San Patricio County approves new vendors for employee health program; consultant says prescription oversight cut costs

The San Patricio County Commissioners Court approved a package of third‑party vendors to manage components of the county’s self‑funded employee health plan, including record keeping, pharmacy benefit management, care navigation and primary‑care options.

An insurance consultant who presented the item described the county plan as "cash‑centric" and said the recommendation balances continuity with opportunities for cost control. The court approved continuing with Centivo (third‑party administrator/medical adjudication), Maxor (pharmacy benefit manager), Michi Health (care navigation) and KCOS (preferred primary care), with staggered effective dates and one‑year contracts.

The consultant said prescription drugs drove a large share of recent plan cost growth, identifying two high‑cost drugs that represented about 30% of plan spending for 157 people. He said enforcement of the existing plan document, implemented in April, reduced costs and that annualized savings could reach roughly $700,000. "If you annualize the cost reduction, it could be as much as $700,000," the consultant said.

The presentation explained the county’s multi‑part approach: a third‑party administrator to adjudicate claims; a pharmacy benefit manager to manage drug pricing; a cash‑payment program for out‑of‑network or high‑cost claims; care navigation to assist members with appointments and treatment pathways; and potential primary‑care models including fee‑for‑service, direct primary care and on‑site clinic options.

Committee members recommended a one‑year contract structure and noted a separate request for proposals for stop‑loss insurance will follow. County commissioners approved the recommendations on a motion by Commissioner Gillespie, seconded by Mr. Gorski. The court recorded the motion as carried without a roll‑call vote listed in the transcript.