Benefits specialist reports high prescription costs and nearly $1 million in estimated savings from clinical programs

Rachel, the county's new benefits specialist, presented a quarter‑one renewal and claims review that highlighted rising prescription costs and identified opportunities for savings.

Ross County's prerenewal position showed an overall medical loss ratio of 94.8% and a prescription loss ratio of 160.8%, producing a combined medical-and-prescription loss ratio of roughly 105.6%, Rachel said. She told commissioners the county had 11 high‑cost claimants in the reporting period (seven employees, two spouses and two children) and that the plan's $150,000 stop‑loss attachment point removes roughly $1.3 million in high-cost claims for renewal calculations.

Rachel said the county’s estimated total savings across clinical-management and wellness efforts is $997,000. She drew attention to avoidable emergency‑department visits identified in the report — 124 visits with a potential $304,000 in savings — and suggested the county could coordinate with Anthem to obtain time‑of‑day and urgent‑care usage data to better target interventions.

Commissioners asked about repeat users of the ER; Rachel said the claims and visit data show repeat usage and that additional reporting could be requested from Anthem to identify patterns. She also summarized program engagement: outpatient care represents 47% of claims, inpatient 16%, and telehealth and other services were used for mental health and chronic‑care management.

Rachel closed by noting a new wellness program is being finalized and by offering to share the underlying survey and engagement reports with commissioners. "We have the estimated total savings for Ross County, which is at $997,000," she told the board.

The board did not vote on benefits policy during the meeting; Rachel said staff will provide additional reports and supporting data if commissioners request more detailed breakdowns from Anthem.