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Centre County trustees review 2025 health claims; consider opt-in programs and plan changes
Summary
Capital Blue Cross told Centre County trustees that 2025 medical expenses rose 5.8% and pharmacy costs rose 10.8%; trustees heard about optional Omada programs that would add $72 per member per month, asked for more data on program effectiveness and facility fees, and discussed plan design and surplus use.
The Centre County Employee Benefits Trust reviewed a Capital Blue Cross analysis showing a 5.8% increase in medical claims in 2025 and a 10.8% rise in overall pharmacy costs.
Fred Briggs, account executive for Capital Blue Cross, and Dr. Mark Jacobson reviewed paid claims through February 2026 and described utilization trends and interventions. They said multiple stop-loss claims occurred in 2025 (stop loss applies when an insuredinclaims exceed $100,000). In-network cost savings improved from 53% in 2024 to 57% this year, and urgent care visits fell by about 45% while other types of visits rose. Capital noted the countypopulation skews older and more female, contributing to higher risk scores and chronic-condition costs.
Dr. Jacobson described new program options that would require an opt-in decision by the county: two Omada programs (a hypertension program and an enhanced GLP-1 program) that Capital said add $72 per member per month if adopted. He also described an "integrated prescription" program launched Jan. 1 for certain injectables and IV therapies tied to specific treatment centers, and explained that a 90-day mail-order option counts toward deductibles. Capital also flagged a "restrictive generic" policy that could move to mandatory for some ADHD medications; the minutes note four employees would be affected under current enrollment.
Trustees pressed for more evidence and analysis. Commissioner Mark Higgins asked for data on Omadaeffectiveness and any realized savings; Capital responded that the program began this year and outcomes are not yet fully evaluable. Higgins also requested an investigation into facility fees and how those fees have affected claim costs.
During a discussion without Capital representatives, staff and trustees credited employee use of Revive with reductions in prescription and urgent care costs and discussed outreach steps for open enrollment, including promoting Revive and Capital Virtual Health and providing a wallet card with login information. Commissioners also questioned how much of the COVID-era surplus remains and explored whether shifting employees from the low-deductible plan to a higher-deductible plan — with incentives — could lower costs, noting concerns about selection bias.
Trustees asked staff to provide enrollment counts for each plan and additional financial details at the next meeting and to bring back analysis of facility fees and program-effectiveness metrics.
Votes at a glance: Controller Jason Moser moved to accept the March 24, 2026 minutes; County Administrator John Franek seconded and the motion was unanimously approved (exact tally not specified). John Franek moved to recess the meeting at 2:52 p.m.; Jason Moser seconded and the motion was unanimously approved (exact tally not specified).
The meeting recessed at 2:52 p.m. and will reconvene as scheduled for further review of rates, plan structures and requested data.
