Higley board hears detailed presentation on employee health benefits, savings programs

Higley Unified School District officials on Tuesday reviewed the district's employee benefits program and plans for the 2025'26 plan year, highlighting a shift to self'funding work with Kairos, recent pharmacy savings and expanded member services.

Superintendent'level staff and Kairos representatives told the governing board the district's self'insured arrangement gives Higley more transparency and flexibility than a traditional fully insured plan. "When you choose a carrier direct in that fashion, it certainly provides some level of security, but there's also some limitations on your ability to customize your plan designs," said Jennifer Sherman, Director of Account Services for Kairos. "Being a member, a self insured member like Higley... provides a level of autonomy to let Higley customize participation."

The presentation outlined benefits the board and staff said have produced identifiable savings and additional services. Kairos renegotiated the district pharmacy benefit manager contract in October and staff said the change delivered "several million dollars" in savings and some members have already seen lower drug prices. The Kairos nurse navigator team also flagged claims and enrollment issues: Sherman said a claims audit identified a COBRA enrollment error that saved the plan about $38,000, and cited a separate intervention that reduced a member's infusion costs by roughly $9,000 a month.

Why it matters: Higley covers roughly 4,145 people on its plan and is managing rising drug and specialty medication costs that industrywide have increased 15% year over year, officials said. Trustees questioned plan design changes that shift cost between district and employees; Human Resources and Kairos staff said they tried to limit out'of'pocket increases for members while keeping the district's self'insurance fund solvent.

Details and new services: Staff described four medical plans (a legacy $0 deductible plan, a $500 deductible copay plan, a $1,650 HSA-eligible plan and a $5,000 PPO) and said most employee contributions were increased modestly or held flat this year. Ancillary benefits include Delta Dental, VSP vision and voluntary options such as supplemental life and short'term disability. New no-cost member services announced for the district included:

- Nurse Navigator program: district-hired nurse Meredith Albers works with members to identify alternatives, correct enrollment errors and negotiate with providers.

- Aware Health virtual physical therapy: a 90'day pilot produced 57 evaluations and 159 visits; staff said virtual PT can reduce unnecessary scans and surgeries and improve access by offering care by video during the workday.

- Centers of Excellence: the district and Kairos identified vetted providers for high'cost procedures (joint replacement, spine, cancer care, substance use therapy). Staff said members routed to COE providers can have certain cost sharing waived to encourage use of higher'value, lower'cost providers.

Board questions: Trustees asked for details about how errors occur and how often out'of'network single'case agreements are used. Sherman and Kairos staff said errors typically stem from administrative or file'feed breakdowns and that when necessary Kairos negotiates single'case agreements or direct contracts to avoid unpredictable out'of'network bills. When a board member asked whether the district could require members to use COE providers, Sherman said the program is voluntary but the district can waive member cost sharing to "steer" utilization.

What's next: HR and Kairos will continue quarterly reporting to the district insurance committee and provide the board with plan financials and utilization updates. Trustees asked for more member satisfaction data; HR said informal feedback has been largely positive and that staff will follow up with more survey data.