Homeless Issues Committee - Regular Meeting

We're going to call the meeting to order now at 8.30.

New enroll call. Marissa Burek?

Here.

Brian Tischer?

Here.

Scott Drummond?

I'm here.

Jay Brower? Jay Brower? Tommy Rylander?

Rylander here.

Amy Yutzig. Yutzig is here. Shannon Meyer.

Meyer is here.

You have a quorum.

Thank you. like to start by looking at the minutes for July. I did notice I think we have one member missing. I believe my recollection is that Supervisor Rylander was present for that meeting. You can correct me if I'm wrong. But I'm I'll be looking to make a motion to approve those minutes with that correction. Unless Tommy, Supervisor Rylander tells me I'm incorrect.

I'm sorry, which correction is that?

My recollection is that you were present at the July meeting. You're not listed either as present or excused. And so I, we're just missing you. And so we need to put you in the correct spot. And I thought you were present, but maybe I don't, maybe I'm not remembering.

I was, thank you.

Okay.

So I move approval with that correction.

Okay.

Tisha will second.

Any other discussion or notes on the minutes? All right. All in favor of passing those?

Aye. Aye. Aye. Aye.

Aye. Thank you, Linda. If you can just update or Amy, I'm not sure who's going to do the minutes.

Yeah, I'm writing down notes. I'll between Linda and I will get them done.

Okay.

Thank you so much.

All right, let's go back. So now the next item on our agenda. Last time in July, we went through the disability RFP. We had some very minor updates to it. Nate had reached out. There were some questions during that conversation. Nate had gotten some additional information on that. That was on the sub-replication. that perhaps he can share with us today. Nate, are you, I'm sorry, I should have asked you ahead of time if you're prepared to share your screen. We can give you a minute if you need it.

I don't have the email and subrogation pulled up by the other docs. Give me just two seconds.

Well, and Nate, while you're looking for that, that subrogation language about workers comp was something that Dan Lowens wanted added into all the RFPs because our health insurance cannot subrogate against workers comp. So it was put in all the RFPs as a protection for the county for that. I checked with Joshua and he would like it left in every RFP we do, whether it's really applicable or not, just as a protection.

That makes sense. The answer we got from standard was that it doesn't really apply to that coverage so that that tracks.

So I think our hope today, no, I think Amy, you and Scott weren't here last time. So we just wanted to make sure everyone had a chance to look at the minor edits we had made and then be able to move on from that. I know Nate had also sent some kind of additional questions that the carriers are asked. I don't know if anybody had a chance to look through that. It was included in the email from Linda. And if there was anything on there, people had flagged.

So the only thing that I noticed. Go ahead.

I read through the edits. I didn't have really anything significant to change from those.

And same thing for me, Marissa.

Okay. Thank you.

So the only thing that I noticed just for consistency of language throughout, we have highlighted in 2.7, you must be able to offer a STD, LTD and a standalone LTD policy. But if we go back up to section 2.3, the last couple of sentences in there or the last sentence says the provider must be able to offer both LTD only and STD LTD plans. So if we do eventually land on moving that to preferred versus it being mandatory, I think we would just have to make sure that we change the language in both sections.

I think all of this is mandatory, right?

Yeah, right now, everything in here is, and that's what I'm just saying. If eventually we decide that that portion would be more of a preferred, if we're going to keep it mandatory, I don't think language needs to be changed at all. But if it does get changed, I think we have to change it in both sections. Otherwise, you're going to be up in 2.3, and it's going to say one thing, and then you're going to get down to 2.7, and it'll say something different.

Was there discussion of doing that, of not requiring an STD, LTD, and LTD standalone?

I don't think we've had any decisions on it. I don't know that we've had any major discussion on it. It's highlighted, so it's something that I thought was being flagged for potentially looking at it as preferred. Got it. But I don't think we've come to any conclusions yet on any of this.

Okay.

My recollection was we were just the yellow highlight were things that where we had made some minor changes. And I think the bullet points, you know, if you compare the bullet, the bullet points are kind of the change. And then we had the red was something we were, we had thought we could eliminate. And then the green was the question that Nate had taken back to folks.

I believe that that is, I don't think there's, I can't imagine a circumstance where we want to drop The STD, LTD piece, I think certainly having disability coverage is a really important offering. I mean, and I think that, you know, unless I would love to see everyone have both short and long-term disability, just to cover that. And there are reasons where some folks just don't want to pay for that short-term, but having the long-term is really important because that's the disabilities that are going to ruin your life versus shorter-term issues.

Yeah, and the majority of the employees are enrolled in the STD, LTD versus the LTD only, but we do have a handful of people who did just enroll in LTD only.

Can they switch over to the other one without going through underwriting?

I don't think so. Shannon?

I don't think so. I think you have to, you can reduce coverage and go to just long-term, but you can't go from just long-term to short-term, long-term without underwriting or open enrollment.

That's pretty standard, isn't it?

Yeah, it is when you claims risks, they want to take a look at it.

And were there any further concerns about eliminating what's in red there about ID cards?

No, I don't have any issues with that. I don't even think we get ID cards for STD, LTD.

I thought it was not relevant.

Yeah, it's really not relevant at all.

Nate, did you want to... talk about what you learned at all with the green section or?

