Very Smart Risk Management Strategy for Texas School Districts

TSHBP offers Texas school districts a TRS ActiveCare alternative for 2020-2021 school year. A careful review of benefits and rating structures indicates smart risk management strategies to control health care costs for members.

For example a proven common sense strategy is applied to tackling high cost specialty drugs. The following description is included in the TSHBP marketing marerials:

The TSHBP covers the cost of specialty drugs when used in a facility setting as a component of a treatment plan and which are billed by the facility as a claim cost and following the payment parameters established in the plan document.

The TSHBP will also pay for all specialty drugs which cost under $670 after a member’s deductible has been met or their co-payment has been applied. If a member joins the TSHBP program and does require access to specialty drugs outside of a facility and the drug cost is more than $670, the TSHBP will not be able to pay for the drugs under the health plan coverage documents.

The TSHBP has purchased an additional policy that will fund the specialty drug expense for a member for up to 90 days if alternative funding is not available for the drugs.

The TSHBP and Southern Scripts will work with our patient advocate provider to help members gain access to publicly available Patient Assistance Programs (PAP) and Co- Pay Assistance Programs (CAP) that may provide funding for significant portions associated with specialty drugs.

All prospective members are encouraged to review the medications they are currently taking prior to enrollment in the TSHBP.

The TSHBP rates for Region 14 are an indication of the level of cost containment of plan benefits:

High Deductible Health Plan Rates                      Co-Pay Plan

EE $336.00                                                                  $483.00

ES $643.00                                                                  $778.00

EC $970.00                                                                  $1,269.00

EF $1,288.00                                                               $1,427.00

The TSHBP program is well structured, incorporating proven risk management strategies long lacking among status quo health plans.

Other strategies include Reference based Pricing as well as directed referrals to high quality providers with demonstrated outcomes.

If sold properly, with Texas educators understanding how the plan works by following the rule book, we expect long term success. However, school district employees are traditionally high maintenance requiring a tremendous amount of hand holding.

ABOUT THE TEXAS SCHOOLS HEALTH BENEFITS PROGRAM

The Texas Schools Health Benefits Program is a regionally rated, fully-funded, guaranteed cost program developed for Texas school districts. Our purpose is to support the school children of Texas. We do this by providing health benefit solutions to our dedicated teachers, administrators, and support staff so they can concentrate on what they do best – teaching and supporting our kids. It is our desire to increase member health and well-being and provide tools necessary to identify and manage the health of each and every member

NOTE: The brains behind this program is undoubtedly ……………ldbrown@caprockhp.com

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