CalPERS Announces New Health Plan Contracts to Lower Costs While Improving Quality and Accountability (2024)

Terms incentivize Blue Shield of California and Included Health to make coverage more affordable and improve quality by contractually requiring them to put over $460 million at-risk – aligning their interests with CalPERS’ commitment to affordability, quality, and equity.

June 12, 2024

Communications & Stakeholder Relations
Office of Public Affairs
(916) 795-3991 - newsroom@calpers.ca.gov

SACRAMENTO, Calif. – The CalPERS Board of Administration announced its intent to award two new contracts designed to promote savings by lowering health care costs over time while improving the quality of care for members enrolled in its self-funded preferred provider organization (PPO) plans. The new contracts — with Blue Shield of California and Included Health — create financial incentives to provide higher quality care at lower costs.

"The new contracts allow CalPERS to provide unique and innovative programs to better serve our PPO members, while controlling medical costs that have been very challenging, and improving the experience and quality of care our members receive," said Ramon Rubalcava, chair of the CalPERS Board of Administration Pension and Health Benefits Committee. "CalPERS is demonstrating that health care quality and equity is at the center of everything we do for our members."

What This Means for CalPERS PPO members

Under the new contracts, Blue Shield of California – a major nonprofit health plan based in the Golden State – will partner with Included Health, an integrated national care delivery and navigation company, to provide health care, navigation support, and personalized service to approximately 400,000 CalPERS PPO members (250,000 in Basic PPO plans and 150,000 in Medicare Supplemental plans). This represents about one-third of the 1.5 million CalPERS members who receive health care coverage – with the others covered through fully insured HMOs.

CalPERS selected Blue Shield because of its commitment to expanding access to high-quality care, controlling costs through innovation, and addressing health equity. Included Health will provide personalized help for members navigating clinical, administrative, and financial issues, in addition to higher levels of support for those with complex and chronic health needs, while supplementing Blue Shield’s provider network with high-quality virtual care for behavioral and primary care needs.

The organizations will begin providing care for CalPERS members starting in the 2025 coverage year.

Among the important facts that CalPERS members need to know:

  • Most CalPERS PPO members will be able to continue seeing their existing doctor as an in-network provider since Blue Shield has virtually all the same hospitals, facilities, and systems, and significant overlap of physicians and clinicians as the current plan.
  • Basic PPO members will benefit from new navigation and member support services, and those with complex health conditions will receive more tailored assistance that is responsive to their unique needs based on who they are and the health challenges they are facing.
  • For the small percentage of Basic PPO members whose clinician may not be available in-network, CalPERS has developed systems to ensure continuity of care and a range of options to make sure they get the best care possible.

New Contracts Set Performance Guarantees on Cost and Quality

A key component of the new five-year contracts is the establishment of performance guarantees in which Blue Shield and Included Health will put $464 million at-risk if they do not meet the program’s goals for controlling medical cost trends and improving quality. The contracts set the initial medical trend cost target at 5.5% in 2025 and lowers the target each year until it reaches 3% by 2029. If CalPERS’ trend is lower than the target, Blue Shield and Included Health stand to share in the savings.

The total cost of care target aligns with California’s Office of Health Care Affordability's benchmarks in 2029 and will help CalPERS ensure the long-term stability of its PPO plans. The PPO plans are self-funded, meaning CalPERS is responsible for collecting premiums from enrollees and paying their medical claims and those of their dependents.

In addition, the contracts also set new target thresholds for providing quality health care, including controlling blood pressure, diabetes care, childhood immunizations, colorectal cancer screening, and pregnancy care. The targets are identical to those that CalPERS included in its latest HMO contracts, which also contain significant financial consequences for health plans that do not meet quality targets.

"By having these two organizations put hundreds of millions of dollars at-risk if they do not deliver for our members, we are aligning the interests of CalPERS and its members with those of Blue Shield of California and Included Health," said CalPERS Chief Health Director Don Moulds. "It doesn't matter which plan our members pick, they all deserve to receive quality care."

