-882-5322
97:16;113:22;
156:20;160:1;
260:16;264:13;
267:13,17
directives (1)
109:24
directly (7)
19:7;61:23;67:4;
89:20,21;93:15;
122:14
director (8)
45:11;99:4,5;
107:21;148:22;
173:12;182:9;209:3
directors (1)
206:24
directory (2)
168:12;238:8
disability (1)
69:2
disagree (1)
32:5
disappeared (1)
109:23
disc (4)
32:24;37:16;42:11;
49:20
discharge (2)
203:5,8
disclaimer (1)
31:14
disclose (1)
27:14
disclosed (1)
77:15
disclosure (1)
27:11
disconnects (1)
115:13
discount (2)
88:16;249:1
discrepancy (1)
92:9
discs (10)
34:10,13,22;35:4,
5;37:20;38:2;40:17;
42:18;49:24
discuss (3)
40:1;104:11;
256:22
discussed (2)
89:2;172:5
discussing (1)
122:21
discussion (11)
40:7;51:11;82:1;
187:2;190:12;195:8,
9,19;255:10;257:13;
264:14
discussions (2)
92:9;119:11
disease (8)
56:18;69:5;122:7;
129:24;165:2;167:2;
191:17;202:10
disincentive (1)
58:12
Disney (2)
60:22;67:21
disrupted (1)
99:12
disruption (16)
42:10,15;77:15;
78:24;79:2;96:15;
97:23;98:20,21;
103:14;105:2,24;
171:14,17,21;269:19
disruptive (2)
96:14,17
distinct (1)
235:13
distressed (1)
183:14
distributed (1)
256:20
distribution (1)
224:5
dive (3)
73:12,15,20
dividends (1)
162:20
division (1)
266:6
divisions (1)
72:7
divorced (1)
68:6
DMV (1)
245:3
docs (2)
86:13,16
doctor (27)
58:17;62:5,7,11,12,
16,18;67:3,5;69:17;
79:3;119:7;148:1;
153:14;168:16,20;
175:19,22;176:4;
183:3,18;191:11;
192:20;202:23;
203:17;207:22;
245:15
doctor-patient (1)
58:9
doctors (13)
22:21;24:14,23;
25:14;62:9;88:10;
104:22;125:23;
149:11;212:12,14;
224:15;227:14
doctor's (2)
122:24;148:11
documentation (5)
20:5;43:21;142:8,
10;145:14
DOI (3)
199:8;249:6,8
(10) delivering - DOI
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
DOLAN (10)
198:8,9;231:16,18,
21,24;232:3,7;
233:13,16
dollar (7)
135:24;136:19;
137:1,3;138:23;
147:12;165:23
dollars (3)
55:2;166:17;167:5
domicile (1)
159:1
Don (14)
5:11;26:17,18;
32:19;37:8;44:23;
45:8,9;92:20;191:9;
198:20;251:5,15;
259:12
donating (1)
55:2
done (35)
13:21;18:12,15,15;
20:13;36:17;37:17;
42:5;43:1,17;49:9;
57:1;80:13;92:15,16;
93:7;154:18;156:13;
158:9;175:12;193:6;
205:1;228:22;231:8;
242:2;243:6;250:13;
259:11;263:8;
264:18,19;265:15,16;
271:21;272:7
doodle (2)
255:15;273:6
dose (2)
45:19;46:1
dots (2)
69:16,23
double (3)
24:5;66:5;133:9
doubt (2)
250:3;266:2
Douglas (5)
134:4,4,8;150:21;
186:18
down (71)
7:17;8:2,7;9:6;
10:6;15:10,11;24:3;
26:6,7;37:12;39:9,17,
24;52:14;54:22;
62:23;63:1,1,24;
65:19;73:9;74:12;
76:7;77:24;79:18;
80:20;81:4,4;84:22;
95:6;103:1,5,19;
104:11,18,23;105:9,
16,18;106:4,5;
120:13;129:9,9;
134:10;136:5,17;
150:6;153:15;156:2;
183:22;186:19;
187:11;188:15;
190:4,6;193:18;
Min-U-Script®
197:20,21;199:5;
200:5;207:8;210:15;
216:22;219:3;
233:20;234:4;
243:11;262:14;
265:14
downstream (1)
208:5
Dr (30)
62:18;108:1;
158:12,13;161:21,23;
168:2;172:15,17;
173:12;182:24;
183:5;191:14;
193:16;198:22,23;
200:23;201:11,13,15;
203:3,9;207:24;
209:1;210:1;214:10;
218:20;220:21;
223:12;228:2
drain (1)
205:6
draining (1)
126:24
dramatically (1)
226:20
drastic (1)
177:17
draw (1)
227:20
drawbacks (1)
31:22
drawing (1)
104:23
drive (8)
12:1;71:11;111:6;
164:21;166:8;174:7;
193:19;216:9
drivers (1)
58:7
driving (2)
178:4;194:11
drop (1)
177:8
dropout (1)
164:19
dropped (3)
11:17;177:5,8
DROZDOFF (205)
5:3,24;6:3,4,5,11,
13;18:18;19:15,23;
20:7;21:2,6,8,11,14;
25:22;26:1,4,9,11,16,
18,24;27:20,23;28:1;
30:6;33:3,23;34:3,5,
12;35:7,10,14;36:2,5,
16;37:4,7;38:7;39:7;
40:9,11,20;42:1;43:6,
11;44:4,11,20;45:8,
13,15;47:3,6,11,13;
48:4,17,21;50:3,9,16;
76:18;77:13;80:5;
81:2;83:23;84:3,21;
86:20;92:15,20;
96:10;99:16;100:2,
17,20;101:5;103:21;
105:1;106:3,6,9,17,
23;107:3,8,13,17;
124:17;128:22;
130:14;132:15;
133:5;134:9;136:4,
12;138:16;139:19;
144:3;145:2,18,24;
147:21;148:5,14,20;
149:5,15,20;150:8;
151:1,13,15,21,24;
152:3,9,23;153:21,
24;154:11,20,23;
157:5,12,21;158:1;
176:17,23;179:15;
184:24;186:10,23;
190:18,24;191:5,9;
193:9;195:4;197:16,
22;198:7;201:14;
207:21;208:24;
228:19;229:4;234:4;
235:24;236:16;
237:8,10;238:21;
240:11;241:21;
243:11;248:9,13;
249:5;251:13;
254:13,19,21;255:4;
257:8,18;258:2,5,12;
259:1,7,12,15;
260:24;261:8,13,22;
262:2,6,12,23;263:3,
7;264:21;266:12,15,
20;267:1,18,24;
268:8,20,24;269:3,
13,16,22;270:8,10;
271:24;273:3
drug (7)
97:5,6,14,15;98:7;
99:7,13
drugs (18)
18:7;70:14,14;
72:8,9;73:17;98:4,5,
6,11;141:7,8,9;
142:21,23;144:7;
145:5;165:5
dry (1)
259:19
due (1)
28:23
duplicated (1)
120:22
during (6)
17:2;96:19;97:23;
121:9;148:6;206:2
duty (1)
32:23
dynamic (2)
149:11;235:14
dynamics (1)
102:7
Capitol Reporters
775-882-5322
effective (5)
8:10;80:2,3;
172:20;178:8
effectively
(4)
ear (4)
54:17;122:9;
64:11;67:3,5;
167:17;238:6
187:23
effectiveness
(1)
earache (1)
54:5
67:2
effects (1)
earlier (12)
208:5
41:3;67:11;92:5;
efficiency
(2)
94:23;124:20;
189:14;213:16
151:16;159:20;
160:2;176:6;187:19; efficiently (1)
122:10
238:24;255:12
effort (5)
earliest (1)
31:21;76:19;
204:12
219:15;271:23;
early (16)
272:17
15:15;18:2;113:8,
efforts (1)
12,21;204:5,7,8;
166:18
228:2,2,3,12;247:23;
eight
(6)
257:3;266:17;271:16
120:7,12;126:7;
earn (1)
247:24;263:14;
52:17
269:15
ears (1)
either
(12)
113:24
28:19;53:22;54:7;
ease (3)
76:4;79:10;91:11;
100:23,24;213:5
93:14;105:11;
easier (5)
119:17;220:17;
55:6;60:7;194:10,
230:4;263:7
14;215:6
elaborating
(1)
easiest (1)
167:8
239:16
elderly (1)
easily (3)
17:21
17:21;181:15,22
elective
(2)
Eastern (2)
208:4,20
94:3;234:22
electively (1)
easy (4)
208:22
63:6;140:24;
electronically (2)
175:10;216:20
15:8;62:24
eat (1)
elements
(1)
167:17
9:14
echelon (2)
eligible (2)
7:6,10
18:22;246:13
echo (1)
Elko
(12)
161:23
11:22,23;12:3;
Eco (1)
20:19,20;94:2;95:13;
225:4
234:23,24;237:12,15;
edge (1)
248:21
170:14
else (21)
edging (1)
25:16;30:1;40:18;
103:22
43:6;49:7;64:12;
educate (2)
83:3,23;106:4,4;
113:2;244:21
112:7;120:22;
educating (1)
145:18;147:21;
244:22
157:5,13;195:17;
education (5)
197:19;212:16;
71:3;118:23;
217:16;269:14
165:11;207:12;
elsewhere
(1)
246:22
149:17
effect (1)
Ely (5)
271:8
11:22;12:2,4;
effected (2)
20:20,20
97:8,13
E
(11) DOLAN - Ely
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
e-mail (9)
40:1;62:19,24;
95:3;170:19;241:11;
243:23;257:22,24
e-mailed (1)
259:6
e-mailing (1)
241:12
e-mails (1)
112:21
embarked (1)
162:4
embedded (5)
68:22;69:13;137:2,
11,13
emergencies (1)
208:19
emergency (9)
24:13;25:12;63:4;
67:21;87:14,16;
147:7;175:16;184:12
emergent (3)
89:5;91:10;233:9
empathy (1)
126:6
employed (1)
224:21
employee (10)
53:19;54:9;102:1;
112:17;124:6;
149:17;153:12;
195:12;220:22;238:6
Employees (45)
6:17;50:22;52:19;
54:7,7;56:8,10;62:3;
64:6;65:11,13;70:2;
76:11;93:1;101:22;
102:4,5,6;103:14;
110:20,24;113:4;
118:22;120:10,10;
124:1,5;149:22,24,
24;150:4;152:17;
157:14,18;159:12;
160:4;179:10;
196:11;212:22;
213:1;220:22,24;
222:7;237:21;272:23
employees' (5)
51:17;158:20;
161:6,10;196:11
employer (6)
151:11;159:10;
196:9,10;222:6;
231:6
employers (5)
53:19;54:10;97:1;
196:18,20
enable (1)
123:1
enabler (1)
156:24
enables (1)
141:19
Min-U-Script®
enabling (1)
59:1
enclosed (1)
64:9
encounter (1)
206:10
encourage (6)
86:14;147:6;
149:13;156:11,12;
256:24
end (32)
7:24;30:1;44:6;
49:16;51:14,15;62:7;
66:10;70:1;83:5;
107:2,4;113:10;
119:24;123:12;
124:8,11;152:15;
158:3,4;173:14,15;
180:8;186:11;
197:12;198:5;213:6;
215:2;220:4;228:13;
252:18;265:20
endemic (1)
245:18
ending (1)
86:14
ends (1)
80:3
endure (1)
222:15
energy (3)
168:11;170:9;
271:22
engage (18)
50:20;65:12,13;
70:21;83:13,19;86:8;
113:8,11,22;152:17;
162:12;192:23;
204:7,8;224:22,22;
225:8
engaged (13)
53:5;65:4;75:20,
22;83:15;92:3,4,6;
119:4;164:10;201:4;
226:4;244:4
engagement (11)
51:1,12;52:11;
59:21,23;65:24;
86:11;92:7;112:8,13;
201:3
engagements (2)
29:5;52:11
engaging (1)
224:10
engines (1)
125:6
enhanced (3)
57:3;64:24;65:5
enjoy (3)
164:23;165:13;
213:7
enjoyed (1)
213:10
enough (11)
22:17;35:5;39:22;
44:19;48:15;62:6;
107:23;159:1;263:8;
269:13;271:18
enroll (1)
14:24
enrolled (5)
7:3;19:2,17,18;
152:20
enrollees (2)
12:16;172:14
enrolling (1)
9:9
enrollment (16)
8:18,18;9:3,5;13:4,
6;14:12;23:8;44:9;
72:19;73:3;104:19;
109:9;112:1;164:21;
171:20
enrollments (1)
72:23
ensure (7)
65:3;79:10;88:17;
97:18;105:2;127:5;
130:22
entertain (1)
229:22
entire (8)
15:6;31:19;33:24;
36:20;164:3;168:10,
24;252:4
entirety (2)
31:20;32:9
entities (3)
24:6;160:8;248:23
entity (1)
23:19
entrusted (1)
221:12
environment (6)
163:5;166:9;184:6;
195:1;202:2;242:23
envision (1)
128:9
EOB (3)
85:15;93:19,19
EOB's (1)
60:21
EPHC (1)
58:8
episode (3)
202:20;227:5;
250:23
equity (7)
101:16,21;102:11;
103:6,7;105:16;
195:21
equivalent (3)
141:21;148:7;
153:9
ER (8)
58:6;70:12;76:4;
Capitol Reporters
775-882-5322
83:3;86:15;89:4,10;
217:7
eroded (1)
209:17
err (1)
272:23
errors (2)
113:5;271:13
ER's (1)
76:7
E's (2)
203:3,9
Esmeralda (2)
132:4;186:19
especially (5)
36:22;74:22;98:3;
99:12;145:22
essence (1)
235:21
essential (1)
156:10
essentially (8)
9:9;36:11;38:23;
110:3;123:20;126:7;
145:6,22
establish (1)
81:9
established (3)
108:11;136:15;
202:7
establishing (1)
194:12
Estimate (3)
61:2,3,8
et (1)
130:24
evaluate (14)
29:1;31:1,2,21;
32:8,9,24;35:19;
37:11,12;41:15;
188:19;256:9;266:7
evaluated (1)
124:5
evaluating (3)
32:13,22;105:5
evaluation (24)
28:24;29:17;30:12;
31:11,24;32:2,4,15,
16;34:17,18;35:2;
37:9,16;43:4;47:1;
173:3;261:24;
262:10;263:21;
264:5,7,9;272:2
evaluations (1)
42:5
even (38)
22:2,3;35:20;
41:11;69:18;75:1;
86:6,9;94:12,24;
97:12;98:10,15;
100:9;132:9;141:13,
18;142:22;147:7;
156:14;166:5,13;
171:19;176:11;
184:13;195:12;
203:20;204:21;
206:5,17;208:13;
222:1;227:1;235:13;
269:21,24;271:13,13
evening (1)
34:15
event (3)
54:21,23;190:11
events (1)
66:12
eventually (2)
190:13;267:13
everybody (24)
11:2;17:8;23:15;
39:18;40:7;45:5;
53:7;57:21;60:9,10;
65:10;72:7;83:24;
97:7;111:6;127:11;
193:6,22;212:16;
215:13;236:1;
257:21,24;259:1
everybody's (4)
39:19;46:20;48:12;
185:7
everyday (2)
52:17;211:1
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41:22;44:15;113:8;
151:8;166:14;
189:11;253:18;
259:18;263:18
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94:6
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154:3;202:1;
205:14,23;223:13
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217:24
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219:10;241:11
evolution (1)
197:3
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163:12;197:3
evolved (1)
197:3
Ewing-Taylor (60)
5:7,8;26:14,16;
36:1,4,6,17;40:21;
84:1,4,9,16,19;96:11;
97:21;99:15;106:19;
107:9;133:6,15,17,
19,23;134:3,7;
138:17;139:20;
140:3,9,14,17,21;
141:22;142:1,4,7,15,
17;143:1,8,10,13,15;
144:4,8,15,20,24;
145:6,20;146:2;
237:9,11,14,18,20;
238:4;264:10,16
(12) e-mail - Ewing-Taylor
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
exact (1)
233:16
exactly (7)
24:16;32:21;45:19;
209:22;211:8;
240:21;255:22
exam (3)
69:16,20;227:19
example (21)
8:24;67:20;69:16;
70:24;79:12;81:14,
18;88:7,8;113:20;
125:7;126:11;
136:18;148:17,20;
208:7;209:15;
225:24;248:19;
250:24;265:12
examples (6)
113:12;114:3;
163:23;166:15;
202:13;207:23
exceed (1)
47:12
Excellence (16)
121:1,5;134:17,20;
169:5,9;171:9,10;
173:21;177:23;
178:6;209:13;
214:10,17;246:12;
250:5
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36:10;272:11
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251:1
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32:11
Exchange (20)
6:18,19;7:7,8,16,
17;9:22;11:9;15:13;
16:24;17:13;18:6,8;
19:3;45:11;53:4,12;
109:8,10;225:18
excited (4)
57:2;75:4;184:6;
225:24
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140:20;237:2
exclusive (6)
110:6;112:6;
120:22;224:6,13,14
Excuse (9)
21:10;42:12;48:4,
20;117:4;201:5;
227:24;269:2,4
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5:13,16,20
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77:9
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77:10
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31:16;182:9
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167:20
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111:11;195:18
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238:20
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251:17
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38:9
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224:13;225:12,19;
230:22
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59:24;247:16
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188:14
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225:17
expect (3)
36:19;42:9;212:13
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40:24;41:1,9,11;
46:8
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36:18,20;38:6;42:3
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260:17
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121:5;135:22;
136:21;137:5;161:3;
196:14
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22:22;228:11;
252:19
experience (30)
12:22;53:1;103:23;
123:13;124:4;125:1;
144:23;149:16;
153:8;157:3;160:3;
178:24;179:2,2,11;
180:8,9,9;182:5;
187:9;190:7;201:22;
202:14,15,17;205:8;
231:14,20;241:7;
262:19
experienced (2)
204:23;205:4
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6:18;113:16
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205:12
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29:4,6;161:19;
199:22
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29:1;74:1;142:22;
198:16
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28:12
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28:14
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117:17;121:11;
210:13;241:4
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80:21
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20:3,4
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216:22
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249:2
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7:10;214:19
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7:20
Extend (4)
7:7,16;86:14;223:5
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173:24;269:7
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82:24;242:8;
243:23
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10:11,15,15;58:17;
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78:11,11
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46:10
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40:18;69:16,17;
273:6
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113:24
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198:22;201:13,15;
207:24;209:1
F
face (11)
102:6,24;160:13;
171:2;196:7;198:12;
216:18,19;220:12;
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10:9;55:21;56:1;
240:24
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209:14;247:14
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102:24;108:24;
131:20;132:12;
133:8;140:7;215:15,
16;217:2;223:4;
224:16;227:13;
234:9,10;236:6;
246:21,21,22
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16:12,13,14;61:9;
68:1;102:16,19;
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Capitol Reporters
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6:20;9:22;16:14;
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153:2;159:7;164:18;
170:11;189:18;
192:12;213:3;225:3;
271:4
factor (2)
47:17;195:14
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182:19;262:18
fair (7)
35:1;70:20,21;
109:7;123:16;
152:19;269:13
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44:10;82:21;
237:14;249:19
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38:5
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66:14;70:20
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117:24
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73:4
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112:13;121:4;
250:5,7
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112:18;134:19;
137:1,3,7,8,12;167:1;
168:21;202:24;
203:13;204:24;
206:15;209:19;
210:4,24;211:9;
215:11;250:10,11;
251:12
Fantastic (3)
50:15;198:6;217:1
far (19)
20:17;22:17;42:22;
58:4;59:4;64:15;
79:13;96:22;98:19;
114:11;121:2;
188:10;198:22;
218:13;219:23;
229:15;243:17;
244:24;263:5
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223:22
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224:23
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179:21
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26:21,22
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62:19;170:19
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61:23
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122:17
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127:13
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68:4,14;112:6;
152:22
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105:6;113:7
federal (3)
