District reports $900,000 spike in health claims and explores new interventions

Franklin County Public Schools finance staff alerted the board on Oct. 13 that employee health insurance claims are running significantly higher than a year ago and that the division is evaluating interventions to contain costs.

Benefits administrator Mrs. Tuttle said claims through Oct. 8 were approximately $900,000 above the same point last year. The plan currently has 23 high-claim cases compared with 19 last year; the district reported 256 emergency-room visits so far, and staff determined roughly 31% of those were avoidable and may have been more appropriately handled in urgent care or virtual care settings.

Mrs. Tuttle identified high-cost specialty drugs, including cancer therapies and GLP-1 medications (she named Ozempic, Mounjaro and Jardiance), as significant cost drivers. Anthem, the district administrator reported, is offering digital tools under consideration: a diabetes-prevention program called LARK and a virtual musculoskeletal therapy pilot (referred to in the presentation as S.W.O.R.D. or similar) staff said they would demo.

Mrs. Tuttle said the district is self-funded and that a sustained upward trend could produce premium-rate pressure in the next renewal; she estimated premiums could rise 25% to 30% if claims continue at current levels. The board asked staff to work with their broker and present projections during budget planning so the board and employees can prepare for potential rate changes.