Yeah, so the subrogation of workers' compensation, I did reach, so there's two green sections. I think there was the subrogation of workers' comp and then the other question that we had, maybe this wasn't outlined here. Was there was a question dizzy while i scroll through um but i did connect with standard regarding the subrogation piece um and they confirmed um yeah that the because i went and looked back at standard's response to that question so it made sense they mark it na they confirmed that subrogation will usually not typically employed workers' compensation. Under the STD policy, disabilities arising out of or enforced employment are excluded from STD coverage, so subrogation wouldn't apply since the STD benefits would not be payable for work-related disabilities. For LTD, workers' comp benefits are considered deductible income and treated as an offset against the LTD benefit. So essentially, I think that it doesn't really apply

I think where one of the problems has come in is that once somebody reaches end of healing and workers' comp ends, that doesn't necessarily mean they can come back to work. And we've had problems in the past having them switch to STD or LCD once that happens. And that happens most with the Sheriff's Department, to be honest with you. But we have had it happen with highway guys, too, where they are told that you've reached end of healing, the workers' comp case is being closed, or or they end up being denied. Well, the standard has tried to deny those claims going forward. That's where we have the problem, I think.

And because those claims were incurred during the course of employment, they would be excluded from the short term.

Why?

That's how the policy is written. Folks can't double dip.

No, no, no. I'm saying once the workers' comp ends.

So the exclusion still stands if the disability was from an excluded cause.

Could they go on long-term disability or is that the problem too?

So long-term disability, workers' comp, or deductible income, I'd have to go back and check to see. The way I'm reading this is that they would still be eligible for a long-term disability because they're talking about how workers' comp is treated.

What about if there's other factors that weren't related to the work injury? that keep them out of work. For example, somebody might have had an incident where they got hurt at work and that part is covered by workers' comp, but they reach out and have healing on that, but then something else is wrong.

So I would recommend they file a claim and they go through the process, but without seeing the medical information, it's hard to say whether it would be a payable claim or not.

I just know that that's a place where we've struggled. Because, you know, I mean, and it's easy for us to say, you know, they'll have to file a claim and everything else. But if they have to go through all the hassle, I mean, they're living with no income during that time. So I just wanted to point that out because that is one of the one complaint that I've had is how do we switch somebody who had a workers' comp claim but has other underlying factors that are keeping them away from work after they've reached end of healing? So just pointing it out.

Shannon's correct because I know that we've had many claims that denied work-related issue and we have sent the standard documentation from workers' comp that the claim was either denied and not deemed workers' comp or Or that exactly what Shannon said, where the person's workers' comp reached end of healing, but the employee still was not physically able or medically able to come back and return to work. We've then had it switch over to a disability claim, but we have gone through a lot of hoops to try to get that covered for the employee, sending documentation multiple times about the workers' comp stuff.

i was just hoping there could be language added that would make that clear that that person could then be entitled to that benefit but would that be under that section then i don't know where we would put it it might be like maybe its own section

Maybe there's a workers' comp section that talks about subrogation and then also what happens when there is actually a workers' comp claim that is denied, ended, reached end of healing. Maybe it's just two different bullet points under a workers' comp section.

Yeah, that would work.

So I think I want to double check with some of our carrier partners just how that gets adjudicated and where we call that out. I just don't want to think I'm trying to make these things more friendly to bidders. I don't want to sneak in some language that's going to be a big reload from an underwriting standpoint.

Right. I'll just write it down in the notes that we're looking into it. Thank you.

All right. So it sounds like Nate will ask around about what might be, what might be able to meet that need, but not create a different barrier.

So do you think it's, it is a tough claim situation when you, when you end up in that, because there's just that automatic side of it's workers comp, this isn't us. And then it's telling that story that it's, it's not workers comp, but it's not exactly hard to, to convey and makes for a frustrating experience for the member for sure.

Right. It definitely puts them in a hardship situation, not having any income and having to fight that. And usually a lot of times we did have to step in and say, OK, this is the situation. But it seems like they it almost seems like two insurance companies fighting over who has to cover them.

Yeah.

Right. But I see what you're saying. I mean, you can't write in there that there's some guarantee. So what could be done? All right, so we'll flag that for Nate to get some more homework to report back.

Were there any- And you're right, Nate. It is more about the, not the... the workers comp claim in and of itself, because if somebody is deemed end of healing and they can't return to their own job, if there aren't any other factors, they would be able to look at a reassignment. So it is if they're just, if there's other underlying factors keeping them from the workforce.

Right, which I'm sure happens, you know, I mean, you could end up with a mental health situation that you didn't previously had due to your new physical limitations.

Yeah, or like arthritis, you know, that seems to be the big one because that's always a pre-existing condition. And, you know, maybe now during your recovery and injury that has gotten worse and you're unable to return because of that, not necessarily the work-related injury in and of itself.

Okay, well, thank you for flagging that. Were there any other issues that people can think of or areas to look at on this? Then Nate had also sent along, I think it was Nate, it might have been somebody else, sent along attachment B, which was that insurance questionnaire. It seemed like a four pages worth of questions. I don't know that we need to go through all of them or if there were any that jumped out at anybody as being onerous or anything that needed to be updated.

The one that we had some homework on last time was number 13. Okay. your policy. I did go back to confirm how that is handled and has been handled by standard as well as like the number of late enrollees. And effectively, their answer was, we're going to give an open enrollment to anyone that has not previously been declined. So prior declines remain declined. which has been that is standard for what we see there from insurance carriers where someone applied for insurance and is denied the creation of an open enrollment doesn't mean that they have to then buy that claim.

Does anyone know how many people, I mean, I think there's fewer than a dozen people not on short-term, not on disability insurance. Is that accurate? Amy or Shannon, you probably know.

Well, there's more than a couple dozen. I think there's a couple hundred, like 300 or less.

300 people or less that have not enrolled at all?

Yep. We'd have to run a report out of payroll.

I agree, though. It's more in the hundreds. It's not in the dozens.

Oh, I guess I thought it was fewer. No.

in terms of the people that this applies to where they applied for coverage and got denied, it's like 12.

Yeah. Right. And I've always told people that if you're applying for, if they're going to go through underwriting because they didn't apply previously, I do, or I did make it really clear to them that if you are.

