Edit Grant Details

Gather data on emergency room usage and urgent care alternatives; present final analyses of Composite Segmentation study and urgent care options to trustees.

Committee approves surveys and plans for implementation of recommendations and directs assignment of responsibilities through its Working Committee.

BCBS issues final report, including data on responses and engagement results and recommends surveys & any continued follow-up plans for implementation.

Communications are initiated to subgroup members under BCBS rubric.

Trustees review plans, and determine continuation of study.
Trustees approve sharing of data and direct any changes.
Trustees receive recommendations for plans for various, targeted communications.

BCBS provides preliminary report to Working Group regarding specific comparison data and diverse communication programs and study methods.

Telligen provides program participation data, and the City provides wellness enrollment and participation in order to refine and validate the segmentations created by BCBS.

The LMCC will identify third party and City health management vendors to gather data, and approves program outlines.

City of Chicago Labor Management Committee
Grant Report to the Federal Mediation and Conciliation Service
January 2020

The City of Chicago and its unions established a joint labor-management cooperation trust as a non-profit organization established under 501(c) (3) of the IRS Code. It is the Chicago Labor Management Trust, and it is governed by the Labor Management Cooperation Committee (“the LMCC”) consisting of labor leaders and City officials. From 2007 through 2017, labor and management agreed upon a target limiting any “projected increase in costs for any individual plan of no more than 8 percent.” If costs increased more than 8 percent, then the LMCC was required to make the changes necessary to bring the cost increase below that level through such methods as increased co-payments, deductibles or other means. New collective bargaining agreements for trades and AFSCME follow the LMCC model under various savings terms, and certain collective bargaining agreements are currently under negotiation.

In 2010, the Chicago LMCC received FMCS grant funding to conduct an analysis of the projected future costs for the City’s health plans. The health plan cost study recommended creation of various programs for savings including ones that promote wellness, diabetes and chronic disease management, maternity management, radiology review and the creation of tiered networks to encourage the use of preferred providers. The LMCC proceeded to implement those programs and others in order to address the projected long-term costs.

The study in 2010 also showed that targeted communication in a variety of modes should also be initiated. Participation has been lower than desired in some programs, especially in telemedicine, alternatives to emergency room usage, counseling for those with hypertension and hyperlipidemia, preventive dental and colorectal screening for members over age 50, fostering medication compliance and encouraging the use of free-standing (non-hospital) facilities for high-cost testing such as magnetic resonance imaging (MRIs).

To address this problem, the City and the LMCC applied for this second grant in 2017 in order to conduct a study designed to segment the LMCC population and target communications to each segment. The grant award totaled $95,000, and the City provided a 10 percent additional contribution. The Segmentation Study and the corresponding pilot communication programs used targeted messaging for better-informed choices by families and more information for members. The segmented outreach program increased participation in one of the programs promoted by the LMCC. Additionally, the Segmentation Study allowed the Chicago LMCC to learn where communication problems may have been limiting or impairing engagement. This Segmentation Study also yielded data on problems related to incentives and retaining members that the City of Chicago and the LMCC will now use both with its provider contracts and with ongoing member relationships.

Specifically, the Segmentation Study revealed that digital communications with employees and their covered dependents was restricted. Under law and the terms of employee email, health care communications could not be delivered electronically without the express prior consent of each member. Also, the City’s online platform could not be effectively modified to allow targeted communications. The study also indicated that a targeted communications strategy was needed and should include brochures, letters, email and phone outreach when permitted.

The results so far have shown a significant increase in the number of members receiving preventive dental care for their children, which can be a link to longer-term healthy practices and provider relationships. Data also showed that the telemedicine outreach remained stubbornly ineffective. This lead the City and LMCC to consider eliminating its telemedicine program, as of the end of the year, and they will instead seek other design and contracting options for telemedicine if it will be offered again in the future.

Overall, the Segmentation Study assisted the City of Chicago and the LMCC in reassessing its member outreach. In the short-term, it provided data to inform contracting decisions and member outreach programs. In the long-term, it provided tools to increase member engagement that should help to bend the healthcare cost-curve for the City’s benefits plans. The City and the LMCC plan to use the results of the Segmentation Study to communicate about its future programming. Early indications also show that telephone scripts that are based on the Segmentation Study classifications may be effective in order to prevent drop-offs and withdrawals of members from programs in which they are currently enrolled.

MINUTES FOR THE MEETING OF THE TRUSTEES FOR THE CHICAGO LABOR MANAGEMENT COOPERATION COMMITTEE

August 14, 2019

The meeting was called to order by Co-Chairman Bob Reiter on August 14, 2019 about 8:30 a.m. at the offices of the Chicago Federation of Labor, Prudential Building, 130 East Randolph St. Suite 2600, Chicago Illinois.