122:22;131:11;
172:1
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122:17;165:17
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136:22;146:14,15,
17;185:4
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57:18
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38:8,9;48:15;51:7;
80:22;151:7;160:23;
161:1,9;185:12;
187:13;252:1
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23:6;116:18
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137:19
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52:16
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39:6
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32:22;57:22;64:19;
171:22;172:1;207:7;
230:14
female (1)
62:12
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52:23
few (15)
63:18;93:24;98:23;
110:11;112:16;
113:12;115:4;
124:24;163:20,23;
168:5;172:16;177:3;
229:5,11
fewer (3)
58:6;113:5;132:23
field (2)
8:4;29:1
fields (1)
24:18
figure (19)
38:16;39:1,2;
(13) exact - figure
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
46:22;53:9,22;54:16;
83:4;95:7;116:2;
140:15;177:14;
236:17,20;237:1;
255:21;256:7,12;
262:13
figured (2)
15:15,24
figuring (1)
183:23
file (2)
214:3,6
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236:13;239:10,15
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34:22
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239:8
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15:3;79:8;149:9;
241:19
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79:18
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29:18,24;89:11;
143:1;188:24;269:11
finalist (2)
29:8;220:10
finally (6)
10:18;11:4;54:18;
114:22;118:3;166:22
financial (9)
22:18;71:4,5;
74:18;108:2;109:19;
114:23;149:2;161:19
financially (2)
110:4;159:6
find (16)
15:2;18:7;33:14;
46:17,18;73:23;
93:16;96:17;99:1;
102:19,20;105:24;
130:3;148:7;174:5;
180:12
findings (1)
176:3
fine (7)
35:17;106:5;
201:14;259:13;
263:3,16;268:24
fingerprints (1)
60:9
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60:16;61:16;
205:22
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220:4
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16:17
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210:10,14,15,16
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210:16
Min-U-Script®
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126:10
first (36)
8:7,17;11:12;
27:12;30:5;31:14;
35:20;38:22;40:6;
43:2;44:13;50:17,18;
53:8;58:10;64:23;
87:2;96:21,22;99:11;
108:17;120:6;
130:16;163:15;
168:6;172:19;
184:19;207:24;
210:11;215:8;
244:12;255:16,16;
257:9;259:23;263:12
fit (1)
38:13
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56:20;202:4;
223:10
five (26)
12:1;13:2,18;15:4;
16:20;34:13,22;
37:12;40:5;44:2;
47:12;48:6;74:15;
94:11;109:4;125:9;
133:13;139:3,16;
147:13;150:6;
227:12;265:13;
269:23,24,24
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48:3;49:20;109:18;
183:11
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149:10
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127:2
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144:18
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53:18;90:14
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101:20;110:23;
111:18;123:19;
172:11;200:8;
229:19;250:18
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101:11,17;149:5
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38:1;83:16
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215:20
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264:4
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9:4;51:10;73:23;
105:1;110:12;
111:21;118:19;
168:11,17;170:9;
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59:15;110:5;
124:12;226:4
folk (1)
23:18
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48:13;50:11;52:21;
54:8;55:5;63:2;65:3,
20;66:4;74:11;76:6,
22;86:17;89:7;
101:15;105:19;
128:22;136:5;
155:22;234:4;
256:17;270:5
follow (5)
56:16;59:14;
160:24;203:7;229:7
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19:6;39:19;104:14;
142:14
follow-up (13)
101:8;131:15;
132:24;133:6;
137:15;141:22;
149:1;186:8;203:8;
227:5;237:9;238:23;
242:4
Food (2)
55:1,2
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117:4
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200:1;224:11
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92:8
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174:20
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154:12
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168:6
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18:21,23;49:20;
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194:12
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17:4
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72:16;96:13;
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96:19,22,24,24;
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5,6,6,7,10,10,11,18;
142:13,19
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165:21;167:22,23;
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108:3
Found (4)
14:1;208:11;210:6;
218:5
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211:15
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12:1;27:2;28:24;
29:1,8,14;32:6,11,23;
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127:21;132:2;
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17:14
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77:6;82:6,22;96:23;
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197:20
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111:5;161:14;
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190:16;212:3;232:22
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G
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125:11,17;216:1;
226:23
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5:18,19,23;6:2;
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40:16;44:13;92:19;
106:5;129:2;134:11,
(14) figured - Garcia
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
11,22;135:2;191:7;
243:13,14;244:13;
245:7,14,24;246:4;
248:4,12,15;249:3;
269:2,4,5;270:7,9
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220:17
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199:1
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92:10
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159:7
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23:6
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187:23
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198:6,21;220:3;
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233:19;234:1;240:6;
242:8;243:20;
245:23;246:1;247:8;
248:14,16;249:9,11,
16,19,24;250:13,16;
251:19;252:5,21;
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215:9
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89:18;101:18;
184:2;198:23;224:1;
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198:3
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88:23;104:15;
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110:7,10;111:2,3;
126:5;134:8;148:20;
164:16;182:4;
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196:22,24;197:16;
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64:13;65:14;68:4,14;
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144:24;158:6;159:8;
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handled (1)
112:3
hands-on (1)
174:12
hangs (1)
117:21
happen (13)
11:3;22:18;29:16;
30:18;31:8;38:4;
44:18;119:3;167:7;
206:11;233:15;
251:7;263:6
happened (6)
25:1;35:23;104:6;
115:5;203:3;206:7
happening (4)
21:23;202:23;
203:2;206:4
happens (8)
17:22;69:4;72:3;
104:7;123:24;
148:16;253:1;263:12
happy (20)
25:24;33:21;46:18;
51:8;58:5;63:21;
76:14;124:16;149:8;
159:22;160:13;
172:22,23;173:13,15;
176:3,15;189:15;
191:14;194:4
hard (12)
25:21;34:18;35:3;
82:17;91:14;93:14;
113:13;159:16;
173:10;243:9;271:1;
272:21
hardly (1)
36:10
HARRIS (12)
6:10,12,14,16;
18:18;19:22,22,24;
20:8,23;21:5,7
hate (3)
82:10;99:10;
262:24
haul (1)
76:12
Hawthorne (1)
132:19
Haycock (28)
28:8;31:13,13;
47:5,7,7,12,14;48:18;
49:5,6;50:7;259:14,
16,16;263:17,18;
264:3,12,19;265:23;
266:1,1;267:11,11,
20;268:13,22
HCA (2)
234:9,10
HD (13)
136:18,19;138:22,
24;139:2,2,3,3,6,14,
15,15,16
head (11)
64:12;94:2;127:18;
144:6;157:4;181:14,
19;228:1,3;254:23;
272:20
heading (1)
153:18
headquartered (2)
229:18;233:20
Health (245)
7:7;23:24;24:5;
27:5,5;28:10,10,12,
13;29:12,14;30:13;
35:6;37:14;41:14;
44:17;51:15;53:4;
54:15,22;55:4,6;57:4,
12;58:10,14,15,24;
(15) Garofalo - Health
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
59:2;60:7;61:6;62:1,
3;63:12,23,24;64:2,
24;65:5;66:13,14,14;
68:24;69:6,7,10,20,
22;70:15,20,20,21;
73:14,15;75:10,20,
22,24;76:1,9;83:11,
15;86:4;95:20,23;
96:4,5,6,7;107:19;
108:9,11,12,13,14,
24;109:4,14;110:2,4,
17;112:7,19,23;
113:2,8,10,23;114:1,
5,13;115:19;118:15,
22;119:2,8,9,11,11;
120:11,15;121:7,9;
122:2,10,18;123:4,5,
12,17;124:3;126:2,
21;127:13;131:2;
133:21;135:17;
141:14;145:4;
149:19,22;150:5;
152:18;155:15;
157:16;158:11,11,13,
19,24;159:2,8,12,20,
21,24;162:1,3,13,14,
22;163:8,18;164:11,
12,13,17,23,23;
165:7,14,17;166:8,8,
16,22,23;167:7,16,
21;171:5,15,16;
177:14,18;183:15,20;
188:2,14;189:4,4,7,9,
10,12,17,18;190:7;
192:9,14,16;194:7;
196:10;199:23;
200:12;201:4,7,9,22;
203:12,24;204:1,2,4,
8,10,12;205:9;206:9,
16;207:5;210:7,10,
14;212:19,21,21;
218:11,15;219:13,23;
220:9;221:7,11,14;
222:11,11,13,15,17;
223:15;224:23;
225:2,4,7,14;226:2;
231:10;233:19;
234:12,14;235:2,3,6,
7,8,12,13,17;238:16,
18;249:11;261:3,4;
265:12
Healthcare (8)
32:13;198:13,22;
209:11;218:11;
222:1;234:8;246:9
Healthcare's (1)
222:2
healthier (8)
65:12;70:22;71:11;
165:13;166:14;
167:19;174:21;219:9
Health's (2)
30:20;158:12
Min-U-Script®
healthy (17)
45:19;46:1;56:17;
65:3;66:9;96:7;
162:10,10,18;163:12;
164:16;165:18,20;
174:17;177:6;185:3;
219:9
hear (20)
11:19;23:10;25:11;
42:22;43:1;44:23;
45:3;46:20,21;48:3,
15;50:9;72:8;75:7,
16;136:11;190:19;
200:22;209:24;210:1
heard (22)
37:15;44:22;46:16;
76:1,2;106:15;
108:17;128:23;
133:11,11;163:24;
175:3;183:14;192:8;
195:9;207:4;223:12;
255:22;258:6;260:9;
267:21;268:17
hearing (2)
106:23;184:1
hears (1)
241:20
heart (6)
67:5;95:20;162:9;
176:11;186:12;251:2
heavily (1)
167:4
HEDIS (2)
207:3,3
held (2)
18:21;23:12
helicopter (2)
102:18,18
hello (1)
117:16
help (45)
10:10;16:7;26:6;
54:17;56:23;69:23;
71:10;74:21;88:12;
89:12;93:18,18,21;
96:15;113:1,3,23;
114:1,16,17,19;
118:11,17;141:1,21;
164:7;165:19;167:2;
170:8;178:7,15;
201:8,9;203:9,13,19;
205:7,7;211:11;
219:20;220:1;
224:22;260:17;
268:19;272:19
helpful (3)
15:18;81:16;157:3
helping (7)
53:6;57:12;58:13;
66:10;83:15;162:18;
164:21
helps (8)
56:22;69:15;70:15,
16;71:10,23;89:1;
117:17
hematoma (1)
174:4
Henderson (2)
56:3;109:5
here's (15)
66:12,12;81:2,22;
96:1;97:13;103:2,2,3,
4;105:23;106:10;
115:15;255:8,17
Heroes (1)
54:23
hesitant (1)
114:21
hey (4)
58:16;105:17;
116:6,17
HHP (1)
267:4
Hi (1)
134:11
high (39)
35:18;54:2;68:18;
70:12;98:3,6;110:16;
115:21;121:3;
123:21;125:9;135:4,
9,17;136:24;137:20,
24;138:2,7,18,19;
139:12;151:10;
152:12,17,20;164:19,
21;181:15;189:13;
203:16;207:9,23;
208:4;224:16;243:2,
4;244:6;246:21
higher (14)
29:11,15;57:23;
138:13;153:22;
154:5;178:21;179:3,
4,12;181:18;187:5;
217:5;232:10
highest (1)
224:17
highlight (3)
113:13;168:5;
214:9
highlights (4)
108:8,8;110:11;
224:2
highly (3)
112:11;155:16;
238:18
Hill (2)
133:20,22
hindrances (1)
75:14
HIPAA (1)
22:19
hired (3)
24:15;215:3;216:6
hiring (1)
126:9
historically (2)
Capitol Reporters
775-882-5322
35:23;104:4
history (5)
70:10;108:16;
127:11;163:19;221:1
Hit (3)
6:10,13;190:23
HMO (105)
28:11,18,21;30:12;
32:17;38:17;41:5;
43:21;46:9;48:13;
52:11;54:2;63:8;
66:19,20;67:15;68:8,
9,10,11,12,13,15,18,
22,22;74:23;75:2,21;
87:11,11,22;89:3,14,
15,17,22,23,24;
90:13,19;91:3,9,13;
93:12;96:8;109:6;
110:16;111:10,11;
135:4,6,7,10,20;
136:19,20,24;137:17;
138:2,6,7;140:1;
152:13,17;153:16;
155:3,3,19;156:4;
159:19;169:6,11,15;
171:19;172:19;
174:18;179:3;
180:23;181:5;
186:14,17,19,21;
187:5;195:9;198:10;
212:22;213:10;
220:10;224:9;
229:10,11,15;230:6,
19;231:5;233:8,9;
235:18;237:22;
255:11;267:13,15,16
HMO's (11)
30:17;39:1;49:8;
66:22;67:15;75:11;
89:16;91:16;172:8;
264:9;266:11
hockey (2)
117:4,6
hold (12)
15:24;16:5;19:15,
15;25:16;30:7;34:3;
43:11;136:4;186:5;
213:12;240:16
hole (1)
38:13
holiday (1)
273:7
home (26)
11:2;23:15;32:24;
57:3;68:10,11,17,20;
69:9;79:23;114:24;
159:9;202:6,7,8;
205:10,21;206:6;
216:21;217:16;
218:22;244:15,18;
245:5;263:18;273:2
homes (1)
59:7
Hometown (41)
23:24;24:5,8;27:5;
28:10,13;29:12,14;
30:13,20;32:14;35:6;
37:13;41:14;44:17;
48:22;49:2;50:4;
158:11,12,19;159:8,
12,20,21;160:4;
168:6;171:5,15,16;
172:18;177:14,18;
179:2;188:14;189:4,
7,15,17;260:23;261:2
Hometown's (2)
30:24;34:24
homework (1)
269:17
hone (1)
73:23
honest (2)
33:22;38:21
Honestly (2)
231:5;242:16
honey's (1)
174:9
honor (1)
142:11
honored (2)
162:1,1
hook (2)
68:7,9
hope (5)
21:22;78:11;89:4;
244:11,11
Hopefully (8)
6:7;62:6;75:7,16;
220:12;221:4;223:9;
260:13
Hospital (53)
22:2,2,10,16,20;
24:10,15;25:1,3,7,8,
16;56:8,11;78:4;
79:3,15;81:15;84:10;
87:17;94:5;109:3;
129:8;131:22,23;
132:10;137:4;153:4,
14,15;164:14,15;
167:12;171:8;174:5;
177:22;183:10,18,22;
187:14,14;193:23;
203:4;205:20;
211:23,24;213:19;
233:12,17;234:23;
237:4,16;239:14
hospitalist (2)
24:14,17
hospitalists (1)
25:13
hospitalization (2)
202:15;206:3
hospitals (38)
22:7,15;52:8;56:7,
13;77:18,19,22,23;
84:6;87:6;88:9;93:9,
(16) Healthcare - hospitals
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
23,24;95:14;108:23;
109:2,4;120:13,14;
122:24;129:22;
131:16;133:10;
136:21;150:6;153:5;
163:6;166:8;194:8,9,
11;205:18;233:22;
234:11,17;248:18
host (4)
68:8;102:4,5,6
hotline (2)
121:24;173:23
hotspot (1)
57:14
hotspots (1)
105:10
hour (4)
15:7;107:6;186:1,1
hourly (1)
170:10
hours (8)
9:19;12:1,1;76:6;
86:14;126:22;127:5;
216:3
house (3)
15:23;23:18;
210:16
housed (1)
215:12
HPN (29)
50:5;198:11,12,12;
199:10,11;201:6;
227:2;231:5;233:18;
234:11,15,20,21,22;
237:16;238:12,13,15;
239:13,15;251:3;
257:9;260:9;261:9;
266:24;267:3,24;
269:7
HR (1)
72:21
HRA (3)
13:13,16;14:4
huge (1)
225:20
Humana (1)
19:13
humbled (1)
57:19
Humboldt (6)
94:3;131:18,20;
140:7;153:12;235:6
hundreds (1)
188:9
hung (1)
118:4
hunker (1)
39:9
hurts (1)
165:5
husband (3)
95:20;174:3;
241:15
Min-U-Script®
hypotheticals (2)
45:4,5
121:14;130:2,4,10;
162:5,11;163:8,11;
166:24;168:12,15,18,
I
19,22;184:4,18;
201:3;204:13;207:8;
212:23;220:24;272:9
IBM (2)
importantly (5)
54:14,15
41:12;164:9,9;
ID (12)
166:5;222:20
61:20,22,22;86:4;
114:7,9,14,22;115:2, impress (1)
221:6
15;126:23;170:18
impression (1)
idea (5)
30:10
71:15;79:24;
121:14;189:5;256:6 impressive (1)
115:18
identified (5)
improve (1)
177:20;184:19,20;
58:11
202:9;217:12
improvements (2)
identify (5)
177:19;199:16
50:16;56:22;
125:11;126:8;216:2 improves (1)
120:1
ill (3)
in-between (2)
56:18;162:16;
44:1;172:10
167:13
inbound (2)
illness (1)
114:4;119:17
125:8
incentive (4)
illnesses (2)
65:23,24;66:5,16
172:21;192:4
incentives (4)
imagine (2)
66:1;68:20,21;
126:23;166:10
92:12
imaging (1)
incentivized (1)
175:11
58:19
imbedded (1)
inclined (1)
96:8
176:20
immediate (5)
include (7)
125:22;140:6;
144:21;164:3;
198:24;205:11;
166:16;239:23;
206:18
248:7,17;254:10
immediately (2)
included (16)
25:1,4
8:12;62:1;81:21;
immunization (3)
82:18;87:8;137:19;
208:2;228:2,3
143:22,24,24;144:13,
impact (4)
16,21;174:21;185:5,
111:4;112:9;179:9;
6;249:17
202:17
includes (4)
impactful (1)
115:21;120:1;
120:17
221:18;267:13
implementation (3)
including (9)
29:6;107:24;128:7
24:4;116:12;
implemented (2)
159:18;160:6;165:9,
82:13,14
17;166:6;178:6;
implication (1)
263:10
208:21
incorrectly (1)
implies (1)
271:20
91:15
increase (4)
importance (1)
65:3;66:9;141:6;
206:21
226:3
important (44)
increased (1)
25:18;35:5;46:9,
178:19
10;47:10;52:5,12;
53:13;54:5,19;71:17, increases (1)
111:5
18;72:5;74:18;75:18,
incredible (2)
24;76:10;95:10;
37:21;218:2
99:12,14,23;118:20;
Capitol Reporters
775-882-5322
incumbent (1)
148:7
incumbents (1)
267:9
incurred (2)
232:5,6
incurring (1)
137:4
indemnity (3)
135:16,20;152:20
independent (1)
189:23
India (1)
122:18
indicate (2)
84:10;133:10
indicated (1)
84:5
indicators (2)
207:5,13
indigent (1)
166:17
individual (18)
16:8,18;52:24;
122:5,9,12,16;124:9,
12;130:5,9;131:10;
135:1;137:4;160:9,
14;227:5;265:16
individualizing (1)
130:8
individually (1)
196:11
individuals (23)
12:23;168:13,14;
169:3,6,13,16,19,24;
170:1,3,21;171:16,
19;172:8,9;177:24;
178:3;185:20;186:2,
3,20;196:15
infamy (1)
23:8
inflame (1)
46:5
inflammatory (1)
38:14
influence (2)
58:15;265:11
information (36)
8:17;9:11,12;
13:20,24;15:3,5;
18:9;30:24;37:20;
41:10;48:15;57:13,
15;58:1,2;60:16;
98:17;112:21;