We lost sharing. We lost sharing. Yeah.

Shannon, you cut out if you're still there. Shannon, we can't hear you. Supervisor Rylander?

Yeah, my thing was unrelated, so I hate to interrupt Shannon, but it's also probably brief. Numbers two and three Are we talking about devoted employees of the insurer just for county or like how do they calculate? I would assume if I was an insurance company, my customer service people would serve a whole variety of folks. How do you count exactly how many serve the county?

Go back and see how that is. I think it's a little bit different of a breakout.

And I guess as a follow-up, are we able to use this information to assess how good the proposal is? In my day job, sometimes we collect information and then everybody admits that we're not actually doing anything with it.

Well, I think... Maybe the reason we've asked those questions is like with other insurance like Delta Dental or health insurance, we have like a dedicated group of people who work on our account. and that are like our people we can contact and basically immediately get answers. So I think that's more of where those questions are coming from is who is the disability carrier going to have as our dedicated reps, where if we have a question about an enrollment or whatever, we can call Susie Jones right away and she is dedicated to our account, not a call the 1-800 customer number and wait online for 40 minutes to try to get an answer. I think that's kind of where those questions are coming from.

Yeah. Okay. So, so we, go ahead. I was saying to Amy's point, I think it is the idea of like that Elena Deering sits in Wisconsin and these are entirely virtual.

But so then does the question need to be changed? Because if what we're trying to get at is who is our dedicated person, the question isn't really asking that. It seems like there's additional questions that are similar below, kind of starting at number 23. You know, where it's asking about kind of Are you providing us with an intake number? Um, etc. You know, so maybe two and three aren't needed.

You know, here's the I've got the I got house responded to, and it was responded to and more of the general idea of, hey, how many people do you have that are speaking to this? So this might help us think about these questions.

Yeah, I agree. I think we can reword the questions of two and three. But I also think the dedicated phone number thing is completely different. It's like Dean Health provided us with a specific phone number that Dane County employees could call again versus calling the generalized 1-800 number again. that everybody calls. We have like a dedicated phone tree. Like if you're a Dane County employee, press one and it gets them a little bit better service. So I think those two things are different of dedicated account reps for like ER side of dealing with issues versus toll-free or dedicated numbers that our actual employees use.

Yes, and for Dean, are you referring to the advanced questions line?

Yeah, there's like a dedicated number they gave that can kind of escalate someone's call to someone if they press a certain number.

Didn't they end that?

But I see that as different than our dedicated account reps.

Right, yes, I would agree. Okay. I think, I guess my, yeah. So Dean has that advanced questions line, which I think goes straight to the supervisors. But I agree. I think, yes, having the assigned rep is certainly needed. So Nate, do you wanna, can you make that a little bigger? I'm sorry. Thank you. So, I mean, I think I agree with what, Supervisor Rylander is saying, you know, are we really doing anything with the information we're getting from two or three? Or should that just be updated? Because our real question is, are we going to have a dedicated account rep and where are they located?

I mean, I think there's value.

I also, yeah, I also think that. If we're a county the size of what we are, say we have 2,700 employees who need to call in and the company answers the question and says, well, we only have three customer service reps. And we're dealing with 85 companies and your company has 2,700 employees. How long are our people going to sit on a call waiting for one of those three customer service reps to answer their phone? So I think that's also part of the reason we're asking how many customer service reps do you have working for you that answer all of your calls for all the customer base that you provide services to?

And I think either. i think either is whether they're telling us how many customer service reps they have or how many customer service reps they have that service specifically county employees either is usable data but i think maybe the question could use some rewording so because as an applicant i wouldn't know which of those two things you're asking yeah makes sense i think this is useful though to be able to say to amy's point like the number of folks that are they're deployed making sure they have a scale and there's also just a piece of we want to make sure these are aren't

different pieces there.

All right. Could we combine two and three then, and then replace three with the question of the dedicated rep?

Back in the regular RFP portion, isn't there a question about that or am I wrong? I don't have that up on my screen here, so I can't look at it real quickly, but I thought that was in the actual RFP about who will be handling our account. Or am I wrong about that?

No, you might be right. Let's, I will. 2.73 is vendor must assign a central point of contact for the county and its subscribers.

Okay. I thought it was there.

So it's listed as a requirement, but then are they answering that or do we want them to know who that is? And we've listed it as a requirement, but then do we want to know who it is in the question later?

I do think that on attachment B question 24 is probably, I guess, more targeted towards what we really want to know is how long are people going to be on the phone? Are they going to have abandoned calls? Like they try to call in and just can't get in because that's talking about abandonment rate, average speed to answer the calls, percentage of calls answered within 20 seconds. But that's kind of the, initial point of contact. The other, I think, important question is, how long is the turnaround time for actually either denying or approving a claim?

Well, they're not going to be able to answer that, though, because that really depends on how fast they get the medical information needed. And that's usually where our holdup is. It isn't usually how fast the claim is processed. I mean, that's kind of out of their hands.

And we do ask average time from receipt of claim for don't have everything, you don't want to start the clock.

It shouldn't.

I think we're set on, you've pointed out that the point of contact is in the general requirements, and then if you go down to 3.5, it does already ask for a written confirmation that that'll be complied with. So we may be set there. All right. So coming back before we lose sight of where we were, did anyone have edits then to the two and three? Supervisor Rylander was pointing out, were there anything that could make that more clear or helpful to us?

I think there's a better way of wording servicing group. Do you think we're getting the answers we want of this kind of the claims and customer service? So it's both. So I think servicing group kind of encompasses that.

If we're getting the answers we want, then this is fine. I just, I wasn't sure if we were getting at it in numbers two and three or elsewhere in the document, sort of the structure of the specific county liaison. But it sounds like we are getting those answers.

