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Whelan-Weinberg Bill To Create Program On Chronic Medical Conditions In State Health Benefits Plan

Pilot Program Aims to Save Taxpayers By Reducing Increased Benefits Costs, Other Incidentals Related to Chronic Health Conditions

TRENTON – A measure sponsored by Senate State Government, Wagering, Tourism and Historic Preservation Committee Chairman Jim Whelan and Senate Majority Leader Loretta Weinberg which would create a pilot program within the State Health Benefits Plan (SHBP) to address chronic health conditions for public employees was approved by the State Government Committee today by a vote of 3-0, with two abstentions.

“When you talk about health care costs, you need to take a serious look at preventive care and chronic illness management to help lower health insurance costs across the board,” said Senator Whelan, D-Atlantic. “By promoting chronic disease management through the State Health Benefits plan, we stand to save the taxpayers money in the long-run, and promote better health care outcomes for individuals covered by the SHBP who are living with chronic health conditions. It the savings are substantial – and I think they will be – I can foresee us expanding this pilot program across the board in the future.”

“One of the biggest cost drivers of health insurance today is the cost of treating chronic health conditions after those conditions become health care emergencies,” said Senator Weinberg, D-Bergen. “When it comes to public employees covered by the SHBP, not only do taxpayers foot the bill for health coverage for individuals with unmanaged chronic health conditions, but they also pay the cost as a result of missed days of work resulting from the employee’s unmanaged chronic health condition. This pilot program will allow public employees to make smarter health decisions when it comes to chronic disease management, resulting in lower health care premiums for the taxpayers, fewer missed days of work, and better healthcare outcomes for the employee.”

The bill, S-1623, would require the State Health Benefits Commission and the State Health Benefits Plan Design Committee to establish a three-year pilot program to provide benefits coverage to select employees with chronic health conditions using a value-based benefit design. The benefits coverage design would target individuals with diabetes, high cholesterol, hypertension and asthma. The State Health Benefits Plan Design Committee would be charged with selecting one Department, Division, Office, Agency, Bureau or other unit of State government, with at least 500, but no more than 1,000 employees who are eligible, based on their chronic health conditions, to participate in the pilot program.

Under the pilot program, eligible employees would be matched up with a participating pharmacist who, in collaboration with the employee’s primary treating physician, would oversee the employee’s medication therapy services to manage their chronic medical conditions. Participating employees would also receive certain financial incentives for taking advantage of chronic health condition mitigation benefits provided under the State Health Benefits Plan. Among these incentives are: tuition costs for any educational program attended by the employee which provides information for self-management, and which is recommended by the primary physician or assigned pharmacist; the costs for private visits with the employee’s assigned pharmacist; all costs for a medical device or supply deemed medically necessary by the primary physician or assigned pharmacist; all costs for laboratory testing; and waiver of all co-payments for any prescription drugs.

“We believe that the increased cost of providing financial incentives for employees to manage their chronic health conditions – incentives like zero co-pays for prescription drugs and free lab testing – will be more than made up by the savings to the taxpayer,” said Senator Weinberg. “Not only does this bill make great health sense, it also makes great business sense.”

To remain a participant in the pilot program, an employee must comply with all aspects of the value-based benefit design regimen, including attendance at all medical appointments, adherence to advice or instruction provided by the primary treating physician or assigned pharmacist, and use of all prescription drugs as directed. Under the bill, the State Health Benefits Commission and Plan Design Committee would be required to submit a report to the Legislature, no later than the date of expiration of the three year pilot program, recommending any extension, modification or expansion of the program which may be appropriate.

“Obviously, we want individuals with chronic medical conditions to take the steps necessary to live healthier lives, because by doing so, it will pay dividends for themselves and for the taxpayers of the State of New Jersey,” said Senator Whelan. “New Jersey already has some chronic disease management programs in place for individuals covered by the SHBP, but by doing a better job encouraging employees to take part, we can maximize the savings to the taxpayers of the State. I look forward to hearing about the tangible benefits of this pilot program, and if appropriate, extending that program to the rest of the State’s public workforce.”

The bill now heads to the Senate Budget and Appropriations Committee before going to the full Senate for review.

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