As part of this process, the city's insurance broker helps educate HCBC members about health care issues.
HCBC members then present the proposed health care package to the City Council at both a work session and business session meeting.
After the package has been approved by the City Council, the HCBC meets to plan the rollout to employees.
The most notable and clearly defined outcomes of the HCBC have been the reduction in the rates of increase for the city's insurance coverage, the shift of a portion of health care costs to employees, the creation of a city-sponsored employee wellness program, and a reduction in employee sick leave usage.
Since the HCBC was created six years ago, the city has experienced average annual health care rate increases of 11.
Another direct result of the HCBC has been the shift of health care costs from the city to a cost-sharing system with the employees.
There have also been some adjustments to benefit levels, as the HCBC has recognized the need to modify the city's health care coverage by increasing co-pays, increasing charges for the prescription drug program, and limiting the amount of rate increases in any given year.
Brainstorming among HCBC members on methods for reducing health care costs was also responsible for the creation of a city-sponsored wellness incentive program.
Comparing the number of HCBC recipients with Medicaid-reimbursed nursing home recipients, the percentages were as follows: Kansas, 48.
Maine's rank in per capita HCBC spending is 10th nationally, and Oregon is ranked 7th (Bectel and Tucker, 1998).
However, as the simulated effects on case mix were more pronounced in some States than others, it seems appropriate that attention be given to further delineation of other LTC policies and their implementation and that the supply of alternative services, such as HCBC and unlicensed housing, be incorporated into the analysis.
The work groups, consisting of 80 key state officials, members of the senior coalition groups, HCBC
and nursing home providers, under the guidance of a representative Steering Committee, meet regularly.