And maybe we can eliminate one of those two questions and just ask a general question of, you know, how many representatives will be available to service Dane County employees or something like that with claims or something, but get rid of one, not have both and somehow reword it.

But aren't there like two different things? I mean, servicing would be like the claim representatives and all those people behind the scenes that are working on claims where the customer service rep would be when you call in. At least that's how I read it.

Yeah. Yeah, again, if number two is for kind of the employee relations people that we're going to get to contact when there are questions on that side of it, then I think number two needs to be more clear about that. And then three would still be the customer service for the employee side of service versus the backside side.

See, I still think that number two is more about overall servicing of county employees, not just employee relations. Like somebody behind the scenes who's processing claim information or who is the actual account rep, they don't answer the phones. So the customer service reps are the ones that answer the phones when people call in. I guess that's how I read it.

Here's how it was answered. It's probably a little bit. kind of total, it could potentially touch your stuff. And then the third question was how many folks do you have in the customer service department specifically?

And then, I mean, I guess another question is just the overall organization of it, because when you get down to the bottom of page, I think it's maybe page three, the claim administration, which starts at number 23. Should any of this be moved there or do you like it at the top? Because it's asking similar questions about the intake center and the call center. I don't know that it matters, but.

And that's Amy Kirby. I don't think we've gotten a whole lot of like, or puzzlement over these questions in the past, folks have been pretty able to answer them.

Yeah, not that I remember. I mean, that isn't to say that we couldn't put them in groupings and just reorganize them in order so like questions are in the same area. Right.

Nate, can you show us how the standard answered? I think it was a 3.7, the general requirements. because I think that's where the point of contact was, just to make sure that that was answered in a way that's helpful. I think it's 3.5, which is responding to section 2.7. So I don't know where that would be. If they're just writing confirmed, that's not necessarily getting us what we want. Yeah, so they just wrote confirmed. So do we want more information than that that we could then add?

well like elena was yeah right there yeah i was curious because i know we got the answer of saying where they gave us kind of the organizational capacities where they talk about their team so like do you want them to you know to name that person in that section

I mean, I think that probably makes sense because this is just how the standard answered it. Otherwise, they saw it as all they needed to do was say confirmed, not really answer question. So if we want an actual answer that's more clear, it may be worth adding in attachment B.

My only thought or pushback would just be that certainly servicing teams do change. And you would want to be a spot where they said, like, it's going to be Elena. She goes out on maternity leave and someone else is there. So confirming that we're doing this, you can pick and choose the person at a later time versus locking that in is probably...

Well, and until they're actually awarded a contract, and they may have more additional reasons why they can't give us that information upfront, they're confirming that they're going to have a dedicated account rep, but we can't ask them to organize their business ahead of an award of a contract to necessarily give us that, can we?

I mean, generally, they're going to tell us who they're going to assign to an account on your side is going to be their best rep, and they're kind of a large person, but I feel like confirm probably gets us the answer we need there.

Okay. Amy, are you comfortable with how it is?

Yes.

You're probably the one who deals with it the most at this point.

Yep. It's fine by me.

Okay. Well, I mean, we don't need to reinvent the wheel. All right. So then do we at this point, I guess, At this point, it sounds like we're pretty close to being done with this, but we are going to ask Nate to follow up on the workers' comp issue to see if there's any language that could be added to help clarify that. Is that where we are on this?

Yep, I think that makes sense. I'm going to remove the green from the subrogation workers' comp question because we wanted to keep that. I do want to delete this ID card thing we talked about. Let's delete that. change the numbering on some of these subsequent sections.

And we can, so then we'll end up circling back. We'll add this to another agenda. Then once we get the answer from Nate, and then at that point, maybe we can, you know, recommend this for the next RFP on this. Is that fair? Does anyone have any other thoughts on that before we move on? We're not taking action. This is going to remain pending until next time and hopefully we can take action then and move it off our docket. All right. So next I'll move us on to the next item on the agenda is just a discussion item. I know that there have been a lot of different conversations going on about health insurance and different options and what could we do. And so I just thought maybe giving some, some space for people to be able to ask questions and discuss things they've heard. There's no formal presentation or anything. know i have a list of questions and others may as well so i just wanted to open up an opportunity for people to chat um Nate, I know this is, you know, we've had a couple of conversations about self funding, for example. So I know there's, you know, kind of different schools of thought on that and what, if that's feasible or not. That conversation continues, you know, kind of what's feasible, what's not, what would be the next steps and kind of getting more clear answers on the feasibility of that?

fair question in a second i'm trying to make sure i save this before we move you mentally on before i get distracted completely after where we sit here Okay, so I was able to save the updates to the SELT thing. In terms of further discussion on self-funding, I think that part of it is purely understanding the county's appetite for that funding mechanism and what some of those pieces would look like as far as a reserve. If there are research that needs to be done to see if that's something that We need to look at, just like we would need to do a formal RFP to actually get quotes and some of those different things. I don't necessarily know if we want to go down that route to solidify it. Trying to think of good, we've talked about it conceptually in terms of where it could fit. There didn't seem to be a big appetite for that from the administration and other folks there. Just generally from the costing, we wouldn't expect it to be advantageous. We were talking to our underwriters and they said, essentially, we don't have Dean's purchasing contract. We would expect about a 15% bump in medical costs. And to offset that, know if we want to have a presentation or or you know one of the more innovative or aggressive pbms come in and present or talk about kind of what that sort of model is and could feel like from a member experience an employer experience can you remind me the acronym ppm pharmacy benefit managers so they're the the folks that cost of pharmacy and drugs.

Okay. And how much ballpark, when you're looking at kind of an overall plan, what percent of the overall cost, you know, to a self-funded group is pharmacy?