113:22;114:8,12;
116:12;168:5;
170:16;176:5;
191:11,15;193:4;
205:12;243:22;
254:11;256:15;
257:1;271:18,18
informative (1)
9:16
informed (5)
48:22,24;49:2;
113:3,4
infrastructure (4)
166:5;200:2;
214:15;222:19
inhouse (1)
129:16
in-house (1)
129:20
initial (4)
106:19;180:1;
243:20;252:5
initially (2)
105:1;252:7
initiative (1)
57:3
injured (1)
162:17
in-network (14)
78:5;79:11,15;
88:21;89:1,16;90:5,
11;102:18;133:2,3;
136:20;180:23;181:6
innovating (1)
218:14
innovation (6)
60:17;200:24;
211:4;218:11,14;
224:20
innovations (1)
243:16
innovative (6)
65:7;112:6,12;
161:1;200:5;208:1
inpatient (5)
58:7;61:13;120:13;
187:14;201:19
input (1)
30:13
instance (4)
54:13;83:14;
131:17;236:9
in-state (1)
17:16
instead (3)
58:12;113:9;150:6
Institute (3)
164:11,13,17
instructed (1)
37:13
insufficient (1)
13:19
insulin (1)
24:22
insurance (16)
22:16;25:17;27:14;
53:4;114:7;119:22;
124:10;159:1,2;
196:16;207:6;210:7,
10,14;215:4;225:14
insurances (1)
221:15
(17) host - insurances
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
insure (1)
93:8
insured (5)
53:2;112:20;
118:13;188:22;
212:21
insurers (1)
87:2
integral (1)
53:8
integrated (5)
189:12;200:20;
201:12;226:22,23
integration (4)
112:11;199:21;
200:14,19
intended (2)
30:2;208:18
intent (1)
47:15
intention (1)
253:8
interact (5)
55:18;83:18;
122:10;173:24;225:1
interaction (3)
62:17;116:14;
119:12
interactive (2)
58:2;62:4
interest (8)
35:17,23;44:15;
155:17;205:7;
250:19,21;266:8
interested (3)
73:13;125:8;214:4
interesting (3)
150:11;160:16,19
Interestingly (1)
158:24
interference (1)
222:23
interim (1)
7:19
internet (2)
17:19;85:5
internists (1)
24:15
internships (1)
226:2
intertribal (1)
16:15
interventions (1)
204:13
interview (2)
16:10;126:15
into (67)
8:13;9:15;11:7,14,
21;16:12,13;22:20;
23:18;24:12;36:7;
37:1;48:23;55:5;
59:21;60:14;62:13,
15;63:7;67:14;68:22;
Min-U-Script®
72:24;73:12,15,20;
76:19;79:6;93:3,5,6;
95:13,13;96:8,8;
102:9;103:22;110:6;
137:4;146:13;149:2,
11,14;153:19;154:1;
158:18;159:8;
161:14;163:20;
168:16;169:19;
175:7;180:6;181:11;
182:17;193:22;
194:8,8;203:21;
214:16;219:16;
228:13;253:20,24,24;
254:23;265:17;
272:17
introduce (2)
107:14;198:15
introduced (5)
7:3;119:2;120:9;
215:21;218:23
introduces (1)
115:12
introducing (1)
55:4
introduction (4)
28:6,8;108:6;
158:15
invaluable (1)
214:19
invest (3)
222:8,18;224:21
invested (3)
65:5;166:16;
227:16
investing (1)
167:4
investment (2)
162:19;252:21
investments (2)
57:8;166:6
invite (2)
223:5,5
involved (13)
10:8;12:24;13:2;
17:21;23:22;36:10;
76:8;93:23;113:21;
135:22;152:19;
220:13;222:3
involvement (2)
33:9;46:15
iPhone (1)
116:7
issue (19)
10:3;33:11;38:16;
55:19;70:23;72:22;
73:21;74:1;85:24;
98:22;101:16;104:3;
116:20;124:9;156:5,
6;164:12;183:10;
197:7
issued (1)
248:16
issues (21)
14:10;38:16,24;
71:1,24;73:3;76:4,
15;89:10;106:12;
113:1;126:23;
128:16;148:15;
165:11;175:21;
195:21;213:6;
256:18;262:7;269:11
Item (4)
26:12;27:2;269:23;
271:3
items (4)
28:7;42:2;110:12;
244:16
76:20,23;84:2;85:10;
24;116:20;118:14;
106:18;124:22,23;
127:1;136:9;154:9;
138:16;145:2;
155:24;182:12;
176:21,24;229:1,2;
190:4;195:11,21;
249:5;256:16;261:1;
196:1;202:11;203:2;
270:17
207:22;210:12;
Judy's (2)
212:11,18;214:8;
44:14;133:7
219:9,11;223:12;
July (1)
228:14,22;243:7;
43:19
245:18;251:9;
June (7)
259:17;261:14
28:12,14;43:10;
kinds (3)
108:12,14,19;109:21
64:13;101:18;
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194:13
89:4
kink (1)
40:16
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kiosks (2)
64:7;86:12
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Jack (3)
Kari (2)
61:7
6:16;19:22,23
5:6;255:15
knew (5)
Jacque (8)
Kathleen (1)
116:8;239:23;
5:7;37:18;42:19,
18:12
251:6;252:12;253:9
21;44:22;96:10;
keep (18)
knowledge (4)
139:19;254:13
14:24;16:15;40:17;
9:9;160:4;193:13;
January (17)
44:1;56:23;65:8;
272:23
43:2;44:5,7;
72:23;76:7;81:3;
142:13,14;226:9,10;
89:9;109:14;115:19; known (7)
91:17;108:12,16;
227:18;251:22;
155:17;176:20;
122:5;163:18;213:8;
255:16;257:3;
236:11;253:13;
219:14
259:24;263:2,5;
254:9;273:6
knows (6)
266:17;270:1;271:16 keeping (2)
49:2;53:7;72:2,2;
Jeff (2)
149:3;193:12
157:2;272:21
5:20;47:8
Kentucky (2)
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102:5,5
114:24
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178:24;179:11
5:16
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job (13)
29:6;73:21,22;
120:14
14:19;37:10,10,14,
109:2;161:16
labs (2)
17;38:6;46:6;93:7;
keys (1)
181:10;243:6
174:23;193:6;271:1,
200:19
lack (4)
22;272:8
kicking (1)
23:6;37:2;101:21;
jobs (1)
136:17
188:1
36:23
kid (4)
lactation (3)
John (1)
251:1,4,6,7
204:11,18,20
193:19
kids (8)
lady (2)
join (2)
60:14,23;61:21;
14:18;16:1
6:7;23:1
68:4,6;164:14,16;
lag (1)
Joining (1)
165:1
231:24
198:20
kill (1)
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joins (1)
241:20
77:4,22
199:3
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Lake (4)
Jones (1)
198:24;224:2;
10:13;14:18;15:17;
62:18
226:5
134:21
journalism (1)
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Land (2)
164:5
6:24;9:11,20;
60:22;67:21
journey (1)
12:10;24:16;36:12;
landscape (1)
273:2
48:11;57:9,10,11;
163:9
Judy (30)
64:22;66:4,17;74:2; language (1)
5:14;18:19,20;
81:20;82:15;85:7;
254:5
27:13;30:8,9;32:10;
89:9;91:16;98:6,9;
large (13)
33:19;36:22;37:18;
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23:19;52:24;53:19;
42:1;44:22;46:23;
111:15;113:9,13,13,
65:17;96:24;102:1;
Capitol Reporters
775-882-5322
(18) insure - large
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
108:22;150:20;
151:11;159:14;
189:3,18;237:14
largely (2)
197:24;198:2
larger (5)
54:10;149:18;
188:7;200:1;253:2
largest (6)
52:15;94:8;109:4;
147:15;214:13;222:9
Las (33)
5:17,18;8:23;9:1;
11:11;12:15;30:5;
52:20;54:22;55:17;
56:3;65:19;71:19,21;
73:9;109:4;127:17;
128:22;150:21;
153:9,12;187:19;
209:5;223:3;229:18,
24;234:10;245:18;
246:23,24;247:3,24;
253:3
last (36)
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16;13:14;23:5;24:4,
8;39:19;47:8;48:11;
59:11;68:16;99:3;
108:19;116:13;
159:20;162:2;171:5;
173:2;174:1;175:3;
196:13;215:14,22;
217:19;218:23;
219:11;220:3;
226:14;227:15;
228:24;246:2;254:6,
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59:17;62:21
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226:6
late (1)
257:22
lately (1)
245:15
later (7)
13:19;25:7;51:7;
76:5;208:6;209:23;
242:12
launch (2)
244:12;254:8
launched (8)
120:6;217:19;
219:6;223:15;226:8,
13;227:22;254:6
lay (2)
104:15,18
lead (5)
44:2;59:5;119:24;
162:1;180:14
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131:4
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74:7,8,11;165:22;
198:17;220:23;
223:9,19,24
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203:13
Lear (2)
21:18;270:11
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126:14
learning (1)
58:1
least (18)
12:20;33:2;41:14;
42:9,10,15;44:4;
45:3;46:13;48:10;
123:13;141:14;
190:4,8;201:18;
219:15;220:21;
264:24
Leatherwood (47)
107:21;131:19;
132:18,21;133:14,16,
18,21;134:2,6,17,24;
135:7,11;136:18;
137:18,22;138:14,22;
139:9,14;140:1,5,16,
19;143:6,9,12,18;
144:10,22;145:13;
146:19;147:2,12;
150:4,22;151:6,14,
19,22;152:1,4,10;
153:11;154:15;
155:10
leave (8)
15:20;27:10;127:8;
216:21;247:3,5;
255:2;257:7
leaving (3)
175:9;267:16;
268:10
leeway (1)
12:18
left (9)
16:1;24:13;25:13;
185:12;198:20;
227:16;233:7;255:1;
270:14
leg (1)
118:1
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7:15,20;172:1;
254:4
Legislature (1)
23:4
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113:24
Leo (4)
47:5;83:7;154:22,
24
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13:23;67:20;97:9;
137:17;147:2;
165:14;170:12;
186:5;188:10;
197:17;227:13
letter (2)
30:22;41:16
letting (1)
236:1
level (38)
11:9;32:7;33:8,14;
34:2;35:16,20,23;
37:2;38:22;39:20;
40:5;41:1;49:22;
57:23;76:3;91:7;
120:2;125:22;
130:23;131:7;148:9;
152:8;153:3,11;
167:14;172:5;179:6;
183:19;193:24;
217:4,6,15;224:17;
232:10;243:4;244:6;
246:21
levels (6)
67:19;81:24;90:4;
125:21;189:13;
192:11
leverage (1)
188:11
leveraging (2)
223:10;225:5
license (2)
186:19;249:12
licensed (5)
63:14,16;191:20,
23;249:14
life (16)
69:2;114:19;
166:14;167:19;
208:6;231:10;
233:19;234:12,14;
235:2,3,6,7,8,13;
238:16
lifestyle (1)
96:7
light (1)
197:12
lightest (1)
209:16
likely (2)
76:21;204:9
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72:7,8
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110:1;169:2
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43:23;63:20;
236:12
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186:20
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8:8,8,9,9;41:13;
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115:11,12;195:5;
211:11;218:24;
219:2;220:4;245:4;
260:20
lines (3)
90:9;139:21;195:6
link (2)
245:8,11
linked (1)
209:11
Linking (2)
205:10;213:17
links (1)
245:12
Lisa (1)
108:3
list (20)
60:20;96:1;97:7,
13;98:2,11,12,22;
103:5;116:2,4;
131:19;133:7,20;
134:4,7;160:9,14;
235:16;238:8
listed (6)
27:4;143:16;
207:16;236:4;239:9;
270:17
listen (2)
15:5;113:14
listeners (1)
126:5
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13:11;114:5
literally (2)
63:19;104:13
literate (2)
164:22,23
little (43)
12:14;13:16;33:1;
48:5;51:20;53:3,17;
55:4,9,15;58:23;
63:20;65:13;74:12;
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87:22;95:18;96:3;
101:9;105:2;110:10;
114:21;121:21;
143:4;146:10;
152:18;158:18;
159:10;161:22;
162:24;167:20;
168:3;169:12;
191:11;194:6;195:5;
200:4;210:13;
211:13;239:1;259:17
Live (18)
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76:1;83:11,15;
165:13,13;166:14;
167:19;193:11;
219:9;226:10
liver (1)
250:6
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23:7;24:17;147:17;
162:18;219:9
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16:12,13,14;68:7;
162:18
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43:16
local (24)
52:19;53:18;55:2;
65:18;73:8;74:16,17;
102:22;112:1,2;
124:2;160:8;174:12,
15;184:21;191:21;
192:3;210:2;214:13;
218:12;222:6,8,24;
226:1
locally (8)
51:13;74:9;85:22;
102:23;112:3;
175:12;212:20;222:2
localness (1)
109:15
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55:16;90:23;126:1
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62:23;64:5,6,7;
132:5;199:6;253:9
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71:19;131:20
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121:6
log (1)
63:16
logic (2)
195:10,10
long (33)
42:8;43:14;68:3;
76:12;87:23;91:12;
98:17;100:19;118:9;
120:2;123:23;157:9;
158:8;160:9;165:6;
172:12;180:12;
182:13;183:11;
185:13;197:11;
198:11,11;202:10;
211:23;212:3;
216:18;219:1;220:5;
228:20;246:10;
255:5;257:11
longer (3)
36:3;97:5;203:7
longest (1)
176:12
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55:16;160:14
look (73)
23:16;25:11;31:6;
33:20;34:17;35:3;
(19) largely - look
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
47:14;51:13;52:5,14;
58:24;60:21,24;62:8,
11;64:14;70:12;
71:16;72:8,10;85:14,
15,17;98:22;99:23;
101:15;103:24;
105:17;111:13;
118:8,19;122:16;
123:13;142:21;
145:10;154:7;
156:22;165:20;
167:11,14,23;170:10,
16;172:3;173:4,20;
175:22;177:18;
179:24;181:18;
187:15,15;196:8;
202:16,16;214:5;
218:18;221:5;
230:14;232:15,17;
233:23;237:21;
252:18;256:11;
262:12,14,16,17;
263:8;266:2;267:10;
268:9
looked (19)
14:20;100:7;
142:20;155:2,2;
160:16;177:13;
188:14,16,17,19;
207:9;208:2,3,22;
215:1;227:11;
242:18,18
looking (51)
6:20;14:4,16,16;
20:18;25:11;30:23;
50:20;59:2;61:5;
73:18;102:2;114:12;
115:2,6;117:16;
118:5;119:7,20;
120:19;123:4,5;
126:5,16;133:7;
138:17;143:7,9,10,
13;144:19;145:3;
148:18;154:7;156:4;
169:21;175:16;
177:3;187:22;
203:24;207:14,18;
208:12;215:18;
243:8;264:23;267:3,
4,5,6;268:5
looks (12)
14:22;16:19;41:1;
64:9,14;72:9;113:11;
116:21;143:11;
183:23;184:9;212:3
loop (3)
20:21,21;253:13
loose (1)
106:18
lose (1)
260:18
losing (2)
114:24;116:20
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loss (6)
125:1;182:5;
231:14,15,20;232:24
lost (6)
61:21;136:7,8;
172:6;190:20;238:11
lot (84)
7:4,4;10:7,22;12:8,
9;17:12;37:19;40:23;
41:18;43:19;50:1;
51:17,18;52:18;58:1;
59:21,23;60:13,13;
61:11;65:17,17,18;
70:11,24,24;71:2,2;
73:14;74:19,21;76:1,
2;86:2;92:9,24;93:9,
9;94:7,23;102:20,24;
112:23;113:21;
118:19;125:18;
159:14;160:3,22;
162:24;171:7;
177:15;179:18;
180:6;181:16;
187:20;188:2,8;
189:20;192:20;
196:14;202:22;
205:5;210:8;211:20;
213:3,5,10;217:6;
218:12;219:15;
225:12;235:16,21;
236:6,10;237:3;
244:3;248:1;253:2;
255:5;256:16;260:19
lots (2)
74:3;255:6
Louisiana (1)
191:24
Louisville (1)
102:5
love (3)
108:19;226:17;
228:6
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203:1;204:24;
205:4
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257:10
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71:1
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58:6;76:3,3;89:10;
155:18;178:14;
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Lowe's (1)
112:15
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218:1
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131:21
M
machine (2)
79:21,22
Madam (1)
264:13
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257:6
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94:22;95:1,2;96:3;
114:10;115:16;
127:8;131:7;244:1
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72:24
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17:8;193:14
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11:22
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190:8
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222:6;225:3;265:10
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makes (10)
22:18;66:21;82:1;
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makeup (4)
33:7,8,17;110:21
making (14)
11:4,20;12:21;
18:1;48:16;58:12;
86:8;103:15;162:12;
163:20;164:21;
185:15;186:5;193:19
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62:11
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247:20,21
mammogram (1)
243:6
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57:21
manage (8)
74:21;97:17;
135:21;167:1,16;
218:9;220:1;253:22
managed (3)
97:3;189:13;
250:17
management (34)
51:3;56:18,18;
59:1;71:13,14;74:11;
85:21,23;88:11;
112:2;121:12;122:4,
5,6,11;123:6,8;
128:13;129:24;
161:19;167:2,5;
174:23;192:17;
199:22,23;200:14;
202:10;203:16;
206:22;247:11,14;
Capitol Reporters
775-882-5322
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72:13,16;122:12;
202:19;203:3,6;
206:23
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156:19;222:1
managing (5)
72:15;103:13;
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156:11
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118:23
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203:14
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82:16
many (53)
23:9;36:4;42:4;
46:18;47:11;53:18,
20;60:14;64:6,6;
65:20;67:8,8,8;
70:13;72:8;78:19;
82:16;88:9;101:24;
124:6;127:18;141:3;
157:14,18;158:21;
160:8,8;163:23;
164:13;174:20;
181:10,12;188:9;
195:19;197:4;
204:23;207:4;
213:20;220:14,14;
223:10;229:13,23;
231:8;241:13;
246:11,11,21;252:8;
262:13;263:15;
270:14
map (2)
218:19;227:12
March (2)
44:7,8
Marcus (6)
57:11;107:15,18;
110:14;111:1,22
Marilyn (1)
199:5
market (30)
52:11;95:12;103:3,
10,11;105:6;159:12;
175:9;176:12;178:6;
186:17;187:19,24;
188:4,5,12,19,21,21;
189:16,20;192:15,19;
196:24;197:1,12;
198:21;200:22;
226:22;253:7
marketing (5)
74:2,3;107:20;
199:1;244:11
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94:9,13,14;101:3;
160:6;175:8
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256:6
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35:22,22
marvelous (3)
37:14;271:21;
272:7
Mary (2)
116:6,10
Mary's (12)
22:1;78:7;108:12,
13,16;109:3,12,14;
129:6;133:16;
180:17;213:19
mass (1)
17:7
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71:2
massages (1)
66:16
masters (1)
131:2
match (1)
146:23
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221:5
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49:17
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208:12
matter (7)
27:17;73:12;74:1;
130:4;198:15;
214:23;261:16
matters (2)
124:8,12
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94:14;189:19
maximize (3)
205:7,8,9
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28:13,14;200:8
may (60)
18:9;24:19;44:9;
47:21;49:21;50:21;
51:21;52:20;54:14;
76:16,16;82:5,6;
88:3;89:12;93:22;
96:17;103:4,10,11;
122:5;127:13;130:6,
7,8;131:4,12;132:18;
137:3;142:24;
143:18;150:10;
163:23;164:13;
168:24;170:14;
171:24;185:20;
186:9;190:9,14;
194:21;206:3,11;
(20) looked - may
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
211:1;226:21;
230:21;236:7;
248:14;250:1,20,21;
262:4,8;264:1,20;
271:1,6,10,19
maybe (38)
