Dodgeland board hears pitch for self‑funded insurance with local direct‑care option

At a special Dodgeland School District board meeting, representatives from Cell Phone Health and Dr. Eric Miller of Legacy Medical Services presented a proposal to move the district from a fully insured plan to a self‑funded model built around direct primary care and nurse navigation.

Ben John of Cell Phone Health told the board the proposal is intended to bring price transparency and “smart purchasing” to health care, and to steer routine and scheduled services to independent providers the plan design treats as preferred. “When you go to the preferred providers, because of how much it’s saving the plan, then you will get that service for absolutely no money out of pocket,” John said.

The presentation described a two‑path design: employees who choose the district’s wider, traditional network (“dirt road”) would face out‑of‑pocket deductibles similar to the current plan, while employees who use the preferred direct primary care (DPC) clinics and nurse navigators could receive many services at no cost. John outlined a $4,000 individual / $8,000 family medical deductible in the proposed design and said the DPC plus navigator model helps limit the district’s aggregate spending over time.

Scott Sable, introduced by the presenter as superintendent of Mayville School District, told the board his district moved to the Cell Phone Health arrangement two years ago and, according to Sable, saved about $300,000 in its first year compared with its renewal under the previous fully insured plan. “We actually saved about $300,000 in our first year compared to our renewal,” Sable said, and described an ongoing governance practice of monthly data reviews with an account manager or broker.

Dr. Eric Miller, founder of Legacy Medical Services, described his DPC clinics in Beaver Dam, Mayville and other nearby towns and said his model emphasizes longer visits, virtual follow‑ups and care coordination. “We spend more time with people,” Miller said. “This model gives patients access and continuity that often reduces unnecessary specialist visits.”

Board members focused questions on risk and administration: who pays claims, how stop‑loss coverage works, whether the district’s finance office would face additional administrative burden, and how prescriptions and single‑case agreements for specialty care would be handled. Presenters said a contracted third‑party administrator (TPA) would manage claims and that nurse navigators would help staff and teachers find preferred, lower‑cost options and obtain coupons or exceptions when needed.

John explained stop‑loss (reinsurance) mechanics and walked the board through two contract structures discussed in the proposal (described at the meeting as “12/12” and “12/18”), saying those options differ in how run‑out claims are funded and how much upfront premium is required. He emphasized that stop‑loss limits district exposure above a set per‑member cap but does not eliminate the district’s responsibility for claims under the stop‑loss thresholds.

District staff presented an apples‑to‑apples comparison of the current Quartz HMO renewal, a tinkered Quartz alternative the broker prepared, and the Cell Phone Health self‑funded proposal. Staff noted the Cell Phone Health proposal would not qualify for HSA contributions under the IRS rules cited at the meeting; the board packet also included proposed adjustments that would re‑purpose previous HSA employer contributions to reduce employee monthly premiums under the new plan design.

Multiple board members said they wanted employees to review the presentation; the board agreed to post the presentation and consult staff before making a final decision. The board deferred formal action on the insurance question and scheduled further consideration for the May 18 meeting to allow staff input.

On other business, the board voted to hire a music director (motion carried with one abstention recorded) and to hire a reading specialist to fill a vacancy. The meeting adjourned shortly after those personnel votes.

The presentation supplied concrete next steps for the board: distribute the material to staff, gather employee feedback, and return May 18 with more information and a potential vote. The district’s reported alternatives were to accept the Quartz renewal (with its higher premiums) or to pursue the self‑funded option with the operational changes described by presenters.