The county went to a self-insurance model in 2017 after several years of double-digit percentage increases for insurance coverage. Some large, unusual claims over several years drove those increases, including a single $5 million claim in 2013 and a $3 million claims month in November 2014.
Under the self-insured plan, the county pays an administrative fee and the claims itself. The insurance carrier pays for costs over $175,000.
Facing a 24 percent rate hike for 2019, the commissioners went shopping for a new provider. The health insurance contract sparked uncharacteristic discord among the commissioners with a 2-1 vote in favor of Medical Mutual of Ohio.
“I have never more strongly disagreed with the decision of this board of commissioners, nor any previous board of commissioners since I’ve been an elected official,” Commissioner Cindy Carpenter said after an October 2018 executive session on the issue.
“I believe in my heart that this is completely the wrong decision to make.”
Then two weeks later, the commissioners canceled the deal with MMO and hired United Healthcare.
Carpenter today credits the partnership with United Healthcare for the favorable outcome last year. The company has helped the county design programs to help the employees better manage their health and wellness, and its relationships with providers also helps, she said.
“United Healthcare has contracts with the providers, hospital networks, at a reduced cost,” Carpenter said.
Carpenter said UHC also recommended that the county change its incentive program because the old method had very little impact. The commissioners ended a $720 annual premium credit available to employees who completed programs meant to decrease the costs of claims. About 530 employees participated in the wellness program over the past two years.
Those employees had received a $60-per-month credit in their insurance premiums. The health insurance committee decided to give participants gift cards instead, so the discounts won’t happen in 2020.
Carpenter said employees can receive gift cards for participating in multipleprograms, some as simple as routine medical exams, mammograms, colonoscopies and other screenings. People suffering from more chronic illnesses like heart disease and diabetes can get even more gift cards for participating in counseling and other programs tailored to their particular disease.
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“We tried to make the amount of the gift card coincide with the importance of the health care procedure,” she said. “I think that worked very, very well. We may not get many people into the heart program, but we will get high cost individuals into the heart care program which is what we intended. I think that targeting and creating programs for the high-cost procedures was very, very smart.”
Boyko said the human resources department and “health ambassadors” from the county departments, along with UHC and their insurance broker have kicked off an engagement plan to get even more employees participating in the various programs the county is offering.
“When we started the health/wellness program, you’re not going to see any results from that for about three years so I would say that is kicking in,” Commissioner T.C. Rogers said. “We’ve given a lot of information out so as employees are better informed I think they make better choices for their health care.”