LaSalle County committee hears midyear health-plan review; consultant flags possible double‑digit renewal

LaSalle County Insurance Committee members heard a midyear performance review of the county’s self‑insured health plan and were told the market is unsettled and the county’s 2026 renewal could be steep.

In a presentation to the committee, a Horton Group representative said carriers have struggled to underwrite recent years and that the county has seen more large claimants this year than last. “We are expecting a tough one this year,” the Horton Group representative said, adding that the firm used conservative assumptions for renewal planning.

The Horton Group representative told the committee that, in the firm’s early renewal modeling, stop‑loss costs were estimated to rise about 30 percent and overall renewal pricing could approach roughly 21 percent. The representative also said the county’s stop‑loss experience has included multi‑year reimbursements and that large claims remain the primary driver of year‑over‑year cost increases.

Why it matters: The county’s employee and retiree demographics — including a significant retiree per‑capita cost — and recent multi‑hundred‑thousand‑dollar claims mean the county’s premiums and stop‑loss expenses are sensitive to a small number of high‑cost cases.

The presentation reviewed plan performance since Horton began advising the county in 2018. Since then Horton said the county’s average plan increases were below national trend, in part because the county carved out post‑65 retirees onto a Medicare Advantage plan in 2018 and has pursued pharmacy contracting and utilization tools. Horton reported that, for the first five months of the year, the county’s per‑capita claim cost was up about 8.3 percent versus the same period last year and that the county had eight claims above $75,000 so far in the year compared with five in the first five months of the prior year.

Horton described pharmacy trends and new high‑cost therapy categories. The presenter said the county covers GLP‑1 medications only for people with type‑2 diabetes and that 29 members have used those drugs so far this year at about $62,000 in spend; for the full prior year Horton reported 53 members and about $200,000 in spend. The consultant also flagged an industry pipeline of gene and cell therapies with list prices ranging into the hundreds of thousands or millions of dollars and said underwriters are trying to factor those risks into reinsurance and stop‑loss pricing.

Horton outlined several cost‑containment options the county could consider before renewal, including alternative network designs (Blue Choice Options or similar tiered networks), “bolt‑on” provider‑steerage apps such as Garner, point‑to‑point chronic‑care solutions, continued pharmacy contract negotiations and stronger member steerage via tools such as HealthJoy. The presenter said the county’s HealthJoy activation rate was 38 percent among eligible active employees and that the tool has produced some savings so far.

Committee action and next steps: Committee Chair Nancy Yurek asked for a motion to accept and place the Horton midyear health‑insurance report on file; a motion was made and the committee carried it by voice vote. Horton said it would gather the final census, run market solicitations in mid‑July to mid‑August, and aim to bring renewal recommendations to the county board in September.

Discussion versus decisions: The committee’s acceptance of the report placed Horton’s analysis in the record and authorized work to continue toward renewal and market negotiation; no plan design change or carrier selection was approved at the meeting. Horton repeatedly described the renewal figures as an early, conservative forecast pending final carrier proposals and market shopping.

Ending: Horton and county staff said they would provide an initial renewal estimate to the committee as soon as it is available and planned an in‑person committee meeting on Aug. 28 for further review and action.