By aligning its PPO and HMO health care contracts, CalPERS' health plans will put more than $1.3 billion at risk over the course of the five-year agreements if they do not meet quality targets or contain medical cost trends. The terms and scale of these contracts for self-insured PPO coverage, in which the health plan and its care management partner are financially responsible for costs, are unique.

"For too long health plans offering PPOs have been both quality blind and indifferent to rising costs, because the employers or public purchasers are footing the bill," said Peter V. Lee, former executive director of Covered California and senior fellow at Stanford University who served as an advisor on the project. "This new arrangement represents a mammoth change, by having the interests of the health plan and its care management partner truly aligned with CalPERS' mission of providing the best possible quality care while making coverage more affordable over the long term."

Additional reasons that the CalPERS program could serve as a national model are:

  • Lower costs will be achieved without arbitrarily excluding hospitals and major facilities, as almost all major hospitals, trauma centers, and health delivery systems are in network.
  • The expected reduction in medical trend costs will be accomplished by improving the care members receive, not by reducing the benefits members receive or increasing their out-of-pocket costs.
  • The substantial amount at-risk for improving health care quality is aligned with quality measures shared by the Department of Health Care Services (which administers Medi-Cal, California's Medicaid program) and Covered California – thus ensuring that these three programs, covering more than 40% of Californians, will encourage better care that can benefit the entire state.

CalPERS officials thanked the leaders and staff of Anthem Blue Cross for providing PPO services to its members for more than two decades.

"We appreciate the many years of service that Anthem Blue Cross has provided to CalPERS and its PPO members," Moulds said. "We are looking forward to continuing to work with Anthem Blue Cross in our HMO offerings."

About CalPERS

For more than nine decades, CalPERS has built retirement and health security for state, school, and public agency members who invest their lifework in public service. Our pension fund serves more than 2 million members in the CalPERS retirement system and administers benefits for more than 1.5 million members and their families in our health program, making us the largest defined-benefit public pension in the U.S. For more information, visit www.calpers.ca.gov.

CalPERS Announces New Health Plan Contracts to Lower Costs While Improving Quality and Accountability (2024)

FAQs

CalPERS Announces New Health Plan Contracts to Lower Costs While Improving Quality and Accountability? ›

New Contracts Set Performance Guarantees on Cost and Quality

Will CalPERS get a cola in 2024 in California? ›

The COLA takes effect the second calendar year after retirement to help retirement benefits keep up with the rate of inflation. Eligible retirees, beneficiaries, and survivors who receive a monthly benefit will receive the COLA in their May 1, 2024, retirement check.

What does 2% at 62 mean for CalPERS? ›

The benefit factor changes for every quarter year of age based on the retirement formula . If your retirement formula is 2% at 62, for example, this means you get 2% of your pay if you retire at age 62 . Age 62 is referred to as your “normal retirement age .”

What does 2.7 at 57 mean? ›

Safety PEPRA Member: 2.7% @ 57; which means you can retire at 57 and receive 2.7% x (years of service) x (avg of highest 3 years' salary).

What is the difference between CalPERS tier 1 and tier 2? ›

If you're a First Tier member, you contribute a higher percentage of your paycheck while you're working into CalPERS than a second-tier member. The benefit is when you retire, your pension is calculated using a higher formula.

What is the average CalPERS pension? ›

The average annual CalPERS pension for all retirees who retired with a service retirement is $42,516, which breaks down to more than $3,500 per month. Overall, 61.6% of all CalPERS service retirees receive $3,500 a month or less, while only 6.4% receive more than $9,000 per month.

Do CalPERS retirees get COLA every year? ›

The Retirement Law provides for the payment of an annual COLA to be paid each May. The COLA is limited to the lesser of two numbers, the rate of inflation or the compounded COLA provision contracted by the employer.

What is the 960 rule for CalPERS? ›

A retiree can not work more than 960 hours in a fiscal year (July 1-June 30) among all CalPERS covered employment. The compensation for the retiree appointment cannot exceed the maximum monthly base salary paid to other employees performing comparable duties as listed on a publicly available pay schedule.