So sometimes like 40% in my head, but I don't know if that's, I'd say generally it's closer to 20. Um, and that's just the fastest rising cost driver out there. Just purely even though the actual digital drugs are getting cheaper, we're finding new and exciting drugs to bring to market and extract costs from.

So we could have a presentation from a pharmacy benefit manager. And then my recollection is with cell funding, there are other kind of strategies that provide incentives to employees, you know, use this MRI instead of that MRI because this costs less to the plan, which is at that point the county, who would talk about kind of creative incentives or approaches?

I think the alliance would probably be the best person or the best group to bring in to talk through, you know, just kind of what, their offering looks like, talk about their PVP providers, and give some examples. I think probably the alliance would be a decent step, just thinking of their kind of tie locally here to different systems as, you know, to have them just present about what that could look like, what opportunities could potentially be there.

That's helpful. And then in terms of research that needs to be done, Is that, you know, if the county, I understand that, you know, people are apprehensive, but when we think about that research that would need to be done, is that something that, is that a service the Alliance offers? Is that a service M3 offers? Who offers that?

I think it's more of like a Chuck thing of thinking about like how they would have to, who would need to do a bond or something for a reserve or like kind of what that side of the equation looks like to internally for it.

Okay.

And then if there were, again, this is just hypothetically, if there were an RFP to go out related to self funding, how many RFPs? Can you remind me? I think we've talked about this.

um you could also do a second one for the pharmacy benefits manager and then the other contingent pieces are depending on which tpa you would be selecting then you can you know each of them has a menu of value adds and different you can use their menu or you can also order off menu for different things. So I think at a minimum, the TPA RFP would be the biggest one there.

And the Alliance is an example of it.

The Alliance is a network. So depending on the So UnitedHealthcare, their self-funded arm is UMR. It's out of Wausau. They have access to the Choice Plus Network, which is one of the best national networks that's available locally, kind of anchored by UW and some of those other things. I think it probably, we want to look at the Alliance because their value prop locally is, hey, you have access to everybody. So you'd be able to see sets of things.

Right. So then essentially you're eliminating the POS.

Correct. And so you have the ability to look at that. So that's a network piece. I don't think it's entirely separate from the DPA discussion. They also have their statewide networks and other offerings that are wider. Unfortunately, being a county, your folks are really anchored here. So like, you don't need to have that national coverage and rep. So the retirees appreciate it, but you don't need that. And you don't need to pay for it.

Out of area dependence.

Yeah.

Okay.

Shannon?

Yes.

Oh, you raised your hand.

Oh, I did not touch this. I don't know how that happened. Sorry. I'm getting used to a new computer and it's, I can lower it. Sorry. No worries. Didn't notice that.

All right. So I'm, I feel like I'm getting closer to understanding this, Nate, but so we've got the Alliance, which is a network and the third party administrator is somebody you hire before the Alliance or after the Alliance?

You'd be hiring the administrator first. The network kind of goes Okay, thank you.

And then if, again, hypothetically, the county were looking at something like this, they would be doing RFPs, thinking about timing a year in advance, how far in advance would you be doing this?

So some of the things you could do pretty far in advance, like the TPA stuff. I would have to check with, you know, stop loss. Typically, we're not selecting a stop loss vendor for our clients until two months out, three months out of the effective date. You guys are a larger group, but I think that that general dynamic still holds where it's a later piece. I want to talk to some of my other folks about how that is posted as part of that typically isn't publicly accessible.

Okay. That's helpful. Thank you. Do folks have any other questions specifically about self-funding?

I don't.

Okay. Another area that's come up recently is kind of employee education. You know, we talked, I think, at the IAC meeting last week about, you know, Shannon and I fondly remember our days of traveling the county doing employee education on health insurance. Are there, you know, when we think about that again, I can kind of think about many of the common questions that come up. that would be helpful to employees, but are there kind of areas that we could also focus on that would ultimately impact utilization or things that could over time be saving money?

I mean, I had that conversation with preventive care. And by being engaged, that's going to result in the best outcomes. We're going to catch larger claims early. So it's not a sexy or exciting message. It's the most impactful thing that an individual member can do. On the pharmacy side, trying to say, okay, go to pharmacy A instead of pharmacy B, I think that's a tough message. It's not going to bend the curve entirely. It might save a couple pennies here or there, but one member on a new high-cost specialty med counteracts that. What I don't want to do is tell your members, here's the thing we're going to do to fix this. see at the end result is not meaningfully different but is mail order cheaper than Walgreens oftentimes just slightly like I think mail order is something that's worth encouraging I think just purely from the the biggest benefit of mail order is the adherence goes up is that because the drugs show up at your house versus needing to go make a make a run every couple of days it's not mean percentage of dollars that does help the adherence side. Fair thing to highlight there.

Supervisor Rylander.

Unfortunately, I was unable to be at the Insurance Advisory Committee, but I watched it and it seemed like a lot of what was discussed And I'm not sure if the RFP committee is the time to bring this up, but it seems like the subject's on the table right now. But it seemed like there was a lot of loose wiring as far as like, there's employees who like don't want the more expensive option that they're currently using and they just don't make the change every year. So if we're talking about employee education, is there a lot of money to be saved by finding

better ways to ensure that people who want to make a cost-saving change make that cost-saving change there's definitely an opportunity in terms of just purely having folks move the hmo they're on the pos and aren't thinking and aren't aren't taking advantage of it and don't need to do that both on you know a prepayment basis for them and the cost for the county and others certainly assumptions but you're right there.