7:16;11:17;18:22;
41:11;64:6,18;66:1;
70:7,16;72:3,22;
81:16;83:16;84:14;
101:9;103:3,21;
104:4;114:17,19;
146:24;147:1,1,23;
148:24;149:16;
151:4;153:17;
156:16;167:17,19;
180:15;195:19;
235:24;254:10;
255:16;262:10;266:2
Meadows (1)
165:18
meals (1)
121:6
mean (32)
33:4,11,12;38:15;
45:16;67:15;78:15;
84:12;90:22;92:8;
95:8,12;119:24;
149:6,6;150:18;
180:1,3;181:15;
190:3;235:11;
236:16,19;239:19;
242:2,16;245:16;
251:4;253:4;256:16;
265:10;268:10
meaning (3)
34:6;67:20;85:5
meaningful (1)
255:9
means (7)
137:10;165:23;
201:20,21;238:5;
243:15;265:2
meant (4)
28:19;202:2,3;
206:13
meantime (1)
15:12
measure (1)
245:17
measures (1)
207:10
meat (2)
104:5;272:14
mechanism (2)
75:19;92:13
mechanisms (1)
94:24
med (2)
64:8;81:11
Medicaid (13)
51:24,24;52:21;
221:19,20;225:17;
Min-U-Script®
226:14,15;227:23;
MEMBER (396)
244:4;252:7,23;
5:8,10,12,15,19,23;
254:8
6:2;18:20;19:10;
medical (48)
20:6;21:10,12;26:8,
21:23;55:24;57:3;
10,14,17;27:13,22,
58:5;59:6;68:17;
24;30:9,22;31:12;
69:1,3;70:2;78:7;
32:10,19;33:22,24;
94:3;99:4,5;108:1;
34:4,7,13;35:9,12;
109:1;112:2;122:4;
36:1,4,6,17,20;37:6,
126:18;133:14;
8,11;39:5,8,8;40:10,
137:5;148:21,22;
16,21;41:24;42:2;
158:12;173:12;
44:13;45:7,9,14,23;
202:6,7,8;205:10,15;
46:24;47:2,4,20;
206:24;208:21;
48:20,22;49:4;60:2,
209:3;211:18,19;
19;64:24;65:2,8;
214:21;215:1,8,23;
67:15;69:24;74:1;
216:1,24;217:14,16,
76:23;77:12,14;78:6,
20;242:7;247:10,14;
10,19,23;79:23;81:1,
250:17;253:22
6,11;83:7,22;84:1,4,
Medicare (15)
9,16,19,23;85:2,13;
6:18;8:24;13:16;
86:2;88:2,20;89:11;
17:3;18:22;19:2,24;
90:16,22;91:14;
23:1,1,8,13,18;52:23;
92:17,19,22;93:22;
109:10;221:22
94:20;95:10,17,24;
medication (4)
96:5,9,11;97:12,13,
96:1;165:5;174:24;
21;99:15;106:5,14,
217:23
19;112:8,18;115:12;
medications (4)
121:13;124:9,20,23;
95:22;96:1;98:3;
125:8,15,18;126:12;
206:4
127:4,16,22;128:2,5,
medicine (10)
14,17;129:2,3,4,8,12,
24:22;54:17;
16;130:11,12,15;
147:16;164:2;184:4;
131:15;132:13,16,19,
201:10;205:23;
22,24;133:4,6,15,17,
206:7;223:13;226:1
19,23;134:3,7,11,20,
meet (11)
22;135:2,3,8;136:3,
80:8,14;159:18;
11,13;137:15,19;
161:19;170:6;182:8;
138:10,15,17;139:7,
185:7;186:5;216:14,
11,17,18,20;140:3,9,
15;259:23
12,14,17,21;141:18,
meeting (43)
20,22;142:1,4,7,15,
5:3,4;7:24;10:6,12;
17;143:1,8,10,13,15;
13:4,5,5,6,7;15:10,
144:2,4,8,15,20,24;
11,22;21:3;23:5;
145:3,6,9,12,20;
24:4;25:20;30:1;
146:2,3,7,10,13,15;
32:18;37:2;39:12,19;
147:9,14,19;148:8;
44:3;45:17;47:8;
149:2;154:22,24;
48:7,11;107:10;
155:21;156:4,9;
175:3;190:22;192:8;
157:6,14,17,20;
220:10;254:24;
176:22,24;177:1,2;
256:22;260:12;
178:15;179:14,20;
263:5;264:8,17;
180:16,22,24;181:7,
265:1,18;271:16;
20,24;182:15,21;
272:13;273:5
183:2,3,8,16;184:14,
meetings (16)
23;185:1,6;186:8,11,
7:6,10;8:18;9:18;
22;187:1;188:13,24;
13:3;20:18,19;104:2,
190:3,21;191:3,7,10;
10;160:18;185:9;
193:7,10;194:5,9,17;
198:14;199:3,7;
195:3;197:21;198:3,
220:15;265:18
3;202:18;204:24;
Megan (7)
205:18,19,19,20,20;
50:6,7;257:23,24;
206:8,15,16;207:11,
258:15;259:6;264:6
11,13,17;210:5;
Capitol Reporters
775-882-5322
227:1;228:23,23;
229:2,5,23;230:1,3,
17;231:1,9,13,17,20,
22;232:2,14;233:1,5,
11,14,17,22;234:16,
18,21,24;235:4,10,
18,23;237:9,11,14,
18,20;238:4,9,22;
239:4,11,21;240:10,
12,21;242:4;243:10,
13;244:13;245:7,14,
24;246:4,7;247:6,11,
16;248:2,4,12,15;
249:3,4,6,10,15,18,
22;250:4,11,15,21,
21;251:16,23;
252:20;253:6,12,15,
18;254:12,20,22;
258:20,24;259:10,11,
13;260:21;261:1,11,
17;262:5,10,22,24;
263:4,16;264:10,16,
20,22;265:24;266:13,
18,24;268:7;269:2,4,
15,19;270:7,9;272:1,
6
Members (97)
6:15;7:1,17;9:1;
12:16;14:10;15:23;
17:5,17;39:6,13,22;
40:6;44:19;45:12,21;
47:9,16;51:4;52:1;
55:15,16;56:16,19,
21;57:20;59:7;60:19;
63:8;68:22;70:7,21;
71:12,18;77:15,17;
85:8,11;87:7;94:20,
21;95:11;97:18;
106:12;112:13;
113:11;114:1;
121:20;130:1;133:1;
134:19;137:9;
148:11;150:7;
155:22;158:7;161:2,
16;173:24;174:18;
191:22;193:11,13;
194:15,18;198:8,16;
206:3;210:3,23,24;
211:1,5,22;213:5,10;
216:15,16;221:13;
223:1;224:18;226:8,
10;229:21;232:14;
242:14;243:22;
246:10,13,14;248:24;
252:2;253:9;254:1;
255:17;256:23;270:6
members' (1)
215:24
member's (1)
265:16
membership (8)
20:10;52:23;70:15;
85:4;130:21;176:1;
221:17;252:22
memo (2)
32:21;49:7
Memorial (1)
134:3
mental (3)
63:22;192:9,14
mention (3)
112:16;217:21;
220:11
mentioned (11)
12:23;67:10;
129:13;134:14;
148:9;188:15;
214:21;223:7;226:5;
228:2;248:20
menu (1)
184:10
merit (1)
35:21
merits (1)
31:22
Mesa (1)
94:6
Mesquite (2)
95:14;236:11
message (4)
15:19,20;16:1;
17:23
met (12)
8:6,7,15,15;9:4,17;
15:11;24:19;29:2;
57:18;136:17;193:23
method (1)
89:21
methods (1)
95:9
metrics (1)
118:19
metropolitan (1)
52:13
Microphone (1)
127:23
mid (1)
183:19
middle (5)
65:1,8;83:8;
111:15;148:18
might (27)
23:17;44:15;62:12;
63:3,18,20;69:18;
77:17;83:22;93:20;
98:23;100:17;108:4;
127:20;130:23;
141:16;148:18;
156:7;165:20;
203:22;228:17;
229:6;237:21;
247:13,17;250:7;
269:11
Mike (12)
50:23;55:11;58:23;
64:22;65:16;67:13;
(21) maybe - Mike
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
74:7;80:11;127:16;
136:5,10;260:24
miles (2)
188:9;229:13
military (1)
221:24
MILLER (20)
107:15,16,18,19;
123:11;125:5;126:2;
127:7,23;146:22;
147:5;149:23;
153:17,22;154:1;
155:13;156:7;
157:16,19,23
million (2)
221:13;225:13
millions (3)
166:17;167:5;
225:12
mind (7)
44:1;80:7;162:8;
177:12;202:13;
234:2;269:20
mindful (1)
106:11
mine (2)
22:19;92:23
Mineral (2)
132:4,16
mines (1)
93:9
minimally (1)
123:2
minimize (1)
209:22
minimum (2)
47:9;48:5
ministerial (1)
249:19
Minnesota (1)
251:3
minute (3)
113:12;119:15;
231:22
minutes (20)
13:19;14:8,15,15;
15:3,4,16;16:4,5;
21:20;26:12,13,15;
115:14;118:10,10;
192:11,12;216:17;
241:22
mirror (6)
139:10;143:20;
144:14;152:6;
178:18;196:1
mirrored (1)
144:14
mirroring (2)
123:20;144:12
mirrors (1)
110:15
miscommunication (2)
40:24;259:21
Min-U-Script®
misinterpret (1)
150:22
misinterpretation (1)
270:20
missed (4)
202:24;203:10;
269:5,7
missing (1)
13:18
mission (6)
162:5,9,9,22;
174:16;189:1
mistake (1)
84:14
mistakes (4)
223:18,20,24;
271:13
misunderstanding (1)
272:11
mobile (15)
60:3;61:17,19;
218:16;227:16;
228:10;241:9;242:5,
17,23;243:3,16,21;
244:14;251:16
model (19)
64:22;66:24;67:7,
9;68:20;87:11;89:18;
92:6,13;169:15;
180:10;200:21;
201:12;202:6;
206:14;211:21;
222:22;224:14;
260:10
modeling (1)
178:13
models (3)
59:8;206:5;260:10
mom (3)
79:2;210:2;251:3
moment (2)
20:14;200:22
MONDAY (1)
5:1
monetary (1)
250:8
money (13)
11:20,23;13:8,8,9,
12;17:10;41:19;97:9;
159:7;189:20;
250:10,11
monies (1)
66:17
monitor (1)
80:7
monitoring (1)
8:5
month (7)
10:11;40:8;115:23;
116:18;120:5;
259:22;260:4
monthly (10)
55:23;119:18;
125:1,4;182:5,10;
198:14;199:3;
231:13,14
months (7)
7:2,13;8:6;40:8;
43:16;162:2;218:24
Moore (1)
5:13
moot (1)
49:21
more (96)
8:10;9:3,16,19;
12:16,16,16;18:11;
22:13,13;28:20;
31:17;33:21;41:11;
42:19;45:18;46:24;
47:21;48:6;49:18;
51:8;52:22;54:17;
55:6;59:5;68:6,18;
76:14;81:1,13;82:7,9,
19;83:3;86:16;87:14,
22;90:14;92:4;93:2;
101:9;103:4;110:19;
111:6;115:18;117:1;
120:15,16;128:17;
130:7;135:21;146:3;
152:8,18;154:4;
163:3,15,21;164:9,
22;166:5;167:17;
176:11;179:10;
181:7;183:9,13;
186:8;187:11;188:8;
189:12;190:11;
191:11;194:20;
195:13;200:6,22;
201:4;202:1;204:9;
210:13;214:20;
215:7,14;216:7;
217:10;221:7;
224:23,24;225:7;
240:12;247:2;248:3;
252:11;260:4;270:15
morning (9)
15:10,14,15,22;
21:17;62:10;63:5;
174:8,11
most (31)
11:23;51:21;54:5;
55:1;66:6;82:3;
92:23;119:1;141:13;
156:12,15;158:3;
161:3;164:16;
168:14,18;171:4;
172:20;177:22;
196:6;198:5;208:7;
209:15;222:9,19;
234:8;243:24;
250:13,16;263:10;
272:9
mostly (2)
194:8;261:8
mother (2)
126:13;208:18
Capitol Reporters
775-882-5322
mothers (1)
204:16
motion (8)
26:13,16,23;27:1;
47:8;48:5,11;267:12
Mountain (1)
235:5
mountains (1)
108:20
move (17)
6:7;26:11,14;27:7;
41:23;92:14;97:14,
14,15;105:5;149:11;
156:20;165:20;
183:24;184:20;
245:19;252:3
moved (1)
174:4
movement (1)
208:4
moves (1)
40:4
moving (11)
35:19;38:19;46:11,
13;47:10,18;48:3;
57:5,6;167:22;
189:12
MRI (2)
22:21;61:7
MRI's (1)
22:22
much (54)
8:13;9:15,15,16;
18:14;38:23;39:14;
41:7;57:23;90:19;
94:18;98:20;106:6,8;
110:6;115:16;
116:15;124:18;
127:12;131:22,23;
135:2;140:6;147:7;
149:16;153:22;
157:11,22,23;163:4,
11;164:2;176:17;
178:4,21;179:10,18;
187:5;191:8;197:17;
198:3;202:9;205:8;
208:15;214:19;
217:5;218:6;247:3;
249:3;254:19;
270:13;272:17,17;
273:2
multi (2)
102:24;224:14
multiple (2)
48:1;102:23
multitude (1)
221:11
municipalities (1)
102:21
MURPHY (29)
50:15,18,23;75:6;
77:4,21;78:9;80:15;
81:22;83:10;84:8,14,
17,20;86:7;88:19,24;
91:6,19;95:2;99:3,
22;100:4,19,22;
101:23;104:7;105:7;
106:7
must (1)
269:5
mute (2)
190:21,21
myself (8)
14:19;42:18,21;
45:23;74:8;173:12;
174:21;194:11
N
name (17)
6:15;7:9;21:17;
50:23;55:12;70:14;
72:11;97:6;107:15,
18;116:5,7;158:10;
198:9;234:2,6;
270:11
names (3)
50:17;54:12;72:10
Nancy (11)
10:7,14;17:1;
18:12,22;19:1,16;
20:16;144:5,16;
145:24
narrow (4)
54:2,3,4;97:1
narrowing (2)
54:4;68:19
nation (2)
58:11;59:5
national (19)
52:15,18;53:18;
54:10;59:13;65:17;
74:16;75:1;87:1;
90:6,13;101:24;
102:21;173:3;
209:12;214:18;
219:18,20;222:10
nationally (4)
58:4;219:6;225:4;
252:17
Nations (1)
7:24
nationwide (1)
246:19
nature (5)
82:3;196:21;
208:18;224:6;245:19
navigate (4)
93:18;112:23;
114:1;167:6
NCHE (3)
245:8;246:22;
254:23
NCQA (3)
129:5;159:24;
217:15
(22) miles - NCQA
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
near (1)
42:22
nearly (6)
36:24;51:22,24;
52:8,15;54:8
near-site (1)
242:18
neat (4)
61:24;83:9,10;
95:18
necessarily (9)
46:4;68:19;130:18,
21;179:17;195:18;
219:14;236:12,24
necessary (2)
206:8;260:18
necessity (1)
148:22
need (119)
8:2;11:6;12:18,18;
16:7;18:2,23;19:13;
24:18,23;25:10;28:7;
29:21;39:24;41:9;
42:16,17;44:9;45:1;
48:10;49:12;55:7,7;
60:7,23;62:22;66:24;
67:21;73:12;76:1;
82:5;83:3;87:14,15,
16,16;93:19;96:2;
102:11;106:13,16;
107:11,17;108:18;
110:2,2;114:14,15;
122:24;123:24;
124:1;128:18,24;
131:8;134:19;141:8;
145:13;157:7;161:3,
4;162:15;163:10;
165:3;167:10,11,12,
13;168:24;169:3,14;
175:4;182:1;183:17,
18;184:8,20;185:2,
23;191:22;193:5;
194:15,19;197:14;
203:2,20;206:18;
209:8,13;210:18,21;
211:7;212:9;225:22;
242:12,24;247:18;
248:6;257:5,6,19,20;
258:20,22;259:3,4,5;
260:6,21,22;261:2,
18,19,24;262:20;
264:7,16;266:16,16;
270:4
needed (9)
45:12;50:12;
126:18;134:13;
142:18;190:2;203:7,
21;248:5
needle (1)
92:14
needs (37)
24:19;41:10;56:18;
73:2;80:8,14;88:7;
Min-U-Script®
124:10;132:11;
5:1;6:17;12:14,15;
135:1;159:18;
13:1;20:22;21:23;
161:20;170:7;172:2;
22:7;23:4,18;27:6;
175:11,15;182:8;
28:5,10,12;29:10,12,
184:22;185:7;186:6;
15;30:24;31:2;32:15,
193:23;198:18;
18;50:24;51:2;53:15;
203:18,20,23;205:19,
54:20,20;55:1,16;
20,21,24;206:18;
56:6,12,13;62:19;
207:1,17;209:22;
63:7;67:16;68:11,14;
247:12;262:11;
70:2;74:9;77:11;
264:4;268:12
78:7;84:7;87:5,13;
negative (2)
88:18;90:1,18,24;
6:19;195:22
91:5;93:5,11;94:2;
negotiate (1)
108:18,18,24;109:1,
211:24
2,11,15;121:1;
negotiated (3)
127:19;128:3;129:6;
93:6;122:1;178:11
131:18;133:14;
negotiating (3)
145:4;146:8;150:11;
93:8;122:15;171:6
153:9;157:15;
negotiation (3)
158:20;159:2,9,11,
48:23;55:19;
18;160:7,11;161:17;
260:17
162:3;163:2;164:1,8;
negotiations (2)
166:23;168:8,9,10;
264:19;269:11
169:2,23;175:17;
Nelson (2)
176:10,10,11,12;
13:10;107:21
184:3;186:3,12,14,
net (1)
18,21,24;187:3,6,10,
119:20
16,17,19,24;188:4,5,
network (79)
9,12,12,19,21;190:5,
67:10;68:19;74:24;
9;192:16;193:4;
79:11;80:11,17;
196:19,24;197:12;
84:18;87:5,17;88:4,5,
198:21;200:2;
15,16;89:2,17,24;
209:14;211:16,18;
90:5,6,24;91:2,8;
212:14,20;214:14,15,
93:6,12,13;97:2;
23,24;217:13;
100:12;109:1;129:5;
219:13;220:9;
148:2;149:2,3,6,9,14;
221:21;222:5,21;
155:14;159:13,14,14,
223:15;225:8,10,13;
15,17;168:11,21;
227:10;233:21;
169:4;171:19,19;
234:8;235:3,14,17;
187:18;188:20;
236:11,19;238:18;
192:13;199:3,4;
246:15,15;247:18;
209:12;211:2,3,14,
249:12;252:4,6;
14,16,17;213:2,2;
254:23;261:3,4;
214:2,12;216:4;
265:12;267:16;
224:4,15;229:10;
272:22
230:22;231:1,11,11; Nevadans (4)
233:12;234:7;
221:9,12;222:4;
236:11,14;237:6;
225:14
246:17,19;250:2;
new (42)
262:8,17
7:1,9;19:5;23:5;
networks (10)
36:15;44:16;63:11,
54:2,3,4;55:24;
12;64:1;70:9;87:15;
78:3;80:7;104:22;
98:10;102:4;114:7,8,
120:24;214:13;
9,14;121:18,20;
269:21
141:2,9;148:11;
neuro (1)
162:3,5;163:17,19;
204:14
164:10;166:2,3;
neurological (1)
167:21;172:13;
165:2
173:4;178:8;193:17,
neurosurgeon (1)
18;206:5;208:2;
187:23
213:24;242:17;
NEVADA (162)
244:2;267:9,9
Capitol Reporters
775-882-5322
news (1)
164:16
newsletters (3)
55:23;207:12;
244:19
next (28)
7:5;8:12,22;9:4;
15:10,14;20:21;21:5;
40:2;51:10;52:15;
53:17;69:11;107:6;
163:13;184:1;193:7;
203:6;220:21,21;
230:9;255:23;
259:22;260:4,12;
263:11;264:14;
272:13
nice (6)
28:8;96:3;115:11;
189:16;209:4;243:3
Niehaus (7)
107:21,23;127:21,
24;128:4,11,15
night (3)
117:5;174:1,6
nine (1)
263:14
Nobody (2)
49:2;263:9
nodding (1)
144:5
non (10)
137:11;158:23;
178:17,17,19,20;
179:3,10,12;190:5
none (4)
26:6,20;109:17;
273:5
non-embedded (1)
137:10
Nonetheless (1)
189:11
non-transplant (1)
246:20
nor (2)
49:19;183:18
norm (3)
103:9,11,11
normal (3)
37:1;156:17;
243:22
north (108)
21:9;26:4,5,20;
27:9;30:17;31:7;
66:20;69:13;73:5;
77:2,5,11,23;78:6,15,
16,21;79:1;99:19,21;
100:11;102:13;
105:16;111:14;
128:9,11,20,24;
130:18;135:14;
138:1,1,6,11,12,19,
20,20,22,24;139:1,3,
5,23;140:4,6,7,8,8,10,
12,16;143:2,3,12,15,
20;145:16;151:2,17,
22;152:2,6,7;153:22;
154:10,10,17;155:2,
7,9,11,19;156:1,3,8,
11;157:8;177:17;
179:22;180:17;
195:13;196:21,22,23,
23;199:23;204:18;
213:18,20;220:23;
229:16,20;230:1;
234:22;253:2,3,16;
257:15;261:2,5,6,21;
262:4;267:4,5;269:9
northeast (1)
153:9
Northern (39)
12:14,15;21:23;
22:7;29:12,15;32:15;
44:19;54:20;55:1;
56:6,13;77:11;78:7;
84:7;94:2;108:24;
109:1,2;129:6;
133:14;159:11;
160:11;163:2,3;
166:23;168:8,10;
169:1;175:17;
176:10,11;186:12,14;
187:3,17,24;188:8,12
northwest (1)
150:14
nose (3)
67:3,5;187:23
note (13)
7:13;22:14;25:15;
69:20;95:20,23;96:3,
4,5,6,7;144:11;254:9
notes (3)
37:24;116:12;
118:1
notice (6)
12:8,9;14:17;
137:20;162:13;
244:15
notified (1)
40:17
notify (1)
141:4
November (1)
29:2
NRS (1)
266:4
number (38)
15:13;23:19,20;
28:18;42:10,17;
67:23;85:6;92:24;
116:8;131:1,19;
133:8;141:12;150:1;
160:5;165:16,19;
168:7,15;169:4,23,
24;171:7;172:4,7;
177:13,23;181:13,15,
18;185:22;187:9;
(23) near - number
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
188:1;196:20;
212:11;240:16;
265:20
numbers (9)
39:17;68:23;71:9;
86:3,5,5,6;112:22;
181:8
numerous (2)
34:22;173:11
nurse (21)
65:6;79:19;88:11;
115:3;116:1;117:11,
12,14,21,21;118:17;
121:24;122:16;
131:10;205:14,14,17;
206:21;218:18,20;
241:8
nurses (6)
79:9,24;88:10;
125:23;173:9;174:1
nurse's (1)
117:14
nursing (1)
164:4
nutrition (3)
204:21;205:1,7
Nye (6)
94:4;131:17,21;
140:6,20;186:20
O
obesity (2)
165:1,11
OBGYN (1)
207:10
OBGYN's (2)
78:22;208:4
objective (1)
180:12
observation (2)
184:13;217:9
observing (2)
220:18;239:18
obtain (1)
246:14
Obviously (36)
20:11;51:7;52:9;
53:1,5,20;54:19;
76:8;77:6;80:9,18;
82:6,8,11;86:9;99:3,
13,22;100:15;
102:15;131:7;150:1;
151:8;155:15;
172:17;190:12;
193:20;198:11;
200:1,5;208:19;
242:12;244:3;255:9;
259:18;270:22
occur (3)
119:10;121:9;
250:17
occurred (2)
Min-U-Script®
24:24;94:5
occurs (1)
25:3
o'clock (3)
5:5;62:10;63:5
October (4)
18:10,10;28:23;
244:24
odd (1)
34:23
oddball (1)
46:9
off (17)
11:20;23:14;25:4;
31:14;44:5;51:20;
97:5,9;127:18;136:6;
141:7;180:24;
181:13,18;190:22;
194:14;240:19
offer (43)
46:13;47:1;65:20,
21;68:15;81:12;85:7;
96:24;109:6;110:18;
111:16;122:14;
125:1,2;129:14;
138:6;145:21;
150:18;152:11;
169:18,19;170:24;
171:3;179:21;
190:13;196:18;
200:6,7,8;204:6;
231:3,14;232:22;
236:7;242:7;246:23;
250:5,8,9;257:12;
267:22;268:3;272:15
offered (22)
10:13;40:13;47:20,
23;48:1;112:14;
123:21;138:2,3,8;
152:12,13,14;153:2,
3;171:13;198:10;
199:20;231:5;
242:11;246:23;
257:12
offering (14)
22:3;62:2;63:7;
64:2;135:11,12;
138:4;170:13,23;
176:13;238:1;
267:23;268:18;269:8
offerings (2)
24:3;32:17
offers (1)
19:17
office (9)
39:10,13;61:23;
86:14;165:9;166:3;
167:5;229:12;254:3
officer (5)
28:4;31:16;108:1,
3;158:12
offices (8)
52:19;55:17;77:8;
111:24;122:24;
129:22;188:15;
212:15
offshore (1)
223:2
Often (7)
65:13;96:19;164:1;
165:7;168:15,16;
196:6
old (7)
7:15;11:2;22:6,24;
44:16;80:3;169:15
olden (1)
22:6
older (2)
179:15,18
once (20)
6:13;13:21,24;
15:2;25:12;48:14;
50:2,21;55:12;62:17;
98:12;105:3;108:5;
136:17;141:5;
148:23;149:6;176:8;
193:16;194:3
oncologist (1)
247:23
oncologists (1)
247:24
oncology (3)
166:2;247:16,18
On-Demand (5)
175:20,22;176:4;
191:11;192:20
One (266)
6:18,24;7:7,8,16,
16,21;8:16;9:19,22;
10:12,16;11:9,16,17,
20;15:12;16:6,24;
17:1,3,13;18:5,8,8;
22:11,16,16;23:3;
