OGI calls Regence transition 'very successful' but notes member disruptions

Justin Seaman, Group Insurance Manager at the Office of Group Insurance, characterized the recent Regence transition as largely successful while acknowledging member disruption during the changeover. "The transition was very successful," he said, but staff identified common issues such as pharmacy prior authorizations, formulary and cost questions, physical therapy pre-authorizations and enrollment data migration.

The presentation included vendor performance metrics: Regence account management received 140 inquiries from July 1–Sept. 30, and 97% of those inquiries were resolved in seven days or less with an average turnaround time of two days. Quarterly pharmacy figures showed 143,543 prescriptions filled for July–Sept.; 74 pre-authorization appeals (0.05% of prescriptions) with 47 appealed denials overturned and 27 appeals denied. The committee discussed those metrics as part of monitoring carrier performance and member service during the transition.

OGI staff also told the committee that limited internal staffing was the biggest implementation challenge and that vendor responsiveness had been positive; the committee recorded a request for appeals documentation to examine outcomes in more detail.