In attendance were the following:

City of Chicago Trustees: Michael Frisch, Mayor’s Office; Donald O’Neill, Director of Labor Relations;

Union Trustees: Bob Reiter, CFL; Jim Tracy and Dan Scheibenreif, CFFU Local 2; Martha Merrill, AFSCME (by phone); Joe Healy, Laborers, Local 1092 (by phone); Vince Tenuto, Teamsters;;

Co-Executive Directors: Edward Hogan, COUPE; and Carol Hamburger, City Department of Finance;

Other Attendees and invited guests: Don Villar, CFL; Ryan Kelly, IAM; Paul Bilotta, PB&PA Sergeants; James Calvino, Police Sergeants; Ralph Affrunti, CCBT; David Johnson, Franczek, P.C.; George Luscomb, attorney for Laborers; Michael Garrity, Assistant Director of Labor Relations; Barbara Molloy, City consultant; Arlene Ortiz-Cruz and Daniel Ashley, City Benefits Office; and staff members Hank Scheff and Barbara Smith.

1. Bob Reiter called the meeting to order and led the introduction of attendees.

2. The prior minutes of August 8, 2019 were tabled for future consideration.

3. Mr. Reiter stated that discussion would begin on the background for outstanding proposals, rather than upon itemized proposals in the agenda. He noted that some collective bargaining issues are not in the purview of the LMCC. In addition, each collective bargaining organization has its own terms to fulfill within the LMCC. Fire and Police Supervisors continue to work under the 8% limit on cost increases that was negotiated in 2007.

4. Mr. Reiter asked Mr. Scheibenreif and Ms. Merrill to report on their analyses of the City’s response from August 8th on opt-out payments. Mr. Scheibenreif reported that he was able to reproduce the City’s numbers and there was no further need to discuss the study’s assumptions. Ms. Merrill stated that Wisconsin’s records showed Wisconsin continuing to offer the 2015 plan for 2020 so she assumed that it had value in Wisconsin. Ms. Molloy commented that the Wisconsin had 2-year budgets and a workforce that is 3.5 times larger than the City. So, the projected savings from the plan would be $810,000 per year. She also noted that Wisconsin offered four health care plan alternatives, and that its family premium rates were much higher than those of the City. Mr. Frisch commented that the risk should be shared between management and labor. Mr. Reiter responded that the union side had not yet discussed a response to the concept of sharing risk, so that no answer could be provided at this time. Ms. Molloy repeated that an alternative was available in open enrollment to tell employees that opt-out would not be offered unless the enrollment targets were met. Mr. Scheibenreif noted that the numbers regarding self-pay rates should be recalculated in order to include dental. Ms. Molloy also noted that the opt-out plan would require modification of the payroll system, and, since this is not a pre-tax item, the tax effects would also need to be analyzed. Mr. Frisch stated that, if the opt-out fails, then the estimated savings would need to be added to the next year’s savings target.

5. Mr. Reiter suggested using a third party to conduct a cost-out. Ms. Molloy noted that Ms. Hamburger had offered to allow an assumption of $500,000 for migration, so that hiring a third party should not be necessary. The members discussed the methods of having Blue Cross provide analysis without providing its data. Ms. Molloy noted that Blue Cross data includes information from its large book of business for comparison. Ms. Ortiz-Cruz pointed out that the back-up data is the claims data. Mr. Johnson commented that Blue Cross’s models are proprietary. Mr. Reiter asked for new data with a higher level of detail on the underlying data.

6. In terms of MRI usage, Mr. Frisch and Mr. Reiter asked for more information on the number of members using MRIs. Mr. Frisch noted that the City was offering to allow a fudge factor in calculating savings based upon the uncertainty of migration in these changes. Ms. Molloy stated that the City would provide information on the numbers of members who received MRIs in hospitals versus those who used stand-alone facilities. Mr. Johnson noted that information shared in the past proved that voluntary offerings, as opposed to mandates, have shown disappointing results. Mr. Scheibenreif stated that any differential in the MRI usage from prior to the change in co-pays should be studied, that more time might be devoted to communicating the co-pay offer for free-standing MRIs, and that a report include comparison with the Blue Cross book of business.

7. Mr. Frisch asked the trustees to turn to next steps. Mr. Johnson referred to a grievance that Mr. Healy had initiated that purported to include COUPE and AFSCME. Mr. Reiter said that Mr. Healy and AFSCME need to respond, but not in this forum. In the meantime, police supervisors and Fire remain under an 8 % trigger. Any arbitration will bind AFSCME and COUPE only.

No further business having come before the Committee, upon motion duly made, seconded and carried, the meeting was adjourned.

Signed:

___________________________
Edward M. Hogan

Review Blue Cross update on Composite Segmentation pilot programs for preventive dentistry and telemedicine; prepare outreach materials for urgent care alternatives; print and distribute materials for urgent care alternatives.