Yes, thank you for bringing that up. I see Shannon and Scott are next. And just to respond to what Supervisor Reilinger is saying, yes, that was something that was brought up at the IUC. And it was something that when the employee groups did a survey of about 700 members, we had a handful of people, you know, when we asked people, why are you on POS? There were at least three, as I recall, across the groups that said, that answered very honestly that they just simply forget to shift. They just stay in the insurance they're in and they forget to shift. If you look deeper into that data too, there were more people also that said they're on POS just in case. And so they're willing to pay that extra just in case, but they're primarily using the Dean network. So I think explaining to people about the networks and what being on POS versus HMO means, you know, in terms of prior authorizations and referrals, because there's a lot of misinformation out there and misunderstandings about that too. So I do think that that could be part of an education component that would be helpful across the board.

Would it make sense? Can we, oh, sorry.

Go ahead Supervisor.

I was just gonna ask, can we spend money to save money here? Can we, in much the same way we're looking to spend $5,000 to potentially incentivize people to not take the county insurance, can we offer people 50 bucks to take a seminar and delineate at the end of that seminar, delineate the things that they're gonna opt out over into, or like to sort of force the issue with an incentive? And does that actually save money?

Well, I think that part of, are you talking about an incentive to participate in the training?

Yeah.

I think we could also have a seminar that's part, you know, the county's adopted the NeoGov system. that has mandatory trainings annually for people on topics about like harassment, sexual harassment, et cetera. And so could we develop an in-house training to be loaded in there? I don't know. I don't know the capabilities of that system, but that's a question worth exploring.

Well, I probably shouldn't publicly admit how little attention I'm paying to those things when I'm taking them during my day job.

The answer to your question is it is absolutely possible for us to build training and learn all the ones you're watching have been built by us.

Okay.

I also think some, you know, when you think about a training, the more relevant people feel like it is to them, I would imagine the more attention they may pay. I think a lot of people think I'm not harassing anybody. I'm not being harassed. I don't necessarily, this isn't as relevant to me as my health insurance may be. So I guess maybe I'm naive, but I would hope people would pay attention.

I think part of it is, fried. I'm guilty of this as much as anybody else is doing 30-minute presentations on health insurance because I want to be educational. I want to be specific. I want to cover all the scenarios. Sometimes it is that quick hit 30-second, two-minute, hey, here's the plans. If you want to do the POS plan, here's why you could do that. One of my colleagues put together a different like their decision matrix was tiny. Like versus you guys have $0 cost versus a couple hundred dollar cost is a much more stark contrast. But just thinking of some of those things or even a targeted communication to POS numbers is the, hey, remember you are on the point of service plan. We're paying X dollars today.

After open enrollment, you're gonna be paying Y.

thoughts on that and you can call out the five thousand dollar piece and just you know make that a one pager email mail something like that that that could be an easy way to really make sure folks are thinking about that yeah yeah i think there's probably some creative things i see shannon i want to get to you and then scott you're next

Okay. I just want to raise the issue. I think it's two different levels of insurance education. I think people being hired from the private sector coming in or our new hires, they see more of a value in the insurance than people who've been around a long time and have never really had to worry about it. I think with the changes in health insurance that are being proposed, whichever way it goes, I think if employees now were given a chance to kind of see that more directly and how their day-to-day operations of healthcare affects the rates and so on, that they'd be more receptive to that. But I think we do have an audience of new employees who probably already see more of that value and just need to know how. So I think there's two different levels, but I think the education is going to be a huge piece. And if it could be mandated for anyone who has the insurance, I think that would be awesome.

Thank you. Yeah, I think there's probably a lot of different angles. I agree. Scott?

Yeah, thank you, Marissa. I just wanted to share my observation that you sent me some numbers about the changes in what programs people chose over the last couple of years. And when I look at that, I'm seeing something like 300 and some odd numbers of people choosing that have shifted out of the POS family or POS single coverage. And so I just wanted to say that we may have gotten successfully, certainly we've gotten successfully to those numbers of people. And it's not certain how much may remain that could still be moved. The people that have chosen not to, may have some compelling reasons or maybe stubbornly wanting to stay on the POS.

I think you are correct. I would agree that I think with each year, it's the choice. most strongly committed folks that are going to remain on POS. I think, I know you weren't able to be at the IEC meeting last week, but that was something that we did talk about there as well, where we, the employee groups did survey members. And we, again, surveyed about 1400 people and had about 700 respond. And one of the questions was about people's anticipated shift off POS next year, given the rates that would be projected for next year, given the rate cap increases. And I'm not looking at the data right now, but I recall it was about 39 or 40 people indicating that they plan to shift off. And so that survey went out, you know, again, to about half the county workforce. the county workforce that answered. So using that number to project, I think we can take a guess that, you know, an educated guess on what sort of shift we may see. But I also like, you know, what Nate's talking about, we're kind of some targeted or one on one, you're not trying to push people, but just inform people because the something else that was clear in the survey is that some people are simply confused or forget. And so even if that's a handful of people, a handful does help.

Oh, I agree. I just wanted to say, you know, supervisor Rylander suggested, you know, there may be this pool of people out there. I just, I think that that's a pool that is solidifying and, and is going to take maybe individual outreach.

Thank you.

linda yes ma'am um so Heather and I have already talked and we have a, I don't want this date shared right now. We have a September 14th date to do a health insurance presentation where we wanna talk about the upcoming changes and just present the options out there and educate people. It will be recorded. so they can attend the Lunch and Learn webinar and or watch it later on. But that's not a fixed date right now because we're kind of waiting on what's going to happen with our health insurance. We want to make sure that once everything is in place, then we can create the presentation accordingly. I also want to point out that I understand that sometimes Providing all this education can be helpful, but it's not just about providing, it's how you're presenting it. A lot of people are very visual individuals and creating a more visually stimulating presentation can probably be more helpful and more effective, but just know it is very time consuming to put such a presentation together. And yeah, so I'm just putting that out there. It's not just about presenting vocally or just putting a few things on a PowerPoint. It's about visually stimulating as well if you want to have more of an effect. It's just the way we are. We're evolving a lot on how we intake information. Thanks.

