District health plan report: reserves healthy, PATH analysis highlights chronic and behavioral-health costs

Santa Rosa County School District officials told the board their self-funded medical plan remains well-funded and that a recent PATH analytics review identified chronic conditions and behavioral-health services as the largest near-term cost drivers.

Christie, the district’s medical-plan presenter, said the plan’s balance was “a little over $22,000,000” in reserves. March claims were roughly $6,000 under the expected combined medical and pharmacy budget for the month, the presenter said, but pharmacy costs and high-cost claimants warrant attention. Two members in March had already reached the plan’s specific deductible of $250,000; claims beyond that level are subject to stop-loss reimbursement.

The PATH (Planning Analytics Total Health) review used a rolling three-year data window and showed that medical claims trended down about 10% across the period, while per-member-per-month cost decreased 3%. Pharmacy costs were up 1% overall, with drug costs per-member-per-month up about 9% year over year. The presenter said 50% of members have at least one chronic condition (higher than the benchmark of 45%), and that 16% of members had a behavioral-health claim.

Christie said the insurer/practice-review team identified five focus areas: chronic-condition management (the top spend category, with an estimated $12.9 million associated with moderate- to high-risk members), behavioral health services, preventive care, strengthening primary-care relationships, and well-being programs.

Board members asked whether recent pharmacy-tariff changes had affected costs; the presenter said she would check with the plan’s pharmacy center of excellence and report back. The insurance committee received a fuller PATH briefing the day before the board meeting.

The board received the report; no vote was required.