24:20;25:2;27:3,9;
28:19;29:10;31:21;
32:23;34:16,16,22,
23;37:6;40:2;41:14;
42:2;43:1,23;45:7,
18;46:9,9,10,24;47:2,
22,24;48:1,5,6;51:22;
52:9;53:8,20;54:12;
55:2;56:20;57:1,12;
59:13,24;60:12;
62:12;63:16;64:18,
20;65:8;66:8,15,20,
20,23;72:1;73:2;
76:24;80:10;81:19;
83:8,9,10;85:13;
87:2;88:19;89:1,9,11,
16;91:6,10,19;92:22;
93:2;94:8,23;96:18;
97:1,1;100:21,24;
101:1,2;102:16;
104:14;106:9;
108:17;109:5,14;
110:20;111:9;113:7,
Capitol Reporters
775-882-5322
15;114:4;115:18,23;
116:1,2,11;118:10,
14,14;121:7;124:24;
126:11,15;128:8,9,
12;129:12,16,20;
130:3,16;131:1,3;
133:12,15;134:13,13;
135:13,23,24,24;
136:1,4,14,19,19;
137:4,12;138:19,20,
21,23,24;139:14,22;
140:10;141:14;
142:12;143:1,2,2,3,4,
15,17;144:21;
145:22;146:3;
147:11,15;151:16,19;
153:4,6;155:22;
158:4;159:3;160:16,
19;162:10,12;167:11,
13,14;168:15;169:17,
22;170:9;174:1;
177:20;180:3;
181:12;183:9,12;
185:22;186:8;187:2;
188:24;191:10;
192:1;195:5,11,11,
14;196:5,6,9;199:19,
20,20,21;200:19;
202:4,13;203:1;
204:12,19,24;205:2,
2,4;212:1;214:1,12;
217:8,14,16;221:20;
223:9;228:11,12,24;
230:9;236:3;239:8;
240:12;245:20;
247:23;248:3,22;
249:16;252:18;
253:2;255:1;256:3;
261:12,19;262:13;
264:11;265:18,19;
267:8;270:15;271:3,
4;272:21
onerous (1)
217:17
ones (13)
8:22,23;11:11;
64:8;98:4;118:20;
159:4;178:11;
215:23;234:19,21;
235:8;239:23
one-third (1)
126:2
on-line (33)
13:18,21;14:18,22,
22,24;15:2,20;18:6;
55:4;58:22,24;60:24;
61:7;62:1,3;63:5,12,
17,17,24;64:3;70:7;
76:2,4;83:11,15;
86:10;93:15;170:15,
22;232:15,20
only (59)
9:1;19:20;27:3;
31:1;32:3,12;39:8;
44:8;47:23;52:12;
53:11,12;69:1;71:4;
75:16;77:2,2;78:15;
79:24;91:5,22;
111:19;118:8;121:7;
122:1;126:21;127:4;
135:20;137:5;
140:12;154:18;
158:8;159:1,3;
160:10;161:16;
163:21;164:12,14;
166:23;167:3;
168:21;186:15;
188:9;189:9;203:24;
212:20;217:14;
218:18;219:20;
236:3;244:13,14,23;
251:7;258:17,18;
267:12,22
onset (1)
202:18
onsite (3)
202:19;203:3;
206:23
on-site (1)
242:18
onto (3)
97:10;141:10;
226:6
oOo- (1)
5:2
open (34)
44:8;66:24;67:7;
75:21;76:5;89:14,15,
18,22;91:3,15,20;
97:18;104:19;109:5,
9;110:23;128:24;
149:13;155:2,8,9,11,
19;156:15;169:11,
19;171:20;213:23;
228:16;230:13,15,17;
260:9
opening (2)
77:7;94:10
openings (1)
121:19
openly (1)
40:1
opens (1)
22:12
operate (5)
39:3;52:3;53:14;
77:7;99:24
operated (1)
174:11
operates (1)
52:3
operating (2)
57:22;189:24
operational (1)
228:12
operations (2)
(24) numbers - operations
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
107:22;229:18
opinion (3)
27:15;35:9;252:3
opportunities (2)
173:11;177:18
opportunity (42)
18:16;21:1;32:5;
41:20;47:21;49:17;
50:20;56:5;58:14;
60:15;61:15,24;63:2;
64:13,20;65:15,19;
110:24;112:18;
118:13;124:20;
158:7,18;161:24;
168:1,4;173:21;
177:21;184:4,7;
198:3;208:1,15;
213:21;217:3;220:7;
221:4;223:5;228:4;
230:14;244:21;
260:14
opposed (4)
26:24;179:23;
180:2;262:15
optimum (2)
221:16;227:8
option (22)
11:10;63:11,21;
77:10;89:3,4;110:20;
111:18;127:7;152:1,
4,17;186:3;199:18;
200:1,4;236:3,19,21,
21,22;268:2
optional (1)
152:13
options (27)
8:19;11:16;14:16,
17;64:17;77:9;82:20;
100:12;111:9,19;
120:20;135:12,19;
137:24;150:9,17;
152:24;172:3,4,6,7;
184:10;186:14;
199:18;200:9;223:8;
264:11
order (15)
5:4;27:4;43:23;
114:6;159:17;185:2;
217:10;219:8;
228:12;241:3;
249:21;255:10;
262:20;264:17;
266:16
ordering (1)
114:22
organic (1)
227:9
organization (15)
15:23;17:24;51:4;
108:23;161:9;162:7;
164:6;177:14;190:5;
210:9;221:8;251:20,
24;265:5,7
Min-U-Script®
organizations (6)
56:9;59:6;228:8;
244:4;252:14;265:2
orientation (1)
120:18
oriented (2)
195:1,2
original (3)
23:3;49:15;138:19
originally (1)
108:19
orphans (1)
23:3
orthopedic (1)
24:12
others (6)
30:15;161:13;
163:21;165:10;
170:14;272:16
Otherwise (6)
63:17,19;194:19;
226:21;249:2;266:9
ours (2)
62:5;189:18
ourselves (4)
38:21;46:17,19;
180:4
out (177)
11:7,8,14,18,21;
12:9,17,17;14:1;
15:3;17:7,8,18,23;
18:2,7;21:1;23:20,
23;24:1;26:6;28:22;
31:15;32:22;33:16;
34:14;38:3,16;39:1,
2;40:3,18;42:22;
43:21;45:3;46:22;
47:16;49:7,20;51:6;
53:9,22;54:12,16;
61:21;63:2,19;66:22;
68:23;71:9;72:13;
73:23;76:4,6;77:4,
22;79:8,11,18,20,21;
80:10,19;82:20;83:2,
5;84:20;85:23;89:10,
17;90:5;91:7,23;
93:6,8,9,10;95:7,24;
96:2,4;97:12;104:15,
18,23;105:18,21;
112:22;114:11;
117:12,20;121:11;
126:22;130:1,9,21;
131:2,3,4,6,7,10,24;
133:2;134:15;
136:16;140:15;
141:19;146:8;163:9;
166:8,20;169:8,8;
175:11;176:12;
177:15;183:23;
185:12,13;187:5;
188:9;189:7,19;
192:6;193:2,11,12,
19;194:11;199:13;
202:18,22;203:22;
204:21;205:5;
208:15;211:9;214:7,
16;215:13;216:14;
219:24;227:11;
229:18;233:6,7;
235:9;236:2,17,20;
237:1,21;238:13;
243:17;244:16;
245:12;246:16,16;
247:1,19,20,22;
248:1;250:6;253:20;
255:21;256:7,12;
262:13;263:1,14,14;
268:11,15,16;273:6
outbound (3)
115:19,23;119:18
outcome (7)
65:5;81:14;92:4;
201:9;202:10;205:8,
9
outcomes (8)
51:15;75:21,23;
76:10;83:6;204:15;
208:6;209:23
outline (1)
126:18
outlined (3)
46:12;91:11;240:1
outlines (1)
249:13
outpatient (3)
61:13;120:13,14
outreach (6)
85:7;86:2;94:15;
131:12;207:3;240:13
outreaching (1)
129:21
outs (1)
194:7
outside (24)
67:17;68:5,5,7;
87:13;88:4,18;90:3,
15,18,24;121:4;
169:4;173:20;
175:17;184:20;
185:19;209:14;
213:3;218:12;236:7;
237:6,7;251:19
over (72)
6:20;7:15;10:14,
14,17;14:5;28:9;
36:9;40:23;42:6;
43:19;49:14;50:13;
52:5,19;55:8;59:7,8;
60:4;61:1;62:19;
76:12;79:19;98:10;
104:19;112:20;
116:13,16;119:9;
120:5,7;126:7;
142:23;147:17;
148:24;158:2;
159:10,11;161:10,21;
Capitol Reporters
775-882-5322
162:4;165:15;171:5;
172:15;188:9;197:5;
198:1;199:9,11,15;
200:16,24;201:11,18,
24;207:5;208:8;
209:6;211:3;212:18,
19;215:3,14;217:19;
219:14;240:20;
245:23;246:2;247:2;
260:4;263:11;272:20
overall (7)
151:4;155:18;
245:17;265:4,8,10,17
overdoing (1)
167:20
overview (3)
28:2;67:12;158:19
overwhelming (1)
202:15
owe (1)
41:20
own (21)
22:19;83:14;
108:24;112:18;
121:13;123:13;
143:19;152:18;
189:10,18;203:11;
212:22,22;213:1;
218:9;232:20;
243:21;244:7,7,7;
263:10
owned (2)
22:17;158:24
ownership (1)
123:17
owns (1)
109:3
P
package (1)
199:21
packages (1)
232:11
packet (3)
17:4;49:19;137:20
packets (2)
70:6;269:6
PADILLA (5)
129:10;142:12;
146:20;147:10,15
Padillo (6)
107:20;110:10;
125:4;128:20;129:7;
133:3
page (5)
8:8,8;53:17;
143:11;226:11
pages (2)
34:23;37:21
Pahrump (2)
95:15;131:21
paid (3)
19:4;187:16,17
pain (1)
24:21
painless (1)
121:9
pains (1)
53:6
palatable (2)
103:4,6
palm (1)
218:18
panel (1)
24:14
panels (1)
213:23
pantries (1)
55:2
PAP (2)
79:21,22
paper (1)
34:15
parameter (1)
230:12
parameters (2)
89:23;190:14
parent (2)
201:7;222:17
parents (2)
68:6;233:7
park (1)
252:14
parked (1)
253:1
parking (1)
253:2
Parkway (1)
199:5
parody (2)
187:14;197:14
part (57)
7:9;9:13;18:11,21;
19:3,4,12;23:1,2,13;
32:7,16;36:8;53:8;
57:2;59:12,12;65:2;
68:17;71:22;72:22;
91:20;93:22;96:7;
109:1;121:23;122:5;
132:11;154:14;
155:23;158:3;
163:14;174:10;
176:1;184:18;185:3;
195:18;198:5;211:3;
215:3;221:16,19,20,
23,24;224:19,24;
225:21;227:8;
229:21;242:16;
244:12;253:3;
254:10;260:19;
267:22;269:7
participant (4)
142:1;195:22,23;
206:15
participants (15)
(25) opinion - participants
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
18:23;28:11;32:6;
43:20;96:14;141:1,4;
176:14;181:5;186:7;
198:19;200:17;
201:2,4,8
participate (7)
31:18;39:22;47:16,
21;48:14;160:18;
220:10
participating (3)
59:8,9;109:8
participation (1)
66:6
particular (7)
24:5;33:19,20;
36:15;77:1;126:20;
154:4
particularly (3)
130:17;175:18;
192:4
partner (9)
83:4;158:20;
172:12;183:23;
184:2,19;198:11;
222:21;250:22
Partners (11)
155:15;163:7,18;
164:6;165:16;
167:23;180:13;
194:17,22;197:7;
199:12
partners' (1)
193:23
partnership (7)
53:21;74:19;75:13;
158:22;164:10;
167:24;194:13
partnerships (1)
178:5
parts (2)
101:10,15
party (1)
109:7
pass (4)
110:9;171:11;
180:10;224:8
passion (1)
225:9
passionate (1)
211:5
past (13)
11:1;14:9;35:18;
46:4;47:19;77:10;
104:6,8;126:23;
187:3;202:1;219:12;
224:21
patent (1)
97:5
patient (40)
51:16;57:3;58:22;
59:15;68:17,20;76:9;
88:14,17;136:14;
147:23;167:8;173:8,
Min-U-Script®
9,11,17;175:2;192:3;
201:8,22;202:1,3,3,6,
14,20,23;203:7,9,11,
17;205:10,24;206:13,
14,15;207:1;226:24;
250:20;251:11
patients (26)
58:13,15;59:2,6;
75:23;80:1;92:4;
123:9;129:23;
162:13;166:24;
173:22;191:17,22;
192:18;193:3;
202:12;209:7,12;
213:23,24;215:7;
216:15;217:7;219:8;
220:2
patient's (1)
174:2
pattern (3)
229:7;236:8;
238:19
Paul (5)
198:9;220:11;
223:7;229:13;245:10
paver (1)
224:14
pay (11)
14:2,6;20:2;89:17;
97:9;134:18;136:3,
15,16;162:19;253:23
paying (3)
19:7;92:3;156:2
payment (4)
57:6;75:19;92:13;
213:17
PCMH (1)
91:21
PCP (11)
57:10,15;63:9;
67:4;89:19;155:4;
156:16;157:8;
206:21;232:18;233:2
PCP's (2)
78:22;80:9
PC's (1)
130:22
PEBP (52)
5:4,5;11:7;20:14;
24:9;25:2;28:11,16;
31:11,12;34:8;39:22;
42:4,13;47:20,22;
49:23;66:11;70:7;
71:17;72:18;74:20;
81:8,20;97:12;
160:17,21;161:17;
171:2,14;172:19;
198:12,18;199:12,24;
200:7,17;201:2,5;
220:8,13,20;221:1,
18;223:1;224:8;
226:17;227:2;228:7;
230:21;246:12;260:6
PEBP's (3)
22:24;128:7;
198:10
pediatric (4)
247:21,23,24;
251:2
pediatrician (2)
204:4;209:19
pediatricians (1)
208:3
pediatrics (1)
207:10
PEDROZA (6)
5:7,9,11,13,16,20
peer (4)
173:12,12;219:20;
253:22
peers (1)
45:24
peg (1)
38:13
Peggy (3)
21:16,18;270:11
P-e-g-g-y (2)
21:18;270:12
pejorative (2)
33:6;35:11
pending (1)
13:22
pendulum (2)
36:8,12
penetration (1)
157:8
people (114)
9:8;10:7,17;11:1;
17:13;18:10;23:9,19,
22;25:2;27:3;38:12,
12,17;41:19;42:21;
45:3;46:5,5,18,21;
48:2;52:16;60:6,6,13,
14;64:14;65:14;
70:11,13;72:9;99:12;
103:7;112:23;
115:21;118:21;
119:1,16;120:3;
125:24;126:5;
135:21;149:13,13;
156:15;159:11;
162:16,18,23;163:4,
10,15,17;164:8,23;
165:13,19;166:7,12;
167:3,6,15;172:20;
175:7;183:15,16;
184:7;185:10;188:6;
190:9;192:5;193:19;
197:4;202:8;204:7;
207:4;208:7,10;
210:9;212:19;213:7;
215:17,18;216:12,14,
22;217:12,22;218:2,
7;219:7;222:20;
224:22,22;225:1;
236:9,10;239:5;
Capitol Reporters
775-882-5322
241:10,14;242:21;
243:1,4;244:16,21;
245:6;246:11;256:5;
258:6;263:11;
269:16,17;272:15
people's (2)
24:16;243:7
per (2)
31:14;32:1
perceived (1)
156:23
percent (62)
10:7,8;29:18,19,20,
24;30:21;31:4;35:4;
49:10,11,13,14,15;
52:7;58:6;115:22,22;
118:21;119:3,9,13,
19,22;120:7,12;
125:9;141:14,16;
143:3,16;144:13,16;
145:17;164:19;
171:18;175:15;
178:1,1,3;180:9;
213:22;252:10;
258:17,18,19,23;
259:5,8,10,20;
263:20,21,22;264:1,
5,8;270:14;271:13,
14,15;272:13
percentage (3)
31:5;144:10;
180:24
percolate (1)
209:4
perfect (4)
113:20;223:18,23;
248:8
performance (4)
29:4;54:3;68:18;
219:23
performed (2)
25:8;207:16
performer (1)
207:23
performing (1)
207:9
perhaps (2)
48:15;184:13
period (9)
37:22;97:23;98:15;
120:5;126:8;141:13;
148:3;162:4;189:2
periodic (1)
209:21
permission (1)
195:16
Pershing (2)
132:4;235:7
person (35)
12:24;15:19;16:6;
25:2;30:2;41:15;
59:3;60:12;69:18;
72:2;73:1,2;79:9;
88:11;112:19,22;
114:23;115:10;
116:5,8;118:13;
127:8;128:6;137:12;
148:18;162:11,13,13;
184:12;208:14;
211:10,11;216:2;
228:23;255:1
personal (27)
12:22;14:1;57:4;
64:24;65:5;112:19;
113:7,10;114:5,13;
115:19;116:12;
118:14,21;119:2,8,
11;120:11;121:12;
123:8;131:7;161:5;
174:15;202:3;
205:24;212:11;252:3
personalization (1)
74:13
personalized (4)
56:23;112:12;
122:11;200:14
personally (2)
113:1;204:4
personnel (2)
29:7;126:18
persons (2)
29:1;30:2
persons's (1)
25:14
perspective (4)
40:12;193:24;
196:8;256:1
Pete (12)
51:1;55:8,12;
57:19;64:23;68:16;
73:4;74:8;78:17;
91:21;92:5;93:22
Pete's (3)
61:11;86:1;93:7
pharm (1)
143:2
pharmaceutical (1)
147:24
Pharmaceuticals (6)
24:2;143:3,16,17;
145:22;148:1
pharmacies (2)
99:1;191:21
pharmacists (1)
206:6
Pharmacy (17)
48:1;63:1,2;72:7,
13,16;86:6;96:13;
97:2,3,17;98:19,21;
120:15;140:24;
142:20;206:2
philosophical (1)
196:5
philosophies (1)
160:21
philosophy (3)
(26) participate - philosophy
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
110:16;160:24;
169:12
phone (77)
14:11;15:6,12,16;
16:7;60:9,10,13;
61:19;85:5,12,19;
86:3,3,4,5,6,9,19,19;
94:11;112:22;113:9;
114:23;115:3,11,13,
15;116:5,6,7,7;117:7,
9,14,15,20,22;118:4,
8,9;120:17;126:13,
22;127:5,10;130:24;
147:10,11,11;170:1,
5,12,18,20;173:14,
16;174:1,9;185:11,
14,24;186:2,4;
192:24;212:9,10;
216:2,11,11,17;
218:17;240:15,20,22;
241:17,24
phones (2)
85:2;170:4
physically (1)
55:16
physician (33)
57:12;62:17,18,20,
21,24;63:3;69:21;
88:13;96:17;99:6;
118:17;125:10,12,16;
146:24;156:9,15,17,
18,22;169:13,16;
173:14,15;175:12;
202:21;206:10;
209:5;227:4,4,10;
241:11
physician-patient (1)
201:21
physicians (14)
52:9;57:16;98:14;
121:18;136:20;
147:3;191:19;
192:10;201:10;
212:6;215:23;216:6;
227:7;250:18
physicians' (1)
121:19
pick (11)
116:2,4;140:17;
212:9;223:9;267:7,7,
8,8,8;271:3
picked (5)
12:24;14:11;
207:10,10,11
picking (1)
255:11
picture (1)
74:10
piece (4)
68:3;99:3;227:15;
244:11
pieces (3)
74:3;202:5;204:22
Min-U-Script®
pillars (1)
51:18
pilot (1)
242:20
piloted (1)
207:24
piloting (2)
228:5;241:9
pivotal (1)
58:9
place (28)
7:23;9:15;43:9;
72:15;79:2;82:24;
83:20;105:6;121:14,
15;123:10;142:10;
162:16,17;165:13;
167:15;178:10;
189:11;190:15;
206:6;211:14;
226:22;240:17;
244:23;251:3,7;
265:18,19
places (4)
82:14;163:10;
166:15,20
plan (142)
14:2;19:12,12,17,
21;23:11,11;27:5,20,
22;28:10,10,13;
46:12;51:23;53:22;
59:12;62:2;63:7;
67:14;70:2;75:15;
77:11;81:2;90:13,14;
96:23;97:21;104:15,
19,24;105:14,15;
107:19;108:11,12,13;
109:14;110:2,4;
111:16;112:7;
124:13;128:19;
130:11,11;135:17,19;
136:15,19;137:16;
138:1,8,19,19,23;
139:6,6,7,9,10;
141:14;143:20,20,21;
144:12,14;145:3,4,
10;146:24;147:24;
150:20;151:2,3,4,8;
153:7,11;154:19;
155:6,6,8,9;157:16;
159:2,2,16,24;162:5;
169:6;171:16,20;
179:7;188:18;
189:10,17,18,22;
195:13,15;198:10;
199:20;200:3,9,15,
17;211:6,6;212:19,
21,21;213:5,7,11;
219:13,23;220:9;
221:7,11,14;223:11,
15;224:9,9,10;225:7;
227:2,2;235:17;
238:2,3,18;247:10,
15;249:7,11;251:5,
23;261:3,4;265:12
planning (3)
166:18;189:2;
243:17
plans (44)
16:13;23:9;25:11;
48:13;51:24,24;
53:20;54:1,2;55:24;
58:13;69:8;83:1;
109:10;110:17,18;
111:10,11,14,15;
123:21;135:15,23;
136:24;137:21;
138:2,7,18;151:10;
152:5,6,13,14,15;
153:10;155:2;156:5;
188:2;189:4;212:22;
213:8;214:15;
226:18;267:14
platform (3)
55:5;83:13;87:22
play (6)
35:1;48:18;93:5,6;
110:21;111:2
played (1)
158:16
player (1)
221:22
playing (1)
117:4
Please (13)
6:11;22:14,15,15;
23:16,16;26:21;28:2;
36:2;50:16;96:1;
241:23;264:20
pleased (5)
67:7,8;174:19;
223:24;226:13
plenty (1)
97:19
plugging (1)
203:20
Plus (7)
14:2,17;16:21;
23:23,24;123:20;
199:12
PMP (1)
58:5
pocket (1)
136:16
pockets (1)
267:16
point (26)
13:4;22:1;24:20;
45:21;46:6,7;55:20;
95:4;100:20,23;
109:7;113:14;
122:22;183:13;
184:9;194:10;
197:16;199:13;
200:7;217:24;
220:19;256:4;257:9,
19,23;259:9
Capitol Reporters
775-882-5322
pointed (2)
193:12;227:11
pointing (1)
84:20
points (7)
27:7;123:17;
194:15;217:11;
257:6;271:8,10
policies (2)
55:24;173:4
policy (2)
15:7;260:5
political (1)
222:19
poll (3)
255:16;263:8;
273:6
poor (2)
35:22;255:6
popping (1)
105:21
pops (1)
62:16
popular (1)
103:4
population (32)
52:23;66:2;119:13;
120:8;150:13,14;
151:8;153:8;166:22;
172:21,24;173:1;
179:16;180:10;
185:16;188:10;
189:12;199:23;
215:23;218:3;226:9,
14;227:23;228:5,13;
237:15;240:14,22;
244:5;252:7,8;254:8
populations (2)
179:1;199:24
portable (1)
64:16
portal (3)
60:2,19;217:21
portfolio (2)
115:20,20
portion (3)
43:18;137:5;
152:19
position (4)
11:18;99:20;
155:14;255:9
positive (1)
195:22
positives (1)
101:7
possible (9)
101:17;105:3;
121:10,21;127:12;
204:7;205:8;259:18;
272:19
possibly (1)
200:9
postpone (4)
43:1,8,10,14
potentially (6)
96:16;124:11;
192:13;216:22;
228:6;242:5
poverty (1)
165:11
power (1)
113:14
powerful (1)
204:17
PPO (26)
52:10;80:11;87:22;
89:14;90:4,5,6,7,11,
19;91:1,4,7,13;109:7;
135:20;159:16,19;
171:18;173:1;179:7;
199:2;231:1,11;
237:19,20
PPO's (1)
90:13
practice (11)
54:17;59:17;
168:22;184:6;189:7;
201:10;215:11;
216:8;217:20;
228:24;231:6
practicing (1)
209:5
practitioners (3)
122:16;131:10,16
pre-approval (1)
134:22
pre-authorization (1)
135:1
precisely (2)
40:9,11
preconception (1)
204:5
predictability (1)
212:1
predictable (2)
200:15;211:17
predominantly (3)
252:6,7,22
PREDOZA (1)
6:4
prefer (4)
106:24;127:9;
151:11;185:20
preferences (1)
169:24
pregnancy (2)
79:12;117:24
pregnant (1)
79:2
premium (4)
19:18;72:19,23;
111:5
premiums (9)
89:13;168:18;
171:1,14,22;179:4;
180:6;196:12;197:10
(27) phone - premiums
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
prenatal (1)
204:6
prepared (4)
36:24;41:22;49:18;
228:14
preparedness (1)
37:3
preparing (1)
41:19
prescribed (2)
174:24;193:4
prescribing (2)
191:21;192:10
prescription (8)
18:7;61:2;63:1;
141:20;174:23;
241:19;242:2;247:6
presence (6)
52:18,19;74:16,17;
75:1;214:13
present (4)
41:17;48:14,14;
185:9
presentation (29)
8:8,11;9:3,6;13:11;
