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District reports about $370,000 in first-year savings after shifting to partial self-funding for employee health plan; staff engagement and reference-based-pric
Summary
Consultant Scott Fuller told the board the district’s move to a partially self-funded plan in 2024 improved cost performance and avoided a larger rate increase, but reference-based pricing has increased member and administrative work.
The Elkhorn Area School District reported financial improvements and operational tradeoffs tied to a change in its employee health plan structure during a March 10 presentation by consultant Scott Fuller of USI.
"By moving to the self funded model that we ultimately decided upon, your actual total costs were $5,100,000. So you saved year over year," Fuller said, reviewing 2024 results. He said the district’s net reduction from the prior year was about $370,000 and that the move also avoided a far larger increase that would have followed continuing in the fully insured market.
Fuller summarized plan details and member impacts: the district has 839 people on the plan (about 275 employees and 564 dependents) and processed roughly 10,147 claims between Jan. 1, 2024 and Feb. 28, 2025. The district now routes claims through three pathways: an EverPoint Elite network (about two-thirds of claims), a direct Mercy contract (roughly 900 claims), and a reference-based pricing (RBP) stream (about 2,395 claims). Fuller said 374 RBP claims required negotiation by the district’s provider-recovery partner (AMPS), and 83 remained open as of the February report.
Fuller explained the RBP approach: "That simply means that there is no contractual arrangement" with a provider; the TPA pays a percentage of Medicare (the plan’s target is about 140% of Medicare, Fuller said), and the remainder may be balanced billed unless negotiated down.
Board members pressed Fuller on the dollar savings. "The bottom line" was "about $370,000" in year‑over‑year reductions, Fuller said, while noting the district also avoided a potential market renewal increase that could have been in the 20% range.
District staff and consultants said the plan’s early financial returns were positive, but that administration — especially Taylor, who helps staff navigate the benefits — has seen significant additional workload helping employees with RBP claims and provider disputes. Fuller recommended additional support for benefits administration to preserve those savings and maintain member experience.
The presentation also highlighted utilization of a virtual care vendor (NICE Healthcare). Fuller said NICE was used by about 27% of the covered population in the latest quarter (well above a typical 9% target); the service provided telehealth, in-home visits, imaging and behavioral health access and reduced other acute claims. Fuller and board members noted the district’s HSA contributions: family HSA funding is $500 and single coverage HSA funding is "just under $2,000," which helps employees manage out-of-pocket costs.
Board members and Fuller said more training and communication for staff will continue and that the district will monitor claims and outstanding RBP negotiations.
