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Broker tells Dickinson County pharmacy costs are driving claims; recommends staying fully insured for now
Summary
Representatives from UK/Bukati reviewed two years of county claims, told commissioners pharmacy specialty drugs and a recent million-dollar maternity claim pushed loss ratios high, and recommended the county remain fully insured while monitoring data and pharmacy trends.
Representatives from UK/Bukati reviewed Dickinson County's employee health claims at the July 3 commission meeting and told commissioners the county's recent high loss ratio is driven largely by pharmacy and a single very large medical claim.
UK representative Emily Albers, who led the presentation with colleague Courtney Bickelmeyer, said the county's current arrangement with Blue Cross of Kansas is preferable to switching to a self-funded model at this time because the county still carries elevated claims and pharmacy trends are volatile. "Call our team. We are your advocates," Albers said, urging employees to use the broker's local service rather than carrier call centers for enrollment and claims help.
Albers and Bickelmeyer summarized plan performance and carrier history. They said the county moved from the state plan to UnitedHealthcare and later returned to Blue Cross. The presenters showed that medical spend while on the state plan was about $1.6 million and fell to roughly $1.2 million under a fully insured UnitedHealthcare placement before a heavy UHC renewal; they said the 2025 renewal from UHC arrived at more than 20 percent. UK/Bukati negotiated the renewal to roughly 20 percent with UHC and later secured a lower renewal with Blue Cross, which the presenters said came in around 8 percent. The broker said pharmacy spending — especially specialty drugs — is the main upward pressure and that one pregnancy complication produced a very large claim; under Blue Cross's rules about individual claim caps, only $250,000 of that claim will hit the county's plan for renewal purposes.
The brokers presented a 12-month loss-ratio history showing months over 100 percent and noted the county ran at a 126 percent loss ratio with UnitedHealthcare before renewal. They said that, absent marketing and negotiation, a 126 percent loss ratio could have produced a renewal in the 35–40 percent range. The company also described prior successes: pooled dental purchasing with Delta Dental that they said produced immediate savings and a local school-district reference where their intervention produced $600,000 in near-term savings.
On plan design and member mix, UK/Bukati noted that more than half of county employees participate on a high-deductible HSA-eligible plan, which shifts first-dollar costs to members and makes claims-and-premium splits look different than in benchmark groups where fewer members choose high-deductible options. The presenters also said the broker's standard compensation is built into carrier rates and that the broker receives roughly 5 percent of medical premium under the current arrangement; they offered an alternative direct-fee option of about $30–$35 per participating member per month if the commission prefers a PEPM (per-employee-per-month) consulting contract.
While discussing options, Albers emphasized that self-funding can deliver pharmacy rebates and exclusion opportunities but carries early-year funding risk and is best considered after three years of consistent data. "If you go self funded too soon, you can get upside down," she said, adding that the broker evaluates self-funding eligibility every year.
Commissioners and staff asked about customer service, compliance, fee disclosure, and whether stop-loss or captive options might be used to limit volatility. The presenters described tools such as quarterly claims reviews, narrow-network and concentric-network strategies in cooperation with neighboring public employers, and vendor programs (for example, a Flex Access program and specialty-drug assistance) that can reduce plan exposure to expensive drug therapies. They also noted limits imposed by HIPAA and fully insured arrangements: under the county's current fully insured Blue Cross plan, the carrier controls direct outreach to members for certain specialty programs, which constrains the broker's ability to target individual high-cost members unless the county moves to a self-funded model and members become identifiable to the plan sponsor.
No formal county action on plan design or contracting was taken at the meeting; commissioners asked the broker to continue monitoring claims and to provide fee-disclosure documents after renewal as required. The broker said fee disclosure compliant with the Consolidated Appropriations Act would be sent within 15 days of renewal.