29:13;50:10,14;51:6;
75:8;94:16;95:19;
106:16;158:2,9;
160:21;182:18;
186:12;198:2;
210:22;257:17;
258:10,13,13,14;
259:5;265:3;269:6;
272:14
presentations (21)
8:13;9:15;11:9;
29:10,20,23;32:17;
37:15;41:20;43:3;
49:11;258:1,23;
259:19;260:1,5;
263:21;267:20;
268:17;272:13,16
presenting (3)
76:24;77:1;158:11
presently (4)
122:15,22;123:2;
131:13
president (13)
6:16;8:1;50:23;
55:13;158:10,13;
198:24;199:2,4;
211:2;221:11;234:3,
7
president's (1)
107:20
press (2)
107:17;257:6
pressure (2)
64:11;224:17
pressures (1)
174:22
pretty (13)
35:22;46:1,12;
Min-U-Script®
52:6;83:9;90:19;
131:22,23;132:7;
140:6;198:3;259:19;
264:17
prevent (1)
165:4
preventative (1)
204:2
previous (4)
33:8;45:17;46:8;
182:9
previously (1)
231:18
price (2)
185:5;200:7
prices (3)
22:4;61:10;171:4
pricing (3)
175:20;230:11,14
pride (1)
160:22
primarily (5)
96:13;111:14;
140:23;175:7;227:22
primary (28)
32:4;57:9;58:11;
62:20;65:6;69:21;
76:7;91:9,24;125:11,
16;146:23;147:2;
148:9;155:14,24;
156:9,16,18,20,22;
167:9;169:15;182:1;
184:11;202:9;208:3;
213:22
print (1)
34:13
printer (1)
38:3
prior (10)
42:20;44:2;98:10,
11,12,17;119:3;
177:8;198:23;232:19
prioritize (1)
58:15
prisoner (2)
23:12;25:16
privacy (2)
82:5,8
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173:1
pro (1)
190:24
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198:18;207:6
probably (36)
8:6;10:7,8;12:24;
34:16,19;36:13;38:5,
6;65:22;66:6;72:21,
21;82:8;97:4;152:19,
20;154:8;156:10;
157:2;178:1;196:6;
207:4,21;220:21;
221:7,8;222:9;
226:11;227:12;
241:19;247:24;
255:15;262:18;
269:19,20
problem (18)
12:5;13:16;15:1;
39:23;47:17;73:17;
83:2;121:21;155:22;
164:20;183:11;
191:3;251:2;259:7;
261:22;262:2,6,7
problems (9)
7:21;8:16;10:8;
18:8;22:23;25:9;
50:1;58:14;70:23
procedures (5)
61:3,12,13,14;
121:23
proceed (1)
257:14
process (51)
6:23;7:1;9:3;13:2;
14:12,15;16:10;
18:16;30:14;31:15,
17;32:4;33:15,21,24;
34:6;36:14,15;38:9,
10,17;48:8;49:12;
53:10;79:17,18;
103:24;106:2;
114:13;118:24;
121:9,23;126:6,9,10;
127:1;135:22;
146:11,11;154:18;
184:16,17;191:18;
217:17;242:9;
249:20;255:19;
257:3;259:20;
260:18;264:4
processed (2)
212:15,16
processes (1)
74:21
procurement (2)
28:16,17
produce (3)
219:20,24;232:23
product (12)
27:18;68:22;138:3,
4;179:22;214:3,6;
236:7;237:3;238:1;
239:10,10
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140:10
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7,12;91:22;93:3;
96:7,8;112:14;
121:12;122:6;
123:15;125:8;
129:13,14;137:23;
143:6;152:10,21;
153:16;158:21;
161:7,10;167:10;
172:14;174:17;
175:6;176:2;191:12,
16;193:15;203:5;
220:13;221:19,21,23;
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240:17;272:15
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164:3;166:1,2,19;
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66:17;72:14;76:12;
122:17;129:23;
130:4,9;131:11;
149:17;201:24;
202:16;204:3,6,20;
205:1;206:2,20;
221:11;226:2;228:1,
4
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197:1
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165:9
Prominence (22)
27:5;32:13;43:15;
50:4;107:19;108:4,6,
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13;111:19;112:7;
123:4;157:16;261:6;
268:3,7,8
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223:22
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24:22
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22;78:1,10,11;81:12;
82:18;90:17;108:8;
110:11,13,15;112:5;
120:19;125:21;
128:2;133:7;135:8,9;
143:11;145:8;168:3;
169:10,17;171:13;
172:16;177:7;
185:15,15,19;186:13;
199:19;213:22;
220:7;236:3;239:22;
240:4,5;248:16;
257:11,13,17;266:7;
271:2,6
proposals (22)
28:23,23,24;29:2,3,
8,22;30:20;31:20;
32:12;34:20;36:21;
42:5;151:19;169:17;
212:2;256:11;
257:10;260:14;
268:4;271:11,12
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Proprietary (1)
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provide (41)
28:11;30:19;56:23;
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105:2;111:24;
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(28) prenatal - provide
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
172:14;175:1,23;
178:13,23;182:17;
185:16;186:13;
191:16,21;192:3;
211:22;213:4,6,14,
15;216:24;236:23;
242:20;250:20;
256:20,24;257:3;
269:8;271:5
provided (22)
24:22;31:20;42:12,
14;69:12;77:11;
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145:24;150:9;172:3,
5,9;184:11;199:11;
248:6;259:24;260:1
provider (75)
18:9;51:1,12;55:9;
56:2;60:22;65:1;
68:2;73:4;75:17,20;
76:5;79:10,14;80:12,
18,22;83:11,16;
85:15,16,24;86:1,5;
87:5,21;90:10,23,24;
91:5;92:6;93:13,14,
16;94:10;98:21;
109:16;114:15,18,20;
117:7,8,9,10;122:19;
141:20;148:7;
155:24;159:13;
168:21;170:20;
171:7;176:6;181:5;
183:6;187:11,13;
192:4,23;193:2;
200:6;202:9;212:9;
213:12;216:4;236:5;
237:5;241:2,5,12,18,
24;245:19,21;248:17
providers (94)
8:19;14:23;23:16,
17;42:11,17;52:6;
53:15;54:16,23;
55:13,18,22;57:18;
59:9;61:11;65:4,4;
68:19,21;69:15;73:6;
75:20,22;78:13,14;
80:10,16;83:12,13,
14,17;92:3,12;93:8;
95:14;96:16;112:3;
113:6;120:5,24;
122:3;136:14;
138:12;142:23;
147:16;149:7,8;
168:12,21;169:2;
175:14,24;177:22;
181:9,17;183:1,2;
188:3,7,8;193:3;
197:6,13;202:12;
207:9,15,16;212:5,5,
7,15;213:9,13,14,23;
214:3,5,7;215:2,3;
220:1;236:7,9;237:6;
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158:20;160:4,12;
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41:18;44:5;51:14;
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64:7,10,16;65:22;
66:4,16,22;71:1,10;
72:15;78:1;82:6;
83:4;95:19;105:5;
114:18;117:13;
156:17;166:24;
168:20;170:23;
191:2;218:17,24;
219:1,15;224:16;
239:8;245:3,12;
271:5;272:17
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115:12
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Q
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224:17
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232:3,4
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Rayne (4)
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R
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84:5;104:11;158:18;
154:7,9;156:2;177:4;
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(29) provided - real
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
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really (112)
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38:22;39:24;46:5;
51:11;52:5,12;53:7,
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58:1,9,17,24;59:2;
60:1,3,5;63:21;68:4,
14,16;69:22;70:5,5,
14;71:10;72:14;
73:12,13,17,20,21,
22;75:18,24;76:10,
11;82:17;93:5,7;
95:8;99:11,14;101:5;
105:8;112:5,16;
113:8,16;114:24;
116:23;124:9,11;
125:9;127:12;130:4,
8;141:15;145:20;
153:10;154:9,11;
162:9,11;164:6;
165:8;168:8,11;
175:10;180:12;
181:11,15;187:10;
188:1,6;195:4;202:1;
204:1,7;205:5,23;
206:12;207:7,9;
210:8,11,12,15,16;
211:20;218:10;
221:6;223:13;226:6;
233:1;236:21;237:1,
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31:13;32:10,19;37:8;
39:5;43:14;45:9;
47:2,7;49:1,6;69:20;
76:23;84:23;86:23;
124:23;130:15;
135:3;176:24;185:1;
198:9;227:3;229:3;
238:22;240:3;
259:17;263:19;
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270:12
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Renown (29)
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(30) Realistically - Renown
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
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responsible (1)
234:8
responsive (1)
198:18
rest (9)
16:2;49:22;111:21;
126:3;187:4;196:15;
200:21;203:14;
255:10
restricted (2)
24:2;67:16
restrictive (1)
87:22
resubmit (1)
19:13
result (2)
143:19;155:18
results (12)
58:4;116:23,23;
117:12,16,17,18;
118:11;120:10;
163:22;165:14;
211:16
retail (3)
145:5,9;215:14
retention (2)
245:15,17
Retired (1)
6:16
retiree (2)
19:2,17
retirees (3)
54:7;178:16,17
retirement (1)
19:24
revenue (1)
189:24
review (19)
32:8;33:16;35:1,
20;36:20;37:1;38:22;
39:9,20;40:5,8;41:1;
49:17;168:4;176:5;
213:21;260:13,14;
269:6
reviewed (3)
191:15;205:15;
248:7
reviews (2)
49:22;219:23
revise (1)
106:20
revised (1)
106:20
revolving (1)
96:12
RFP (21)
28:17;29:4;31:15,
20;32:9;37:1;41:5,6;
45:11;48:7,8;76:16;
131:20;144:1;
199:18;221:5;240:7,
9;248:6;260:3;271:7
RFP's (4)
23:19;47:23;260:1,
15
rich (1)
195:13
richer (1)
103:9
rid (1)
167:18
right (119)
5:24;6:3;10:4;
11:23;13:17,17,24;
14:8,10;20:6;21:6,
23;26:9;33:1,12;
38:24;40:9;44:11;
45:20;47:13;48:12,
17;50:11;51:14;52:5;
53:11;64:15,17;
74:14;78:16;82:24;
83:20,21;89:17;
92:20;96:19;107:8;
110:22;113:5,6;
114:18;115:9;117:8,
13;120:3,4,4,4;
121:14,15,15,15;
123:9,9,10;124:13;
127:14;129:17,19;
136:13;138:15,22;
140:21;142:16;
144:19,24;146:1,8;
147:22;148:5;150:4;
151:21;153:24;
154:20;157:21;
158:1;167:17;
Capitol Reporters
775-882-5322
170:20;175:1;
176:23;177:7;191:2,
3,14;194:17;197:4,
22;198:22,24;202:2,
18;204:8;207:17;
208:18;215:20;
220:4;223:21;229:4;
232:15;233:12;
237:8;240:19,21;
243:10,20;244:9;
248:2;249:7;251:10,
13;254:14;255:17;
261:13;264:1;
268:22;269:22;
270:10;272:22;273:4
rights (1)
248:6
risk (5)
56:17;58:24;
182:19;204:16,16
risks (1)
59:2
Rivera (1)
14:19
RN's (1)
126:3
road (2)
89:3;136:17
roads (1)
163:20
robust (6)
168:10;189:19;
236:22,24;237:6;
246:19
role (6)
5:6;31:16;33:17;
72:5;165:8;247:13
rolling (2)
63:19;68:23
rollup (1)
71:5
Ron (1)
108:1
room (17)
5:5;10:16;24:13;
25:12;60:10;62:14,
15;63:4;67:21;87:16;
147:7;166:10;
175:16;219:4;
244:15,18;245:5
rooms (1)
227:19
roots (1)
184:2
Rosalie (25)
5:18,22,24;21:15;
26:6;39:7;40:15;
44:12;49:19;81:4;
86:20;92:16;134:10,
11;186:24;190:18,19,
20;191:5;243:12,14;
248:3,9;269:4;270:5
Rose (2)
77:24;129:10
Rosen (1)
173:12
round (4)
7:22,22;38:13;
166:20
route (2)
159:23;209:7
routine (4)
16:4;104:2;105:3;
148:24
routinely (1)
192:15
Rowes (25)
108:2;120:23;
129:15,19;131:1;
141:5,24;142:3,6,9,
16,19;143:5,14;
146:6,9,12,17;148:3,
6,17,21;149:8,19,21
RPEN (3)
7:16,17;10:20
rudimentary (1)
244:1
rule (4)
39:16;148:22;
177:24;178:2
rules (2)
32:1;39:16
run (7)
121:3;164:6;
168:16;180:10;
222:21,22;232:20
running (6)
33:4;49:12;179:3,
12;190:5;228:10
runoff (1)
29:9
runs (1)
108:23
rural (43)
11:8,14,21;20:19;
52:13;53:11;55:5;
64:6;92:24;93:1,4,
24;94:5,9,21;102:15;
122:13;130:17;
131:16;140:4;
151:22;153:9;
159:16;160:6;163:5,
6,9;166:9;175:8;
184:6;186:18;
192:15,16,19;193:12,
22,23;194:8,24;
214:7;234:11,18;
242:6
rurals (18)
63:3;93:8,11;
98:24;102:14,15;
139:24;140:11,18;
150:15,21;175:7,18;
186:15;191:12;
193:20;253:20,24
Rutu (1)
(31) Renown's - Rutu
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
198:22
RV (1)
243:3
S
Sable (10)
51:1;55:11,12;
78:18,21;80:4,6;
84:12;94:2;95:12
sad (1)
94:4
safe (1)
273:2
Saint (14)
22:1;77:24;78:7;
108:12,13,16;109:2,
12,14;129:5,10;
133:16;180:17;
213:19
Saiz (158)
5:14,15;18:20,20;
19:10;20:6;27:11,13,
13,22,24;30:9,9,22;
31:12;32:10,10;
33:22,24;34:4,7,13;
35:9,12;41:24;42:2;
46:24;48:20,22;49:4;
76:23,23;77:12,14;
78:6,10,19,23;81:1,6,
11;83:7,22;106:14;
124:23,23;125:18;
127:4,16,22;128:2,5,
14,17;129:4,8,12,16;
130:12;132:13,16,19,
22;139:7,11,17;
140:12;144:2;145:3,
9,12;146:3,7,10,15;
147:9,14,19;157:14,
17,20;176:22,24,24;
177:2;178:15;
179:14,20;180:16,22,
24;181:7,20,24;
182:15,21;183:2,8,
16;184:14,23;229:2,
2,5,23;230:1,3,17;
231:1,9,13,17,20,22;
232:2,14;233:1,5,11,
14,17,22;234:16,18,
21,24;235:4,10,18,
23;238:9;239:21;
240:10;249:4,6,10,
15,18,22;250:4,11,
15;258:20,24;
259:10;260:21;
261:1,1,11,17;262:5,
10;266:18,24;269:15,
19;272:1,6
Saiz's (2)
33:13;99:18
sale (1)
190:1
sales (4)
Min-U-Script®
51:3;107:21;199:1;
211:2
Salt (3)
14:18;15:17;
134:21
same (43)
17:10;22:17;30:15;
32:21,21;35:3;42:3;
59:14;61:19;63:23;
69:6;90:19;102:7;
111:17;127:6,13;
130:23;131:5;
135:16,18;138:8;
141:15;147:23;
151:9,9,9,15;153:13,
13;154:18;155:6,24;
156:2,15;160:24,24;
199:22;215:19;
236:12;241:2,7;
256:4;264:6
Sandstone (17)
51:3;59:20;60:12;
79:5;81:9;85:1,9;
87:11;88:6,22;89:15;
90:20;93:4;95:18;
96:6,21;98:1
sat (6)
8:7;9:5,7;114:4;
116:1;210:11
satisfaction (10)
51:16,16,17;76:10;
119:19,19,21;120:2;
213:16;250:2
satisfied (5)
105:4,4,4;137:8;
157:6
satisfy (3)
137:12,14;175:15
save (1)
17:9
saved (2)
58:4;116:8
saving (4)
13:8,8,9,12
savings (7)
58:5;92:5;120:3,7,
12;178:9;180:11
savvy (7)
185:17;216:13;
240:15;241:15,15,16;
253:19
saw (14)
78:13,14;83:7;
115:18;116:8;128:2,
6;140:12;144:1;
181:8;199:15,15,16;
240:10
Sawyer (1)
220:18
saying (9)
16:15;177:9;189:5;
220:8;239:24;
254:24;258:20;
267:19;268:1
SBC (2)
144:11;145:15
SBC's (1)
143:19
scalability (1)
80:7
Scale (2)
54:21;80:13
scaleable (1)
226:20
scan (2)
22:22;174:3
scary (1)
202:15
scenario (2)
13:1;263:19
scenes (1)
220:14
schedule (11)
118:11;121:19;
139:4,4;148:11;
217:23;218:8;
242:13;244:7;
252:12;263:10
scheduled (8)
117:2,3,19,20,21;
121:22;227:17;
251:21
schedules (2)
117:11;220:15
school (12)
60:14;61:21;164:2,
4,5,19,21;165:10;
166:18;184:3;226:1;
228:1
scope (3)
53:15;190:1;
193:17
score (19)
29:22;39:17;42:23;
106:19,20;119:20;
260:15,22,22;261:2,
5,6,12,18,19,20;
262:13;266:11,19
scored (4)
29:2,11,17;49:3
scores (23)
29:17;30:4;32:6;
106:13,16;107:1;
208:12;257:20,23,24;
258:3,9,11,13,13,14;
259:5,19;262:13;
272:2,3,5,24
scoring (8)
29:3,18,19;39:11;
106:21;107:3;
260:22;261:2
Scott (6)
199:3;234:1,3,6;
247:9;248:20
screen (7)
62:8;72:10;107:12;
Capitol Reporters
775-882-5322
116:11,12;227:16;
251:17
screening (1)
69:19
screenings (3)
57:22;66:14;228:3
screens (2)
66:13;116:11
search (2)
60:22;93:15
second (29)
8:15,15;26:17,18;
32:7;39:20;40:5;
41:1;49:22;60:4;
61:1;68:3;93:22;
96:18;106:9;115:15;
130:20;136:5;
170:11;184:20;
193:10;208:12;
227:18;228:12;
251:21;255:16;
257:19;259:23;263:4
seconds (2)
170:12;186:4
sector (4)
127:19;128:3;
150:3;160:4
security (4)
13:16;19:5,7;20:3
Seeing (12)
26:6,20;58:17;
79:3;80:19;105:12;
119:7;120:4;189:2;
247:3,4;273:4
seeking (1)
119:4
seem (4)
46:11;150:10;
213:7;256:5
seemed (1)
73:14
seems (7)
10:5;24:4;33:13;
257:23;260:21;
270:15,19
segment (2)
53:14;95:5
seizure (1)
192:5
select (8)
22:10;49:13,14;
135:13,13;138:5;
139:22;140:10
selected (11)
27:17;29:8,9;
30:13;32:14;43:24;
48:8;97:22;184:2,16;
231:9
selecting (1)
220:9
selection (5)
123:23;135:22;
180:5;248:19;256:12
selections (1)
41:23
self-funded (5)
53:1;54:2;135:16;
179:7;188:20
self-refer (1)
169:19
sell (3)
27:18;77:16;
189:21
selling (4)
155:22;189:16;
193:14,15
seminars (1)
56:2
send (13)
17:7;62:22,24;
73:19;102:18;169:8;
174:10;241:21;
242:1;248:1;251:2;
264:6;268:15
sending (1)
19:8
sends (1)
25:17
Senior (6)
14:2,17;16:21;
23:22,23;198:16
seniors (4)
93:1;94:23;218:2;
221:23
sensation (1)
130:8
sensationist (1)
129:21
sense (11)
33:6;38:20;82:1;
83:1;94:19;101:17;
208:21;221:1;222:3;
251:6;264:2
sensitive (2)
94:13;131:13
sent (11)
16:20;17:8;25:5;
59:6;69:21;134:20;
169:7;176:6;247:1,
20,22
separate (18)
9:7,13;20:1;87:9,9;
128:8;151:2,2,3;
178:24;179:11;
235:13;261:3,4,6,18;
262:11;266:19
separately (4)
138:1,1;179:1;
267:5
separation (2)
9:5,13
September (3)
28:17;109:5;178:8
series (2)
124:21;260:10
serious (1)
(32) RV - serious
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
25:9
serve (22)
50:21,22;52:21,22,
22,23;54:8;94:18;
110:8;114:1;115:24;
159:11;160:9;161:2,
17;163:1,3,5;164:8;
190:2;221:12;228:13
served (4)
41:4,5;173:11;
193:22
serves (1)
38:23
service (65)
8:1;9:18,21,23;
10:3,4,5,12;12:6;
17:16,16;65:7;71:19;
81:7,7;85:11,13,20;
86:5,7;92:23;93:13,
16,17,20;96:2;108:8;
109:7,16;110:12;
111:21,23;112:2;
113:19;115:14;
117:22;118:5;119:1;
120:1,21;121:15;
122:21;123:24;
124:1,3;125:13;
131:11;136:20;
184:8;185:16;
200:15;224:18;
229:13,16,21;236:12,
13;243:5,16;244:2;
247:12;249:13;
250:22;252:11;253:5
serviced (1)
186:21
services (68)
16:15;28:11,18,20,
21;73:4;88:3,4;
108:9,14;109:23,23;
110:1;112:1;115:7,
22;116:21;119:7;
120:15,18;121:3;
122:20;123:2,18;
124:3;149:19,22;
150:24;154:3,4;
164:15;166:16;
167:9;173:19;176:1;
186:14;192:2;194:1;
206:18;218:7;
220:10;221:14;
222:13,15;224:12;
233:10;241:10;
242:7,11,20,22;
243:19;244:8,10;
246:9,23;247:1,17,
18;252:15;253:11,
20;267:22;268:18;
269:8,8;271:5,6
servicing (2)
71:16;150:7
serving (2)
53:12;169:23
Min-U-Script®
session (2)
10:18;254:7
sessions (3)
10:15,16;254:4
set (26)
14:20;16:20;51:6;
66:14;80:8;85:10;
91:4;116:3;126:17;
128:12,16,19;141:5,
7,11;142:13;146:14,
15,17;149:6,6;
175:12;190:14;
199:9,20;243:7
sets (4)
66:21;112:5;
149:12;200:10
setting (3)
89:8;120:4;166:22
setup (1)
189:10
seven (4)
114:9;126:7;153:4;
216:3
several (10)
17:4;43:16;166:17;
167:4;183:24;
202:17;224:21;
231:6;261:11,12
shaking (1)
272:20
share (22)
6:17;12:5,22;
33:13;39:6;56:5;
57:15;58:1,18;63:22;
80:6;162:6;194:4;
199:11;201:15,17;
208:17;210:8;245:8;
260:15;272:4,18
shared (2)
105:13;224:2
sharing (1)
231:18
sheet (5)
177:4;261:3,5,6,19
sheeting (1)
105:18
sheets (5)
38:3;261:12,19;
266:11,19
shelters (1)
