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County keeps self‑funded health plan and adopts benefit changes proposed by consultants
Summary
Consultants from Novo/Agile briefed the board on the county’s self‑funded health plan, outlined cost‑containment measures and recommended benefit changes including increased PT/OT visits, two mammograms per year and a switch to MDLIVE telemedicine with added behavioral‑health coverage.
Benefits consultants with Novo and Agile presented a review of the county’s self‑funded health plan and recommended several benefit changes and cost‑containment strategies.
Key plan changes discussed: physical and occupational therapy visit limits were increased for many conditions (from 40 visits to 60 annually, with unlimited PT/OT for certain severe conditions); mammography coverage was changed to allow two mammograms per year regardless of diagnosis; telemedicine services were shifted from Teladoc to MDLIVE with an accompanying behavioral‑health benefit (unlimited counseling and a $10 visit for behavioral‑health telemedicine); and prescription‑rebate pass‑throughs and stop‑loss shopping were highlighted as strategies that have produced multi‑year savings for the county plan.
Consultants said the county has realized savings from prior reforms (including $125,000 from coupon recapture and other savings from stop‑loss management) and described an ongoing review of PBMs and stop‑loss carriers to manage rising pharmacy costs. The presenters noted plans to ask the board in January to consider an additional change to allow an extra colonoscopy for certain patients.
What happens next: consultants will continue PBM and stop‑loss market work and return to the board with any recommended contract changes; human resources will implement approved plan document changes for the next open‑enrollment period (noted as Nov. 1–30).