What is the CalPERS 1000 hour rule? ›

The standard to consider for the membership eligibility of less than full-time employees is whether they work 1,000 hours (if paid on an hourly basis) or 125 days (if paid on a daily or per diem basis) in a fiscal year (July 1 through June 30). Overtime service is included in computing the 1,000 hours or 125 days.

Can I retire at 55 with CalPERS? ›

The minimum retirement age is 50, 52, or 55 years depending on the retirement formula associated to the service credit on your account. Your monthly benefit may or may not increase if you wait to retire.

Why do CalPERS retirees flee California? ›

“It's obvious that California's taxes and the cost of living drive some people out of the state,” said Mark Beach, AARP's Sacramento-based communications director, when told about Nevada's popularity among CalPERS retirees. “I'm surprised the number of them leaving isn't higher.”

Does CalPERS pay for life? ›

CalPERS is a 401(a) Defined Benefit Plan. This means that your benefit amount is determined by a formula and not what you contribute to the plan. Once you're eligible and you retire, your benefit is payable for life. service credit, you still may be eligible to apply for a service retirement.

Can you buy years in CalPERS? ›

You can purchase a maximum of two years of service credit for each service leave of absence . Sabbatical Leave of Absence A partially compensated leave of absence from CalPERS-covered employment . There is no limit to the amount of service credit you can purchase .

Which CalPERS retirement option is best? ›

The majority of members electing the Unmodified Allowance and Option 1 live beyond 10.71 years after their retirement date. Based on this data, the Unmodified Allowance was the better Option for this population.

Can I collect social security and CalPERS? ›

Your CalPERS retirement benefits can work very well in tandem with Social Security to provide you the income you will need during retirement.

How to maximize CalPERS? ›

Ways to Increase Your Retirement

It's important to know that in most cases, the more service credit you have the higher your pension. Exceptions may include retiring on a disability retirement or if you're a safety member with a benefit cap. The earlier you purchase your service credit the better.

What is the cost-of-living increase in California in 2024? ›

Consumer Price Index, Los Angeles area — May 2024
MonthAll itemsAll items less food and energy
Nov 20232.82.8
Dec 20233.53.4
Jan 20242.53.7
Feb 20243.43.8
33 more rows

What is the COLA rate for 2024? ›

The latest COLA is 3.2 percent for Social Security benefits and SSI payments. Social Security benefits will increase by 3.2 percent beginning with the December 2023 benefits, which are payable in January 2024. Federal SSI payment levels will also increase by 3.2 percent effective for payments made for January 2024.

What is the OPM COLA for 2024? ›

Cost of Living Adjustments

The increase is effective December 1, 2023, and is payable to retirees in their January 2024 annuity payment. The maximum increase for CSRS is 3.2%. The maximum increase for FERS is 2.2%. Note: The minimum COLA increase payable under CSRS and FERS is $1.00.

What is the 2024 Lafpp COLA update? ›

The Cost-of-Living Adjustment (COLA) is 3.4% for 2024 and was approved by the Board of Fire and Police Pension Commissioners on April 18, 2024.

Top Articles
Latest Posts
Article information

Author: Saturnina Altenwerth DVM

Last Updated:

Views: 6133

Rating: 4.3 / 5 (44 voted)

Reviews: 83% of readers found this page helpful

Author information

Name: Saturnina Altenwerth DVM

Birthday: 1992-08-21

Address: Apt. 237 662 Haag Mills, East Verenaport, MO 57071-5493

Phone: +331850833384

Job: District Real-Estate Architect

Hobby: Skateboarding, Taxidermy, Air sports, Painting, Knife making, Letterboxing, Inline skating

Introduction: My name is Saturnina Altenwerth DVM, I am a witty, perfect, combative, beautiful, determined, fancy, determined person who loves writing and wants to share my knowledge and understanding with you.