Lindsay Bass- Thank you, and I appreciate that that update, and I think you are spot on that sometimes something that can look so simple and put together, it has taken somebody hours behind the scenes.

Lindsay Bass- Oh and i'm sorry I dropped off with issues for about three minutes i'm sorry if this is already covered, but also making sure that the presentation. is perceived to be local and about your job, as opposed to a generalized thing that could be for either us or for an employer in California somewhere. Making sure that people know this is about Dane County and your benefits, I think is important. That's all.

Yes, I would agree. Thank you. All right. So it seems like there are kind of some various things going on and we have some, a lot of good ideas thrown on the table. I think one other thing, you know, I think we could include, again, this may be multiple education or presentations, you know, because these are, some are how you're using it. Some is kind of what you're enrolled in, et cetera. Retirees is another one. You know, we do have people approaching retirement. So just continually educating people because I think it's something that people need to understand and hear probably more than once because you're tuning it out when it's not relevant and tuning it in as it becomes more relevant is what your options are as a retiree. I've taken a bunch of notes. I think there's some good ideas here. Are there any other kind of education components people want to just throw on the table to consider?

Marissa, do you still have that presentation that you and Shannon did? I'm just thinking that that could be a potential helpful document. Like maybe if you could send that to me, I could have Constance do some work mocking up some learn trainings that we have a program called Articulate 360, where we have created a lot of those required trainings that we've been doing. some of them constance was able to add like a video that talked about something or like a three question questionnaire to like hey let's make sure you just understood the stuff you read to make it more interactive with like things that you can click on different tiles to get answers to things and stuff but maybe that presentation could help us be a start of, we could break down your presentation into the specific ones like, what is the difference between the POS and HMO? And that be just a quick five or 10 minute thing maybe. Then we could have another one that could be reading your EOB and how do you do that? But maybe we break down that presentation into very little smaller ones and have it as like a, these are all five or 10 of these are all specific health insurance presentations.

Yes. Thank you. The EOB is with another one that I think would be hugely helpful to people in understanding, especially since the EOB has changed from last year to this year.

Yep, and I think, too, to Nate's point, making them short and sweet and relevant, too. Here's what our county insurance is, and it's very relevant to the employee-specific benefits, as Supervisor Rylander said as well. But I think if you could get me that presentation, I could probably ask Constance to do some mock work on it. And then we can actually add people to do a review of those presentations and they can then go out to articulate and comment on them. But I think we could start working on those now if we wanted to.

Okay. I appreciate that. I can certainly send that to you. I don't know, you know, Just visually how, I mean, I think some of the concepts from back then are probably still very relevant. I don't know that what we visually did in 20, when was that, Shannon? 10 years ago. Things have probably improved since then, is my point.

Yeah, and again, I think if Constance has some, like, just the basic information about She's pretty good at building some of this stuff in ways that I would have never thought of doing. So.

Okay. I will flag for myself to send you something and I'm happy to follow up and chat further on it too.

Okay. Sounds good.

All right. Brian in the room has a comment.

Yeah, I think Amy, this will probably be for you. This is going to show my ignorance and I've done two years of NeoGov training now, but I've never taken any time to go back and look at any of the information. Is that possible? Because I can say one thing right now, someone's going to go through their NeoGov training and then three months later, not remember like, well, what was this or what was that? So how easy is it to reaccess any of the trainings that are in NeoGov?

Yeah, I think, you know, we have the trainings that are required for us that end up being assigned to us that show up on our dashboard. And once you complete those, I think they do sort of disappear generally off your dashboard. But you can go back into NeoGov Learn and go into like the course page. content or there's like a course listing and you can search through that course listing and go back and I think go and review ones that you may have already done before or re-enroll in them and redo them. I'd have to go back in and kind of look, but there is a way to do it. And we could maybe put together some sort of a, you know, I've watched this already. How do I go back and find it? Instructions for people. Yeah. But I know you can go back there and find presentations you've already done before because they are saved in there permanently.

Right. And then I guess my only other, I guess, kind of suggestion on that would be depending upon the difficulty level of re-accessing that. I think one of the things that happens with a lot of people is they don't go to look up information because of the level of difficulty it is to get to it. So how we would go about that, whether that be something that's put out on through NeoGov where we can re-access it or if it's on some centralized server where people can access it. I would say that it should not only be accessed at work, but also at home, because many times people have these questions when they're not at work.

Yeah, and learn, the NeoGov platform is cloud-based. It's not within Citrix. So you can go just on your internet and type in NeoGov and log in with your login credentials and get into the whole system without being at work at all. Okay.

Thank you.

Yep. Yeah, I wrote that as a note to make sure we identify how people can go back in once they've completed stuff to go back in and find it again. So we'll make sure we address that part of it.

Yeah, because I think you're right. You know, it's like many things where you're not thinking about how to read an EOB until you suddenly get an EOB that doesn't make sense. And then you're like, oh, yeah, how do I read an EOB?

Where was that course training that I read three months ago on that? Let me go find it again.

No, that would be nice if it was easily accessible. I wanted to circle back quickly. I think these meetings are honestly starting to blur in my head, but I think it was at IEC last week where we talked a little bit about, and Nate, you can help me remember, because I think the question was directed to you, about the POS shift, trying to anticipate. And right now, the way open enrollment is set up, if you're not making any changes, it's do nothing. And we don't want people to have to all do something to create more work. But we also want to be able to catch these people and make awareness, especially for the people that are kind of just complacently not doing anything because they aren't reading email or forgetting. Is there kind of any approach that we could take that might be, I know, I think, Amy, your office has a survey monkey that you've used for wellness, for example. Is there something that could be done, you know, if, I'm just thinking like we've got, you know, a smaller number of people on POS, a form on SurveyMonkey that could be just sent out to a smaller group that's like just confirming you're staying the same. We haven't received anything from you, confirming you're not making any changes. Or is that an unwieldy approach?

