Horton Group: Barron County's self-funded health plan ran slightly over budget in 2025; stop-loss reimbursements limited the impact

The Horton Group presented the county's 2025 and year-to-date 2026 results for Barron County's self-funded health plan on May 18, reporting that the plan ran modestly over budget in 2025 but avoided a larger deficit thanks to stop-loss reimbursements.

Tim Deon, the Horton Group's executive vice president and sales consultant, said the county's overall 2025 loss ratio (excluding stop-loss reimbursements) was 103.3%, producing a roughly $246,000 shortfall against plan funding. Deon said the stop-loss program reimbursed about $4.4 million on high-cost claims, and "stop-loss really saved the day," allowing the county to avoid a larger net impact to the fund balance.

Key figures and program notes presented to the board:

- Total 2025 plan cost: about $7.6 million; plan funding about $7.3 million; net overage roughly $246,000. - Stop-loss reimbursements in 2025: approximately $4.4 million. - Fund balance: reported in discussion as about $3.9 million on county books. - Retained specific stop-loss deductible: $100,000 per member. - Reported per-employee per-year total cost (presented in slides): $27,928 (2025 figure); Horton's 2026 projection referenced $27,780 per employee per year in renewal modeling. - Year-to-date 2026 loss ratio presented: 107.9% (monthly average around 130% before accounting for reimbursements). - Direct primary care (Oakleaf) costs and savings: county paid roughly $800,000 for direct primary care services while the Horton Group estimated about $377,000 in savings due to utilization; Oakleaf accounted for roughly $123,000 of identifiable cost in 2026 metrics.

Deon reviewed fixed fees (Anthem administrative fee and third-party administrator fees), prescription arrangements (Caroline RX), and cost-containment programs such as OptimMed and RX and Go. He described the Samaritan Fund pilot that helped one high-cost member find coverage and pay out-of-pocket costs.

Plan changes that went into effect included increasing the primary care copay to $30, specialist copay to $60, and raising urgent-care copays to $75, a change the presenter said was designed to steer members toward direct primary care and lower-cost options.

Board members asked for clarifications about monthly loss ratios, fund balance sufficiency and how Samaritan Fund enrollment works. Supervisor Olsson asked why monthly loss ratios exceeded 100% while the annual number was close to 103%; Horton explained that the monthly figures excluded stop-loss reimbursements to show experience without reimbursement distortions.

Next steps described in the presentation included a pre-renewal meeting in July, marketing and stop-loss procurement in August, and a likely recommendation back to the full board in September or October for 2027 renewal decisions.

What the board was told: the county's self-insured plan had a difficult claim year but has reserves, stop-loss protection and cost-management programs that reduce the likelihood of a sustained budgetary shortfall; the administration will return with renewal recommendations this fall.