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Beaverhead County reviews health-plan renewal as chemotherapy, high-cost claims drive 2025 spike
Summary
County department heads heard a detailed renewal presentation from the county's health-plan administrator describing a 2025 rise in medical claims driven largely by chemotherapy and facility-based specialty drugs; the trust approved using reserves to limit the average increase to 5% and staff outlined tiering changes and outreach plans for open enrollment.
County department heads spent much of the meeting reviewing the county's employee health-plan performance and renewal options after a year of unusually high medical costs.
An Allegiance representative told the group that the county's plan had an unusually high claims year in 2025, with 90% of plan members using services and per-member-per-month medical costs running “96% higher than benchmark” and up about 33% from the prior year. The presenter attributed the bulk of the increase to outpatient chemotherapy and facility-based specialty drugs, saying those treatments were the leading drivers of outpatient spend.
The presenter said the Maple Healthcare Trust trustees agreed to apply member-equity reserves to reduce what would have been a 7.5% average increase down to a 5% trust average for renewal. “So that is what they did. So we were thrilled with that decision to come down to a 5%,” the presenter said.
County officials and the presenter discussed options for keeping the county's permissive-tax increase (the portion voters see on tax notices) as low as possible. One option presented would shift some costs modestly to the member-and-spouse tier so that the member-only rate increase placed on the tax roll would be about 4%; the presenter said that approach would raise some spouse-tier premiums by roughly $31 per month in the example shown, and that corrected rate tables would be provided after formula errors in the draft packet were fixed.
The renewal discussion also covered plan design choices and enrollment counts across four offered plans (RM500, RM4000, basic and a high-deductible option). Presenters noted the county can offer alternate tiers or swap plan options (for example, adding an RM3000 option) if the board wants to reduce employer cost further.
On utilization management, presenters highlighted that most ER visits were high-severity (appropriate) but identified three potentially avoidable ER visits in the year (a throat infection, an upper-respiratory diagnosis and a UTI). The plan is expanding education about telehealth and urgent-care options and promoting Recuro, the vendor's telehealth service, which the presenter said saved $255 in one member example compared with an urgent-care visit.
Wellness and value-add programs were emphasized for the coming enrollment cycle. The county has rolled out Hello Heart (a no-cost blood-pressure program) and reported 268 pool-wide signups in the first two weeks; the plan will promote Hello Heart and Recuro during open enrollment.
Next steps: presenters asked the county to confirm plan elections by March 13 so the vendor can configure the open-enrollment platform. Open enrollment is scheduled to run April 1'June 15, with an in-person/open-enrollment event on April 8. Presenters also said the county must notify the carrier by March 1 if it plans to shop or not renew.
What's next: staff will receive corrected rate tables and a revised rate sheet electronically; the insurance committee will be reconvened to review final plan choices before the March 13 deadline.
