Public Employees Benefit program asked to improve healthcare information available to members

Legislative auditors say Nevada’s Public Employees Benefit Program needs to improve the information available to participants to help them make decisions that will protect both their health and their pocketbooks.The report issued Thursday says there is a large disparity in charges for different medical procedures around the state and, with the conversion to a high-deductible health plan, participants need more information so they can comparison shop to save themselves and the plan money.Auditors pointed out, for example, that the price of a colonoscopy ranged from $248 in Las Vegas to $1,620 in Elko.The 2011 Legislature raised deductibles from $800 to $1,900 for an individual and $1,600 to $3,800 for a family. Since the high deductible plan is self-funded, premiums must cover costs. As a result, auditors said participants “have a financial incentive to compare prices when planning surgeries and other procedures.”They pointed out that, while the procedures billed by a provider might be divided into 10 different specific categories of charges, the information provided to the patient at present lists just professional services and “Hospital Ancillary,” giving the member very little information to make a determination whether the bill is correct.In response, PEBP Director Jim Wells said the Explanation of Benefits statements that go to participants are being redesigned to give much clearer information to plan members. The PEBP system that provides resources on the website is also being expanded and redesigned to give much more detail about different provider costs and other factors.Wells said the program is working on a system to make certain plan members are able to better figure out what their total costs and out-of-pocket expenses for a given procedure will , as well as whether they were properly billed after the procedure.Auditors recommended PEBP periodically tell participants about the wide range of costs for different procedures and the potential savings by comparing prices.They also called for better performance measures on contracts with providers to better determine how well they were doing in providing services.Lawmakers on the audit subcommittee expressed most concern about the need to improve controls over information technology and the lack of background information on staff with access to sensitive confidential information.Wells told them he conducts civil background investigations for new employees and on existing workers every three years but the civil name check searches only Nevada criminal history. Although auditors recommended full security checks including fingerprint checks, Wells said he doesn’t believe current statute gives him the authority to have an FBI check done.Sen. David Parks, D-Las Vegas, chairman of the subcommittee, said he would see if that change can be put before lawmakers in the 2013 session.Auditors also recommended developing controls to restrict access to participant credit card numbers, to encrypt sensitive information in the system and develop ways to mask sensitive member information.PEBP accepted the recommendations and lawmakers approved the audit findings.