LaSalle County committee reviews Garner overlay to steer members to higher‑performing providers; costs and union contracts cited as barriers

LaSalle County Insurance Committee members reviewed a vendor overlay program (referred to in meeting materials as Garner) designed to steer members to higher‑performing providers within the county’s existing network.

Beth, a Horton Group consultant, described the overlay as a bolt‑on that “rides alongside of your health plan and works to get people using appropriate providers or appropriate care.” The overlay preserves members’ current network choice but adds a recommendation layer: members who search for care through the Garner tool and use a Garner‑recommended provider would receive an employer‑funded Health Reimbursement Arrangement (HRA) payment to buy down their deductible or out‑of‑pocket maximum.

Horton Group presented three model options: an overlay (no core plan design change), an increased model (some deductible increases offset by larger HRA credits), and an enhanced model (larger deductible increases coupled with larger HRA credits). For the overlay, Horton showed a modeled total program cost near $150,000: roughly $84,000 in vendor administration fees, about $13,000 in HRA administrative fees, and a projected $52,000 in HRA reimbursements. Horton reported the overlay’s projected net savings in one model at roughly $250,000, assuming about 35–38% member engagement. Horton cautioned that the overlay’s administrative and incentive costs reduce net savings unless engagement meets expectations.

The enhanced options modeled greater claimed claim‑dollar reductions — Horton said the largest scenario could drive roughly $2.7 million in gross claim reductions — but those options require plan design changes and collective‑bargaining negotiation. Committee members noted the county’s nine union contracts mean plan design changes would require lengthy bargaining. “We would need to implement [plan changes] over the next plan year,” one committee member said; consultants agreed implementation would not be immediate.

Consultants also provided a geo‑access follow‑up: Horton asked the vendor to run a ZIP‑code/provider access report to verify the availability of Garner‑preferred providers in the county’s service area before any commitment.

Discussion vs. decision: committee members discussed the overlay models and directed Horton Group to obtain the geo‑access report and additional follow‑up information; no formal procurement or plan‑design decision was made at the meeting.

Ending: Consultants recommended further analysis and stakeholder engagement (including union bargaining) before adopting any overlay with plan‑design changes.