252:13
sheriff's (1)
165:9
Shield (7)
50:24;51:23;52:2;
55:14;59:4;87:2;
112:15
shipped (1)
23:14
SHL (1)
234:19
shock (1)
36:21
shocked (1)
270:22
Shop (3)
53:12;61:7,7
short (11)
37:22;87:23;89:1;
91:11;184:12;
206:10;232:9;
249:20;255:10;
262:20;266:16
shortly (4)
6:7;7:19;27:11;
107:10
short-term (1)
67:19
show (18)
6:1;49:8;54:13;
62:6;89:4;113:13;
119:14;145:14,16;
210:17;216:17;
224:9;230:22,23;
231:4;238:15;
252:10;260:14
showed (4)
10:17;39:12;
145:17;251:17
shown (1)
199:19
shows (1)
202:22
shrunk (1)
247:2
sick (5)
60:23;67:22;
162:16;204:1;216:22
side (25)
52:5;83:11,16;
86:7,8,17,18;110:19;
113:18;123:22;
135:16,20;136:9;
152:20;179:22,22;
188:20;192:22;
194:7;211:10;230:6,
6,9,10;272:23
sides (1)
224:8
Sierra (12)
222:13,14;231:10;
233:19;234:12,14;
235:2,6,7,8,12;
238:16
sign (1)
192:22
signed (3)
15:8;43:9;44:6
significant (6)
57:8;109:19;112:9;
171:6,17;187:17
significantly (7)
137:9,16;138:13;
171:10;177:22;
188:10;265:7
signing (1)
Capitol Reporters
775-882-5322
175:21
similar (7)
63:22;97:22;
111:11;135:18;
154:15;190:22;193:1
Similarly (2)
189:22;260:2
simple (6)
27:19;200:17;
204:13;213:6;
216:12;244:1
simpler (3)
215:6;218:6,15
simply (5)
23:12;25:16;35:16;
57:9;253:1
single (11)
32:3;55:20;66:1;
80:12;97:12;137:5,
11,11,14;199:20,21
sister (1)
127:6
sisters (2)
125:20,22
sit (15)
7:17;8:2;15:5;
39:24;45:12;75:12;
95:6;102:24;104:11,
18;105:9,24;160:17;
219:3;220:7
siting (1)
193:18
sitting (13)
9:19,20;80:17,20;
103:18,19;104:23;
105:16,18;116:10;
166:10;175:3;212:13
situation (5)
24:7;41:14;91:10;
100:6;171:2
situations (4)
7:4;22:18;91:11;
127:14
six (4)
7:2;143:11;150:6;
199:19
sixth (1)
109:5
size (2)
52:15;202:4
skill (1)
149:12
skilled (2)
56:15;164:4
skin (1)
209:17
skip (1)
89:20
skipped (1)
212:18
slide (18)
51:10;56:14;59:11;
64:4;69:11;108:10;
119:14;120:5;162:8;
163:13;166:24;
202:5;206:19;
211:19;220:3;221:6;
225:7;242:6
slides (5)
67:11;134:14;
199:9;200:13;211:3
Sloan (2)
257:23,24
Slonum (11)
158:13;161:21,23;
168:2;183:12,17;
184:15,18;189:8;
194:6,24
slots (1)
148:10
SMA (4)
224:11;227:2,3;
246:1
small (9)
46:24;52:24;53:13;
83:17;94:14;178:3;
179:9;184:13;240:14
smaller (7)
94:18;97:2;98:24;
131:17,18;179:18;
188:1
smart (16)
60:9,10,13;85:2,5,
12,19;86:2,9;130:22,
24;147:11;170:4;
185:11;240:20,22
smoke (1)
165:4
smoking (3)
130:8;165:2;
167:18
smoother (1)
8:14
snail (3)
95:1,2;96:3
social (7)
13:15;19:5,7;20:3;
126:19;165:7;203:21
soft (1)
115:11
softball (2)
100:18;150:11
sold (1)
261:9
solely (1)
139:1
solution (10)
77:5,5,6;81:23;
101:1;105:23,24;
180:13;199:10;
227:22
Solutions (4)
55:13;64:5;100:8;
268:19
solve (2)
47:17;50:1
(33) serve - solve
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
solved (1)
10:9
somebody (34)
10:9;11:1;12:19;
15:16;16:5;40:18;
55:19;79:6,7,20;
85:12;89:3;91:8;
92:8;93:20;94:10;
107:12;114:6;116:3;
119:7;147:6;156:1;
157:1,2;175:11;
195:17;196:12;
211:9;216:4,20;
250:6;251:11;
254:23;268:12
someone (13)
14:11;88:7;98:6;
115:8;132:11;144:4,
19;190:13;193:24;
203:2;211:6;212:8;
266:9
someone's (1)
206:7
someplace (2)
78:14;230:20
sometimes (11)
97:14,15;103:8;
104:16;140:24;
151:11;156:23;
169:3;206:10;208:5;
241:14
someway (1)
7:9
somewhat (4)
10:2;101:11,12;
169:23
somewhere (1)
212:16
Sonerholm (16)
198:24;209:24;
232:5,17;233:4,9;
239:6,12;240:7,9,23;
241:23;242:16;
244:18;245:10;
250:24
soon (9)
14:9;24:24;25:2;
44:10;80:2;94:9;
176:4;222:10;258:15
sooner (1)
242:12
sorry (12)
100:4;103:17;
127:16,17,24;128:8;
139:2;159:21;193:8;
207:21;245:7,24
sort (11)
36:19;56:14;76:21;
103:22;104:5;
124:19;150:13;
154:12;174:12;
195:4;208:20
sorts (1)
Min-U-Script®
25:10
sound (2)
35:12;205:16
Sounds (2)
55:11;150:23
south (102)
9:23;10:6;26:7,7,
20;27:9;30:17;31:7;
46:15;66:21;69:13;
77:2,5,24;78:15;
79:1;81:5;84:22;
99:19,21;100:11;
102:13;105:16;
106:4;111:14;128:9,
11,20;129:1,9,9;
130:19;134:10;
135:14;138:9,11,13,
20,21,21;139:3,23;
140:4,5,12,18,20;
143:2,4,14,16,20,21;
144:21;147:12;
150:13;151:3,17,22;
152:5,6,7;153:23;
154:10,17;155:3,7,9,
12,15;177:17;190:4,
6;195:13,15;196:21,
22;197:20;198:11;
199:5,23;200:5;
204:18;225:11;
227:2;229:9;230:5,7,
19;231:2,7;233:20;
234:5;243:11;253:6;
261:4,5,7,20;262:4;
267:3,5
Southern (30)
20:21;29:10;30:23;
31:2;32:18;54:20;
73:6;186:21,23;
187:6,16,19;188:4,5,
12,19,21;196:24;
200:2;211:15,18;
225:21;227:10;
230:8;236:10,11,18;
246:15;252:6;254:22
Southwest (12)
211:18,19;214:21;
215:1,8,23;216:24;
217:1,14,22;221:15;
253:22
space (10)
82:2;168:22,23;
171:8;177:22;
188:22;197:3;
221:23;225:6;236:2
Spanish (1)
62:12
spans (1)
221:17
Sparks (4)
13:6;56:2;62:18;
168:9
speak (7)
41:21;43:17;45:22;
63:14;117:11;
161:22,24
speaking (1)
244:13
speaks (1)
62:12
special (4)
73:12;99:7;205:7;
251:2
specialist (14)
24:12,18;67:1,2;
72:19,23;89:21,24;
128:18;157:1;182:2;
187:12,15;233:3
specialists (8)
24:11;78:22;
168:24;169:15,20;
181:11,12;187:16
specialize (1)
22:11
specialized (5)
127:10;203:6;
204:22;247:4,11
specialties (2)
149:12;187:23
specialty (19)
25:14;69:8;88:3,7;
98:5;99:13;143:2,15,
17,21;144:7;145:5,
16;148:12;168:23;
181:9;209:13,20;
246:14
specific (14)
50:2;73:20;76:21;
80:17;104:3;105:6;
161:11;182:10,17;
196:9;198:16;205:2;
207:12;256:18
specifically (10)
39:1;81:7;102:9;
168:3;187:11;
189:23;223:1;
238:15;248:5;266:4
specifics (2)
105:6;180:1
specified (2)
191:17;192:7
specify (1)
143:19
spectrum (4)
22:12;56:15,17;
167:9
speech (1)
257:10
spell (1)
72:11
spend (2)
11:23;200:20
spending (1)
177:21
spent (6)
20:15;51:17;
118:10;162:24;
Capitol Reporters
775-882-5322
177:15;256:16
spikes (2)
70:17;73:24
Spinelli (9)
19:1,1,16,16;20:17,
24;144:7,18;145:11
spit (1)
71:9
spoke (1)
125:18
spouse (2)
118:12;250:22
spread (4)
12:17;105:17;
179:19;188:9
spring (3)
20:18,19;56:1
square (1)
38:13
stab (1)
248:14
stabilize (1)
217:7
stable (2)
159:6;200:16
staff (22)
11:7;17:2;20:14;
36:11,19;41:10,10;
55:16;72:21;104:2;
127:3;144:5;161:18;
204:17;215:24;
220:9;229:20,21;
256:21;260:6,16,16
staffed (1)
227:21
staff's (2)
40:24;198:18
stand (2)
163:19;235:8
standalone (1)
137:23
standard (5)
126:11;155:3;
192:19;205:16;231:6
standards (1)
173:3
standing (2)
160:23;266:3
standpoint (7)
82:10;93:13;98:21;
101:16;102:1,12;
236:6
stands (2)
49:14;172:1
Stanford (1)
178:6
start (24)
5:5;6:8;31:14;
50:4;51:20;55:14;
61:5;76:20;82:20;
83:19;96:21;105:8;
119:5;124:22;151:4;
158:14;165:1;189:8;
195:8;198:2;220:8;
228:1,4;270:5
started (18)
6:21;7:2;14:4;
16:11;36:9;47:24;
53:4;54:21;64:23;
107:9;109:21;
114:11;115:4;158:2;
215:8,13,16;245:6
starting (2)
165:4;252:22
starts (6)
80:2;105:19,19;
116:17,19;162:10
starved (1)
24:21
state (139)
12:17;13:1;23:4;
28:5;31:2;50:21,22;
51:2;52:4,22,24;
53:16;54:7,9,23;56:8,
10,12;61:21;62:3;
63:7;64:5,18;65:18;
67:16,17;68:5,7;
70:1;74:9;75:3;76:6;
77:6,7,7,19,20,22;
78:4;80:12;82:13,23;
85:17;87:9,12,13;
88:18;90:1,9,14,15,
18;91:1,4,5;99:24;
100:7,15,24;101:10,
15,19,22;102:3,24;
110:13;112:17;
132:11;134:15;
135:13;149:17,22,22,
24;150:11,16,20;
151:4;154:16;
155:23;158:20;
159:2,8,18;160:5,7;
161:17;164:6;166:7;
168:9,10;169:7,22;
171:12;176:15;
178:17,17,18,20,21;
179:3,9,10,10,12;
180:11;186:3;187:4,
10,14;190:9;191:20,
24;193:4;195:12;
196:18,19;197:14;
200:8;214:24;
217:16;221:20,21;
222:7,16;225:18,20;
226:15;227:17;
231:3;233:6,7,23;
238:9;240:3;246:16;
252:4;266:8;272:22
stated (3)
58:8;134:14;185:7
statement (2)
20:3;269:10
statements (2)
19:8,9
state-of-the-art (1)
227:18
(34) solved - state-of-the-art
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
states (15)
51:23;54:6,9;
59:10;65:16;67:13;
70:12;90:11;103:23;
121:1;178:19;216:9;
246:9,13;266:4
statewide (63)
28:18,20;30:12,16;
31:6;77:2,3,3;79:1;
99:19,21;100:7,10;
101:7;111:16;
137:23;140:13;
150:17,17;151:8,20;
152:10;153:1;155:6;
188:14,16;199:19;
229:10,10,11,15;
230:5,8,9,19;235:18,
20;236:3,21;239:4,
22;248:19;252:18;
256:3,8;257:15;
260:11;261:4,6,7,9,
21;262:15;264:15;
266:22,24;267:6,8,
14,22;268:4,9,18
stating (1)
238:17
station (3)
117:14;210:15;
227:20
statistical (1)
266:13
status (4)
159:4;164:24;
165:14;172:9
statute (2)
31:14;266:3
stay (10)
26:4;87:12;88:16,
21;89:1,23;95:24;
123:15;134:19;217:8
stayed (1)
31:15
step (4)
32:23;142:2,10;
156:2
Stephanie (2)
14:19;15:17
steps (3)
53:8,9;183:24
Stevens (1)
199:6
stick (1)
254:23
sticker (1)
78:14
sticking (1)
167:21
still (34)
7:15;11:5,9;12:4,7;
17:15,16,17;20:12;
21:3;46:21;75:2,22;
86:1;87:23;89:23;
109:9;111:24,24;
Min-U-Script®
116:19,20;117:4,22;
138:6;153:16;170:1;
195:13;227:3;242:2;
247:4,20,21;248:1;
270:13
Stockton (1)
266:3
stop (3)
51:7;151:13;
223:17
Storey (1)
132:5
story (1)
224:4
strain (1)
109:19
Strap (1)
54:21
strategic (6)
162:19;163:24;
166:18;188:18;
189:1,22
strategies (1)
100:10
strategy (2)
65:2;200:6
stratified (1)
58:24
Stratosphere (1)
54:22
street (2)
62:23;64:1
strength (6)
56:10;74:16,18,24;
262:8,17
strengths (3)
109:14;201:12;
223:10
stress (1)
167:17
stresses (1)
63:15
strike (1)
195:21
strikes (1)
135:5
stroke (1)
25:3
strong (8)
109:16,16;110:4;
120:24;123:17;
165:8;214:14;236:24
stronger (3)
111:4;178:5;
219:16
strongest (1)
225:6
structure (5)
63:8;71:15;169:17;
200:16,18
structured (1)
68:18
structures (1)
224:7
struggle (2)
39:21;40:13
struggling (2)
38:8;214:24
stuck (1)
210:8
student (2)
233:6,7
studies (1)
208:12
stuff (6)
20:11;39:11;
181:10;231:20;
247:19;248:1
subdermal (1)
174:4
subject (3)
74:1;137:5;198:15
submission (1)
199:18
submissions (1)
32:9
submit (7)
19:4,5;20:2,4;
239:21;258:21;
272:12
submitted (12)
13:18,21;15:9;
32:12;239:8;240:5;
267:13;268:9;
270:21;271:17,19,19
submitting (2)
239:22;271:11
subsidiary (1)
107:22
subsidized (1)
166:16
subsidizing (1)
154:9
subspecialists (1)
247:2
subspecialty (2)
175:6,8
substantial (3)
178:9;197:9,10
substantially (2)
29:11,14
success (2)
165:6;200:20
successful (7)
10:5;124:14;
155:16;171:6;243:9;
252:16;253:13
sudden (1)
177:6
suggest (2)
257:21;272:19
suggested (2)
11:16;14:24
suggestion (8)
6:24;40:22;41:13;
43:5;46:20;259:14;
Capitol Reporters
775-882-5322
260:19;267:12
suggestions (1)
10:1
suit (1)
56:20
suite (4)
64:9;82:6,22;
227:20
suited (1)
151:7
suites (1)
81:11
summarize (2)
74:14;123:11
summary (5)
42:3,9,10,19;
146:20
super (1)
209:17
superb (1)
175:4
supervisors (1)
10:13
supplement (9)
18:24;19:11,12;
20:1;55:22;56:1,3;
58:12;134:15
Supplementing (1)
120:23
supply (2)
226:3;271:6
support (12)
56:13;72:6,17,17;
74:6;112:12;113:22;
123:17;204:11,20;
206:14;220:20
supposed (9)
31:1,1;32:9;41:15,
17;109:5;116:21,24;
117:18
sure (70)
6:2,2;13:4,5;18:1;
34:7,9,10;42:14;
55:5;58:2;74:4;
78:14;79:22;86:8,24;
88:16;89:7;90:20;
94:15;95:15,24;98:7,
9;129:15;131:24;
132:15;142:23;
148:10;151:14;
162:17;163:9;
164:18,20,21;165:4,
10;168:23;170:13;
173:5,5,10,16;
174:23;177:1,12;
180:4,13;183:17,22;
184:5,21;186:5,10;
190:1;193:21;203:9,
18;209:21;210:22;
217:2;220:5;230:23;
238:24;251:3;
252:20;253:9,14;
258:7;268:15
surface (1)
86:17
surgeries (1)
175:10
surgery (3)
13:14;61:7;120:14
surprised (1)
195:5
surrounding (2)
142:22;200:9
sway (1)
272:5
swayed (1)
17:21
sweety's (1)
174:9
swipe (1)
64:12
switch (1)
185:2
Switzerland (1)
108:20
symptom (2)
215:20;218:16
symptoms (3)
218:18;241:4;
242:1
synonymous (1)
162:14
synopsis (3)
36:19;41:4;129:13
system (34)
8:4;9:9,11;10:10,
23,23;11:3,4;13:24;
23:22;43:16;57:6;
93:19;109:4;113:5;
114:2;118:1;122:10;
142:2;146:14;
165:10;182:17;
194:21;203:16;
213:4;217:10;
218:15;224:13,19;
225:4,4;230:24;
256:4,8
systematic (1)
59:1
systems (13)
56:7,9;110:22;
150:5;189:9,18,18;
213:19,20;222:19;
228:1;237:4,5
T
tab (1)
38:1
table (8)
9:20;64:17;66:15;
74:20;94:17;169:10;
198:20;214:20
tabletop (1)
64:16
Tahoe (1)
(35) states - Tahoe
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
10:13
talk (53)
8:3,3;52:18;54:1;
55:3,9,17,23;58:23;
59:22;65:11;66:23;
72:14;76:14;85:14;
87:4,6;98:3;103:1;
104:10;106:1;108:7;
110:10;114:19;
115:1,8;117:10;
118:2;124:7;125:5;
127:9,11;143:4;
170:4;183:3;193:2;
201:5,6;211:1,5,13,
19;214:10;220:7;
221:4;222:24;
223:12;226:17;
227:8,9;228:6;
240:17;248:11
talked (26)
9:17;11:21;12:9;
57:14;64:22,23;
70:19;85:10,21;
87:14,24;90:1;105:8;
116:19;150:12;
151:16;156:24;
165:6;206:23;
218:20;219:10;
224:11,20;246:8;
251:10;254:3
talking (34)
11:10;12:2;43:18;
54:20;55:14;56:14;
59:11,20;66:19;
82:16;105:14,15,20;
116:17;117:22;
119:8;122:6;125:24;
131:5;133:11;
139:12;141:15;
148:12;150:20;
155:5,5;160:20;
171:23;202:21;
209:2;210:5;228:9;
240:13;241:18
talks (5)
64:4;65:10;69:11;
120:5;214:23
tallied (2)
258:15,15
tally (1)
221:13
tap (1)
67:14
tape (1)
191:2
Target (1)
61:5
Tax (1)
171:23
team (46)
51:4;55:15,15;
56:21;61:11;65:7;
71:14,19,20,22,24;
Min-U-Script®
72:17;73:2,5,8,11,19,
21;74:7,8,10,11;
81:10;85:21,23;86:1;
93:7;97:3;105:18;
106:1;107:14;108:4,
6;112:2;118:15;
186:5;198:17;
203:13;205:6;
219:18;220:16;
222:2;223:19,24;
247:11;250:17
teasing (1)
193:20
tech (1)
243:2
technical (3)
29:22;45:10;
258:19
technically (2)
34:16;48:6
technologies (1)
166:6
technology (26)
54:15,16;57:24;
58:22;60:14;83:18;
85:4;109:20,21;
130:22;166:14;
173:4;185:11,17,21;
194:1;200:14;
222:19;224:12,22;
225:1;226:7,18;
240:15;242:3;243:23
teenagers (1)
216:19
teeth (1)
69:6
Tele-Doc (6)
146:6,7,12,13;
147:13,15
telehealth (6)
83:18;146:5;147:6,
16;253:19;254:5
tele-help (2)
55:5;226:16
telemedicine (21)
121:24;122:15;
131:8;146:4,12;
175:5,23;182:22,24;
192:16,23;215:21,22,
24;216:7,8,10,10,23;
240:18,18
telemedicines (1)
175:6
telephone (4)
185:22;205:17;
218:17,20
telephonic (2)
115:7;241:8
tele-visit (1)
203:17
telling (3)
23:23;25:10;
116:19
tells (1)
118:9
temperature (1)
64:11
ten (30)
29:20,24;49:10;
54:6;74:14;114:9;
115:13;119:22;
125:9;141:16;153:5;
172:18;258:17,18,22;
259:5,10,20;263:14,
15,20;264:5,8;265:9,
9;270:14;271:13,13,
15;272:13
tenants (2)
59:14;131:3
tend (1)
150:15
tendency (1)
113:4
tens (1)
167:4
tenure (1)
220:11
tenured (1)
220:21
term (20)
23:4,5;68:3;87:23,
23;89:1;91:12,12;
101:21;120:2;165:6;
172:12;180:12;
198:11,11;202:10;
208:8,9;211:23;
212:3
terminal (1)
126:14
terminology (2)
238:5,12
terms (30)
29:4;33:6,8;38:14;
90:22;121:1,6;123:5,
6;130:1,10;136:14;
143:5;157:3;174:22;
190:9;201:20,22;
202:10;205:18;
206:20,22;207:1;
223:10;225:11;
244:9;245:17;
246:11,22;256:9
terrific (1)
191:12
test (9)
102:10,11;117:12,
16,17,17,19,19;
118:11
testimony (1)
10:24
testing (3)
43:17;105:5;
251:24
tests (5)
116:22;117:1,2,3,
12
Capitol Reporters
775-882-5322
Texas (7)
68:8,9,12,13;
109:11;121:2;251:20
Thanks (6)
21:14,15;50:15;
55:11;157:12,20
Thanksgiving (1)
34:16
theirs (1)
262:11
therapeutic (2)
142:24;148:24
therapeutics (1)
142:20
therapist (1)
63:15
therapy (2)
142:2,10
therefore (7)
22:3;23:2;24:18;
32:22;179:4;188:11;
249:1
thereof (1)
267:7
thinking (12)
30:15;42:3,21;
49:9;82:4;91:15;
163:1;164:5;183:13;
202:14;255:8;257:3
third (5)
16:18;117:24;
163:7;227:18;251:21
though (7)
75:1;195:12;204:1;
222:1;235:13;257:9;
268:2
thought (11)
8:9;18:14;41:15;
57:20;114:3;210:7;
240:10;243:20;
244:6;252:5,10
thoughts (1)
163:12
three (39)
7:5;9:14;15:3;
16:22;26:12;29:9;
32:22;35:2;51:11,14,
22;77:3,9;81:24;
95:23;100:2,4,5;
101:10,18;102:2;
106:11;107:6;
129:20;133:9,10,20;
139:2,15;150:15;
176:18;207:16;
217:15;219:15;
220:22;234:10;
258:8;259:4;265:13
three-month (3)
231:24;232:2,6
three-way (1)
117:9
throat (3)
67:3,5;187:24
throughout (19)
51:5;53:16;54:23;
56:16;69:2;75:8;
94:16;119:10;
147:17;149:22;
159:11;160:5;168:9,
24;187:10;196:18;
215:9,10,17
throw (2)
33:15;262:24
Thursday (2)
117:5;174:1
thus (1)
123:1
TIA (3)
24:24,24;25:3
tied (2)
130:18;213:16
tier (4)
89:16;96:23;97:19;
145:22
tighter (1)
194:13
timers (1)
118:6
times (12)
8:6;11:17;22:6;
52:15;65:13;137:1;
139:22;141:3;
168:15;185:12;
221:2;250:16
timing (3)
48:19;142:12;
216:20
Tina (2)
43:12;255:11
tobacco (1)
129:21
today (65)
5:13,16,21;6:17;
21:22;27:20,22;28:6;
29:13,16;38:16;
40:19;42:23;43:8;
49:13;50:20;51:1,11;
75:12;76:24;77:17;
98:8;107:20;110:3;
111:12;122:7;
158:12;159:4;
161:24;170:1;172:1;
176:6;185:19;
186:20;192:15;
193:5;198:15;
199:10;213:12;
215:2;220:19,23;
221:5;225:13;
227:14;228:16;
232:11;245:11;
248:18;254:1;
255:10;256:16;
257:7,13,20,22;
258:1,7,15;260:9;
266:4;267:21;
268:17;270:14;
(36) talk - today
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
271:15
today's (2)
23:7;220:10
toddler (1)
204:21
together (34)
8:3;11:5;20:12;
51:14;71:6,8;73:5;
78:2;102:19,20;
104:1;106:1;121:19;
158:22;161:11;
162:21;163:2;164:5;
165:19;168:20;
170:23;172:13;
174:21;179:5,8,8;
180:13;219:19;
247:15;251:4;
255:23;256:14;
258:8;262:11
told (9)
16:16;22:21;24:1;
35:5;45:11;47:1;
131:9;210:6;272:12
Tonopah (6)
81:15,15,18;
183:10,10,15
took (10)
15:3,4;16:4,5;
28:16;111:13;
115:13;190:24;
265:18,19
tool (8)
61:2,3,8,11;63:6;
71:10;127:10;219:6
tools (17)
58:3;59:21;60:2,6,
7,8;61:24;65:7;75:3;
86:10;101:2;170:21;
200:24;211:4;
