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Horton Group: LaSalle County health plan costs rose in 2024 as large-claim activity spiked; committee accepts insurer briefing
Summary
Horton Group consultants told the LaSalle County Insurance Committee that plan costs rose about 12.5% in 2024, driven largely by an uptick in high-cost claimants and specialty pharmacy; the committee accepted the presentation and placed the health insurance report on file.
Beth Ishmael and Mike Gulich of the Horton Group summarized the county health plan's 2024 performance for the LaSalle County Insurance Committee and recommended cost-containment priorities including continued use of the HealthJoy navigation app, monitoring specialty and gene-therapy costs, and reviewing pharmacy and reinsurance options.
The Horton Group reported the plan's year-over-year increase from 2023 to 2024 was roughly 12.5%, mainly because the plan had more high-cost members: 36 members had claims over $75,000 in 2024 versus 22 the prior year. The county's specific stop-loss (reinsurance) deductible is $150,000; Horton reported about $3.0 million in claims were reimbursed by reinsurance in 2024 and emphasized that the county's protection likely prevented much larger employer payments.
"Our role as your broker consultant is to provide information. We represent you to the marketplace, not the insurance carrier," Mike Gulich told the committee. The consultants said the county's pharmacy program shows very high generic utilization (about 90%) but that specialty drugs and the new GLP-1 weight-loss agents are driving up pharmacy costs nationally and within the plan. Horton said specialty drugs accounted for about 40% of pharmacy spend and that a small number of members on specialty medication are the primary drivers of the large-claim experience.
Horton provided plan-level figures: per-member claim costs increased; per-capita claims were reported in the presentation (example: plan claim per capita ~ $12,402 for 2024 in the presentation charts), and the group had strong network discounts (reported net discount rates near 55%-58%) and 99.9% in-network utilization. Horton told the committee the county's Benastar retiree program enrollment has grown since 2020 and that retiree plan growth is one element county actuaries are monitoring.
The consultants recommended continued strategies already in place: aggressive market-shopping for administrative and reinsurance contracts, monitoring and promoting biosimilar and lower-cost drug alternatives, continued promotion of HealthJoy (Horton reported roughly $64,000-$65,000 in estimated plan savings from the tool during its first full year), diabetes-management and chronic-condition programs, and expanded Medicare education for employees approaching retirement. They also recommended negotiating renewal provisions to avoid "new laser" stop-loss assignments that can single out high-cost individuals on renewal.
Committee action: Committee Chair Nancy Urich asked for a motion to accept and place the health insurance report on file; a motion was made and seconded (mover recorded as Tom, seconder James Bailey in the meeting record) and the motion passed by voice vote.
Ending: Horton said they will continue to market pharmacy and administrative contracts and will supply more detailed renewal information and compliance guidance to county HR; the consultants also noted potential near-term risks from gene therapies and Medicare Advantage renewals that could affect 2025 costs.
