Delaware officials eye copay cuts to reduce costs for state health care

DOVER — The committee responsible for setting state government employee health care costs plans to eliminate copays for MRIs and CT scans under certain circumstances and lower them for urgent care visits.

The changes, which will be voted on March 18, are part of an effort to incentivize healthy and cost-conscious behavior among state workers, officials said.

They also hope more attention to the cost of treatment can help slow skyrocketing health care expenses.

Ann Visalli

Ann Visalli

The adjustments were discussed Friday at the State Employee Benefits Committee’s meeting.

Copays for freestanding radiology facilities would be waived under the plan put forth by the committee. While that could amount to a $200,000 hit to the state, budget officials claim it will lead to more people using freestanding clinics rather than hospitals.

Three hundred people moving away from hospitals for MRIs and CT scans would cover the cost of the reduction. Any additional workers who switch would save money for the state. The 300 figure is equivalent to 8 percent of visitors.

Geoff Klopp, president of the Correctional Officers Association of Delaware and a member of the benefits committee, urged officials to better educate state workers as to the true cost of care. Many workers may not realize that for every dollar that comes out of their wallet, the state is responsible for several more.

“Are we communicating it well enough to our members?’ he said. “I mean, to them, they’re only going to see that it’s a $50 thing. Or if we possibly explain it to them that it’s an $800 savings to the plan. Does that incentivize to make a better decision as well?”

“I don’t see how that discourages them from that, but at the end of the day, if we can provide like service with like convenience. … I mean, I get it,” he added. “But somewhere we have to start thinking about how are we going to fix this communication gap?”

Copays for urgent care centers would also be decreased, from $25 to $15 under HMO plans; and $30 to $20 under PPO plans. The object is to encourage employees to make fewer trips to the emergency rooms, officials said.

As with the radiology copay, the state would take a hit if a certain number of people do not switch. In this case, 200 people, less than 1 percent of visitors, are needed to switch to make the net impact zero. More than that would save the taxpayers’ money.

Both copay changes could be temporary if few people take advantage of the reduced or eliminated copays.

“It is contingent on people being price-sensitive,” said Ann Visalli, director of the Office of Management and Budget.

In January, Gov. Jack Markell recommended allocating $33.3 million in General Fund spending to fill a deficit. The money leverages dollars from other sources, allowing the state to not only make the necessary payments to provide health care but to also help cover claim liability and begin the process of refilling a depleted reserve.

The changes discussed Friday would help fill the reserve.

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