214:19;218:12;
245:13
top (10)
18:2;64:17;74:14,
15;86:10;127:18;
177:12;181:14,18;
207:16
topic (1)
126:20
total (3)
13:15;23:19;37:20
touch (12)
101:8;114:18;
162:23;172:16;
174:15;191:2;
200:13;202:4;
203:16;209:16;
214:8;218:10
touched (2)
122:4;206:20
tout (2)
70:6;75:2
toward (1)
136:22
Min-U-Script®
towards (5)
44:6;57:6,11;
186:11;232:22
Towers (3)
7:8;20:19;21:4
town (8)
94:10;236:10;
247:2,19,21,22,22;
248:1
TPA (1)
107:22
tracking (1)
186:1
Tracks (2)
174:17;185:3
traditional (1)
86:19
traditionally (5)
47:20;57:5;63:9;
196:19;208:8
trained (2)
82:23;204:17
training (1)
18:11
trajectory (2)
204:9,14
transact (2)
225:2;249:14
transaction (1)
222:12
transactional (1)
58:16
transfer (1)
115:12
transformation (1)
59:17
transforming (1)
58:9
transient (1)
245:19
transition (13)
43:20;109:12;
121:17,18;140:24;
141:1,12,17;147:24;
148:3,13;194:15;
225:3
transitioning (1)
149:1
transitions (2)
99:8;125:22
translate (2)
203:2,9
translates (1)
202:18
transmitted (1)
227:4
transparency (6)
21:20;60:2;161:8;
207:7;232:10;235:22
transparent (9)
25:21;161:9,13;
182:8,19;207:15;
238:6;248:24;272:8
transplant (3)
214:17;246:19;
250:7
transplants (1)
88:8
transport (1)
88:12
transportation (3)
203:21;227:24;
252:9
transported (1)
134:19
trauma (1)
167:10
travel (5)
121:6;134:15;
153:15;250:10,11
treasury (1)
246:20
treat (2)
210:3,24
treated (3)
133:2,2;210:4
treating (2)
99:5;191:18
treatment (2)
25:4;79:7
treatments (2)
99:13;205:5
tree (1)
186:3
tremendous (4)
21:20;222:3;
225:16;226:11
trends (2)
119:14;200:16
triage (2)
122:23;217:7
trials (1)
6:22
tribulations (1)
6:22
tried (8)
35:21;38:12;53:7;
143:19;144:14;
187:8;236:22;242:19
tries (1)
54:24
trigger (1)
95:23
trimester (1)
117:24
trip (1)
220:6
triple (2)
121:14;123:6
trouble (1)
79:16
troubles (1)
114:24
Truckee (1)
165:18
true (7)
Capitol Reporters
775-882-5322
24:12;45:14;128:3;
221:8;229:14;
268:18;270:23
truly (4)
25:17;176:11;
222:21;260:18
trusted (4)
53:19;54:6;74:17;
119:4
try (21)
17:22;38:24;52:17;
54:15;64:18;80:13;
91:14;125:16;158:9;
173:2;177:14;181:3;
208:2;215:6;226:23;
228:2;243:6;252:17;
255:4;256:7;262:20
trying (36)
12:4,13;16:16;
33:12,14,14;38:12;
57:9;73:22,23;76:7,
11;83:19;86:15;89:2,
9;109:13;129:17;
140:15;147:5;153:1;
166:13;171:3;
177:11,16;188:3;
196:1;218:15;
236:17,20;237:1;
242:19;246:11;
260:15;261:15;
263:18
Tuesday (1)
226:14
tunes (1)
167:4
tunnel (1)
197:13
turn (13)
50:13;55:8;136:5;
158:2;161:21;
167:15;168:1;
172:15;190:22;
201:11;219:2;
259:18;260:24
turned (1)
198:1
turning (1)
83:12
TV (1)
61:4
twice (2)
25:1;189:8
two (77)
9:7,18;13:3;16:23;
22:20;24:8;28:20;
38:15,24;40:8;45:12,
18;47:9,23;52:15;
54:12;55:3;60:17;
67:19;68:9;89:1;
90:4;91:11;100:1;
109:2;114:3;116:10;
123:16;125:14;
126:22;129:20;
133:10,12,17,24;
135:13,14;137:1;
138:7,20,21;139:2;
141:12;152:7;
159:23;175:5;
192:11;193:8;196:2;
199:18;200:1;210:5;
215:14,22;216:17;
220:22;225:14;
227:19;233:20;
236:19;246:2;254:3;
256:14;258:8;
262:15;263:11;
265:18;266:21,23;
267:5,9,9,9;268:2,3,
21;270:6
two-thirds (3)
118:22;119:6,12
two-way (1)
62:4
Ty (8)
158:5,10;162:8;
165:23;168:1;
173:19;176:4;195:7
type (12)
22:23;57:12;65:22,
23,23;66:4;113:18;
114:20;215:14;
242:22;260:4;269:11
types (3)
22:11;221:17;
271:5
typical (4)
89:4;114:7;119:22;
124:5
typically (6)
67:16;82:10;
115:14;220:15,17;
232:6
U
UCLA (1)
247:12
UHS (3)
108:22;109:3,19
ultimate (1)
266:10
ultimately (3)
120:1;165:14;
223:8
unable (1)
246:14
unanimously (2)
26:22;32:14
unanswered (2)
270:15;272:24
uncomfortable (1)
176:19
under (32)
30:10;52:21;56:24;
68:15;69:9,13,14;
87:5,11,21,22;89:17;
(37) today's - under
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
90:5,5,11;91:3;
93:12;97:20;143:6,
15,16;144:7;145:4,8;
148:9;153:16;
169:16;192:13;
230:20,20;239:15;
248:22
undermine (1)
214:12
underserved (3)
123:1;131:6,13
understood (1)
271:12
underwrite (1)
121:5
underwrites (2)
73:9;123:15
underwriting (3)
73:8;154:18;
221:14
unfair (1)
195:19
unfortunate (2)
172:21;263:12
unfortunately (7)
46:17;102:8;
179:12;180:14,21;
192:19;204:23
unhappy (1)
212:5
uniformly (1)
183:6
unique (16)
24:7,8;112:6,16;
113:7;120:21;
160:11;169:23;
176:10,11;189:10;
190:4,6,7;211:21;
256:11
uniqueness (2)
72:3;110:13
unit (7)
153:20;184:13;
217:9;221:16;
243:16;244:14;
251:16
United (19)
32:13;90:11;
149:19,21;198:12,21;
209:11;214:12,16;
216:8;218:11,11;
219:5,18;222:1,2,17;
234:7;246:8
Universal (3)
108:13;123:17;
150:5
universities (1)
226:1
University (7)
163:24;164:3,6,11;
166:18;184:3;247:13
unknown (1)
259:8
Min-U-Script®
unless (9)
90:1;91:10,24;
102:17;142:15;
176:19;263:23;
266:9;267:16
unlike (2)
101:24;145:16
unlock (1)
107:12
unmanaged (2)
155:19,20
unquote (1)
188:11
unusual (1)
36:6
up (139)
7:4;8:23;9:1;10:4,
13,15,17;11:12;12:7;
14:11,20;16:2,18,19;
18:5,21;21:5;22:12;
32:2;33:4;37:20;
39:12;41:19;43:5;
46:14;49:8;51:14,15;
53:3,24;54:1;56:7;
60:1,21;62:8,16;
65:18;66:14;68:7,9;
69:19;73:9,13;77:10;
78:15,21;79:20;81:4;
82:21;85:10,15,15,
17;86:15;88:7;89:4;
91:4;94:2,9,11;99:1;
100:8;104:19;
110:23;114:12;
115:5;116:2,3,11;
117:21;118:4,6,15,
18;120:14;126:13,17,
18,24;128:12,16,19;
129:5;134:18;
135:14;137:7;138:6;
140:6;143:2;144:19;
152:7,15;153:15;
156:1,3;157:8;166:4;
167:9;170:16;
175:12;181:8;184:1;
192:22;193:21;
195:14;196:14;
198:14;199:7;207:5;
208:19;209:3,4,22;
210:17;212:9;
213:20;216:11,17;
218:18;220:3,14;
221:13;228:8,10,16,
24;229:2,12,21,23;
231:22;238:15;
243:7;245:23;246:2;
251:14;254:24;
260:14;266:2
upcoming (2)
112:10;178:11
update (2)
7:1;97:4
updated (1)
8:12
upgrading (1)
109:20
uphold (1)
121:14
upon (16)
66:17;70:18;79:12,
12;97:16;135:1;
144:12;148:7;
154:19;162:4;219:7;
221:6,13;224:16;
230:12;266:8
upper (3)
7:6,9;11:9
URAC (4)
159:21,23;160:1,1
urban (1)
153:8
urgency (2)
104:8,12
urgent (19)
67:23,24;87:14;
122:24;147:7;
175:13,18;184:12;
191:16;205:19;
209:2;215:11;217:2,
5,6;218:19,22,24;
244:14
USC (1)
247:12
use (32)
22:23;34:1;35:11;
67:22;83:18;103:3;
104:24;115:22;
125:6,10;130:21;
136:18;139:9;
164:15;166:14;
169:9;173:3;178:10;
193:24;213:13;
216:12,16;217:24;
227:24;243:15,23;
247:4;248:23;252:2,
5;253:9;268:18
used (9)
22:5;56:21;91:22;
101:1;103:7;177:24;
178:24;219:17;
246:11
using (10)
8:24;38:14;61:8;
88:15;101:7;127:2;
205:14;227:2,3;
262:13
usually (1)
66:1
Utah (6)
11:24;12:3;23:14;
121:2;236:10;247:13
utilization (16)
83:3;91:23;105:11,
20;115:21;119:14;
120:13;154:2,5;
155:6;206:22;218:6;
231:21,22;235:16,22
Capitol Reporters
775-882-5322
utilize (6)
169:5,6;185:21;
214:18;226:7;243:5
utilized (1)
238:18
utilizing (3)
76:6;218:2;226:17
V
vacation (1)
89:6
vacationing (1)
10:13
valid (1)
42:16
validate (2)
114:8,11
validated (1)
173:7
Valley (4)
134:4;215:9,10,17
valuable (1)
204:14
value (15)
57:6;58:19;59:18;
164:7;199:11;200:4;
212:23;213:3,13;
214:11,20;224:4;
256:3,3;262:15
values (3)
160:21,24;162:7
variability (1)
150:20
variables (1)
207:23
variation (1)
141:16
variety (4)
167:22;203:20;
204:2;206:4
various (5)
126:3;135:19;
226:2;242:13;254:7
vary (2)
135:15;136:1
vast (1)
52:7
vaults (1)
166:3
veer (1)
91:23
Vega (1)
153:12
Vegas (36)
5:17,18;6:9;8:23;
9:1;11:11;12:15;
30:5;52:20;54:22;
55:17;56:3;65:19;
71:19,21;73:10;
109:4;127:17;
128:23;150:6,21;
153:9,15;187:19;
209:5;223:3;229:18,
24;234:10;245:19;
246:23,24;247:3,24;
253:3;270:5
vehicle (1)
252:14
vendor (17)
27:17;36:21;43:18,
24;46:14;48:9;79:21;
80:1;98:8,10;101:1,2,
7;139:4;184:16;
257:15;267:8
vendors (17)
27:15;28:22;29:9;
32:12,17;34:23;
37:14;41:18;43:14,
24;44:24;48:9;77:16;
78:24;255:11;
267:15,21
verify (2)
192:18;193:2
versa (1)
139:23
versed (1)
201:20
Versik (1)
125:6
V-e-r-s-i-k (1)
125:7
versus (7)
70:14;120:8,11;
155:3;260:9,10,11
veterans (1)
222:1
Veteran's (1)
122:18
VHO (1)
199:2
via (1)
234:14
viable (3)
268:1,9,10
vice (11)
8:1;55:13;107:9,
20;139:23;158:10;
198:24;199:4;211:1;
234:3,7
video (9)
62:4,7,15;158:15,
16,23;166:11;
190:20;199:6
View (5)
94:6;151:2;206:12;
266:20,21
viewed (1)
247:15
viewpoint (1)
12:14
views (1)
190:10
vigorous (1)
126:6
violate (1)
(38) undermine - violate
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
22:19
virtual (5)
61:20;175:13,23;
183:1;192:24
virtually (1)
60:1
vision (13)
14:3,5,6;69:2,6,11,
12,15,20;70:2;162:5;
163:14;165:19
visit (16)
62:17,19;63:24;
64:1;95:12,13,14;
192:8,24;216:21;
219:1,4;227:3;241:1,
2,18
visitation (1)
194:22
visiting (1)
193:15
visits (13)
61:14;70:13;
175:13,23;183:1;
191:17;203:8,17;
206:6;209:21;
215:18;216:8;217:7
visual (1)
240:24
voice (1)
127:8
volume (2)
57:5;216:9
volumes (1)
58:6
vote (6)
26:22;27:20,22;
30:11;49:13;52:16
voted (1)
39:20
VP (1)
107:21
W
Wait (9)
43:11;85:6,6,7;
127:9;174:8;185:13;
219:1,4
waiting (11)
62:14,15;113:9;
118:6;198:5;218:22;
219:4;244:15,18;
245:5;258:18
Wal-Greens (1)
62:23
walk (3)
64:10;71:15;
104:16
walk-in (1)
215:18
walk-ins (1)
12:11
wallet (1)
Min-U-Script®
170:19
walls (1)
184:20
Wal-Mart (1)
61:5
wants (4)
40:7;43:1;63:4;
231:4
Warner (1)
112:15
Washoe (10)
78:19;133:10,12,
19,20;150:1;163:4;
186:17;237:4,5
watch (1)
185:24
watching (1)
21:22
Watson (4)
7:8;21:4;54:14,15
way (64)
17:9;23:21;27:8,
16;30:15;35:22;36:9;
38:2;49:17;51:14;
52:2,9;60:1;63:14;
65:8;81:2;91:22;
103:8;110:19;
114:11;119:20;
121:11;136:24;
145:10;148:23;
149:16;151:9;
152:16;156:22;
157:4;162:7,12;
165:5;167:9;174:5;
178:23;186:18;
195:21,24;196:8;
197:11,24;198:4;
204:10;206:12,12,17;
207:7;210:7;216:20;
222:22;232:19;
241:5;242:7;243:22;
248:8;257:16;
261:13,23;265:21;
268:5,5,18;272:5
ways (10)
11:5;36:4;89:9;
95:7;104:8;113:11;
125:14;159:23;
225:8;241:13
weaknesses (1)
109:18
web (1)
241:6
webcam (1)
241:17
webinars (1)
56:4
website (7)
10:1,2;60:18;
243:21;244:7,20;
245:9
websites (1)
245:8
week (17)
13:23;34:16,17;
36:22;39:10;184:1;
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251:21;253:10;
254:9;255:16,16;
259:24;263:4,12
weeks (14)
24:9;35:2;43:2;
44:2;116:22;118:3;
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weighted (3)
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65:10,10,14;66:14;
70:19;129:12,13,14,
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204:3,6,20;206:20;
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Wells (3)
5:16;182:9;231:19
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31:1;41:16;231:9;
240:1,1
West (2)
133:20,21
what's (20)
8:5;21:22;37:15;
43:22;56:22;89:3;
99:20;112:16;
114:14,16;130:4;
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222:5;245:18;255:19
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227:19
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198:7;255:23;
271:16
Whereupon (3)
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158:16
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272:14
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59:3;68:24;69:3,7,9,
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194:3;199:17;
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230:15;242:22;
245:7,9,11,13
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118:18;126:24
WINDFELDT (22)
158:6,10,17;168:2;
176:8;177:10;
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180:19,23;181:2,13,
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Within (31)
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141:2;148:8,10;
149:3,9,17,19;
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169:7;170:9;177:14;
179:2;199:24;
231:23;245:21;
255:10
without (14)
30:13;42:11;48:24;
86:9;91:2;92:7;
139:23;156:1;
167:20;175:9;
222:23;242:3;
246:16;267:16
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271:22
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271:8
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270:11
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27:15;41:7;43:19;
50:12;60:17;64:20;
65:17,19;66:3,18;
71:7;74:22;79:9;
82:11,19,23;86:1,10;
88:9,10,12,17;90:2;
92:10,10;93:1,3;
95:22;98:16;99:8;
100:10;103:5;
104:19;106:2;
117:20;135:5;
136:24;148:2;
160:14;162:20;
163:16;165:8;166:7;
167:1;173:10;
174:12;181:3;184:7;
188:7,8,20;192:12;
194:3,21;196:20;
197:6,13;199:15;
203:21;241:17;
245:6;272:17
workable (1)
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272:22
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126:19
working (36)
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12:4,20;17:15;18:1,
12;20:18;22:15;
61:11;63:13;65:2;
67:7;95:3;103:19,19;
105:14,19;158:22;
159:15;160:4,12;
161:12;175:20;
183:6,21;212:14,14,
16,19,20;232:19,22;
244:3,9
works (13)
47:16;52:12;66:3;
73:5;91:21;109:17;
135:15;136:14;
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(39) virtual - worry
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
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Z
zero (6)
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0
07 (1)
222:13
1
1 (3)
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262:3
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84:10
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5:5
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11:13;13:14;14:13;
171:18;175:15;
17:22;18:23;19:3,6,6,
180:9;189:9;215:3;
13;20:2,21;24:1;
245:23;246:2
96:20;104:15,19;
11th (1)
116:14,14;119:10,16;
7:8
141:4,10;159:20,20; 12 (2)
160:2;164:15;
201:18;211:2
165:24;171:5;
12,000,000 (2)
187:20;189:23;
59:7;147:17
196:13,13;197:9;
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207:8,24;212:1;
107:5
217:19;226:12;
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244:12
126:14
years (44)
13 (4)
6:20;7:5;13:2;
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130,000 (2)
67:8;112:10;113:17;
59:8;159:11
126:7;158:21;160:8; 14 (6)
161:10;167:19;
51:23;54:6,8;
172:19;173:2;
65:16;226:9;254:6
174:20;195:19;
140 (1)
199:11,12,14,15;
10:17
200:16;201:5,18;
14th (1)
210:5;211:2,14;
18:10
215:14,22;219:15;
15 (4)
220:14,22;221:20,24;
119:22;147:3,12;
223:14;224:21;
194:11
225:15;227:12;
158 (1)
231:8;236:20;246:3;
157:19
247:2
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257:18
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164:14
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120:7
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87:3
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202:7
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108:11
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108:12;109:21;
178:8
2
2,000,000 (1)
188:6
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135:24;136:19,23;
137:1,6,10;138:23;
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181:9
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62:10;63:5
20 (10)
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144:13,16;147:4;
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226:15
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263:1
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226:12
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59:5
27th (1)
28:23
287.04345 (1)
266:4
3
3,000 (4)
134:18;135:24;
139:15;222:7
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54:8
3,500 (1)
134:18
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212:19
3.3 (1)
58:6
30 (14)
98:15;113:17;
115:15;143:3,16;
145:17;147:4;163:6;
170:12;186:4;203:7;
211:14;221:24;
223:14
30th (2)
28:12,14
3202 (1)
28:18
322 (1)
78:21
35 (2)
134:18;237:15
350,000 (1)
226:9
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28:15
362 (1)
215:2
37 (3)
208:8,9,13
38 (2)
208:11,13
4
4,000 (3)
135:24;139:15;
222:7
40 (10)
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13;252:10
40,000 (1)
237:15
40,000,000 (1)
52:1
400 (1)
52:19
400,000 (2)
163:3,5
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241:16
45 (15)
15:7;29:18,19;
30:21;31:4;35:4;
49:10,15;258:18;
259:8;263:21;265:9,
9;271:8,10
48,000,000 (1)
166:1
5
5,000 (4)
136:1;137:3,11;
139:16
5,500 (1)
13:15
5:30 (1)
15:14
50 (3)
67:13;192:12;
252:10
500 (2)
78:12,14
55 (4)
49:13,14;263:22,
24
56-year-old (2)
178:20,21
6
6,000 (1)
196:11
60 (1)
98:15
600 (2)
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62 (1)
78:22
65 (2)
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(40) worrying - 65
Monday
December 7, 2015
Public Employees' Benefits Program Board
Videoconferenced Open Meeting
67 (1)
119:3
7
7 (1)
5:1
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128:3
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58:6
70 (1)
119:19
728 (1)
177:5
7th (5)
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32:18;263:2
8
80 (3)
115:22;178:1;
207:5
80/20 (1)
177:24
832 (1)
177:4
8th (1)
28:17
9
90 (10)
10:7,8;67:20;68:6;
119:9,13;141:14;
148:4,13;213:22
90-day (3)
98:15;141:12,17
90s (1)
247:23
92 (1)
52:8
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178:2
96 (1)
52:7
99 (1)
119:19
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