I guess I would defer to Amy and her team there. Like I could see a piece of just like, Hey, as a reminder, you're on the book. I really need to do a survey. I don't want to just be like, Hey, just as a reminder, you're signing up for the point of service plan, your rates going from X to Y as of this time. If that, you know, if you want to look at their options, go here or something really short and sweet.

Could there be a click like to confirm that you're, that you've read this, confirm that you've whatever, you know, just, you know, a little extra to make sure people are not missing it.

Yeah, I think either way, if we were to do either a SurveyMonkey that went specifically to the POS people One way or the other, if we do it that way or we send a targeted email to the POS, it's still going to be an administrative work on our end because we're going to have to run a report out of payroll, figure out who all the employees are who are on POS, just to then be able to pick those specific individuals, which that's going to be... work doing either one, the survey or the other. But I think, too, with the survey, if you wanted to have them actually respond that they understand and they're not making a change or something, we're going to have to require them also, I think, then to give us their name so that we know exactly who responded and who to track. But I also want to just flag, I don't want employees to feel like we're calling them out and harassing them either by constantly asking them about their POS plan. I mean, Carol currently does at open enrollment. She sends out an email to everybody that says, hey, it's open enrollment time. Here's the numbers. Here's the rates. Here's when things are changing here. If you're not making changes, do nothing, blah, blah, blah. She does send another reminder. People get four weeks to make changes during open enrollment to either change from HMO to POS or vice versa. There is another reminder during that four weeks that goes out to everybody saying, hey, again, I'm reminding you it's open enrollment and it's going to be ending soon. So if you're going to make a change, do something. So we do already do that. I get we all get tons of emails, but I really can't believe that an employee just says, I'm lazy and I forgot to switch from POS to HMO. They're just willing to fork out the extra money just because they're forgetful.

We put it on the survey. I was like, nobody's going to get it. And sure enough, several people did.

And so, I mean, it's because I mean, you know, at that point, I feel like that's that employee's responsibility for themselves. I don't really know that employee relation should be following up, you know, weeks and weeks on end with hundreds of people like, hey, have you made your choice yet? Yes, I made your choice yet.

Yes, but the county is paying for that too. And so there's a benefit to be gained. I mean, if we could get those three people to switch, that's a significant savings.

Yeah, I guess I'd say I want to agree more with the work for Carol. I think a soft touch there. I'm always the team of a month's too long for open enrollment. Yeah. give me a month to do something. I'm not doing anything for probably three weeks. And, you know, you kind of have that, like, let's condense that down, but that's a, that's a, that's a, that's a different conversation there. But, you know, maybe the reminder there, especially because it is under the IRS section 125 D it's an irrevocable election where you can't change it. And so giving, if we're not going to, you don't want to do a full active enrollment and have everybody make an election. that extra nudge could result in some savings. And I would say maybe not even doing it every year. Just the other thing is if you start kind of establishing that precedent and like, well, they always ask me like six times, make me sign off on this. You don't want to go down that road because someone can come back and it's more of a brain insurance side of where I'm allowed to go tell our clients

No, I understand not wanting to set a precedent. I'm just trying to brainstorm creative approaches here that we can, you know, because I would agree with what Amy is saying. We certainly don't want people to feel pressured, but I think there's a fine line that we could probably figure out how to walk. Supervisor Rylander?

Oh yeah. I just, first of all, I want to speak on behalf of the adult ADHD community and say, I am absolutely one of the people who would not make a change to his benefits, even though I knew I was supposed to. Um, uh, so, and if it's costing the County money, one thing I was thinking while we were talking about sort of the tightrope walk between the, um, the balance between being pushy and, you know, basically and advocating for people, uh, Is it possible during the NeoGov process, and I absolutely have no idea, to actually collect an answer and log that answer? Yes, I'm interested in this. Please be pushy with me in October. Or not. Is the training process sort of a no data, get through it kind of thing? Because then we actually know who we're supposed to be having these communications with.

So the learn system is truly just a training and development program. It's not, I don't believe that we can have in the learn module it asking someone questions that they respond to, that that would collect data. It's just a training program that's like recorded. It's kind of like a replacement of PowerPoint presentations. It's a more interactive training program.

So there's not a way for somebody to kind of flag themselves and say, I'm opting into a reminder.

No, I don't think so. I think you would have to probably do something like a survey monkey or something to get survey responses back. That's not what the learn system is used for.

Okay. I think like the little quizzes that are embedded in some of those, all it does is it's really a, You answered enough questions correctly, and then that allows you to be flagged as passed, but I don't think the county doesn't see the individual answers.

Correct. We don't.

I suspected that was the case. I just thought I'd check.

Yep. Always good to think of every option possible.

Any other, I mean, I think we've got a really nice list here, honestly, about kind of education. It might be multiple small things, but I guess this is something everybody can kind of keep thinking about because I think things will pop up to you at different times that we could add to this list. Anything else on education people can think of right now? Okay. Um, I had a few, Nate, I do not know if you're going to be able to answer this or if this is a question for somebody else, something that's come up recently, you know, the county proposed this week, a proposal about premiums for employees. Do you have any concept about kind of premiums and taxable income?

Is that going to be a question that you might be able to talk about or would that be? TAB, Mark McIntyre:" or somebody else i'm not a tax expert, but I guess what are you wondering there I mean there's a general. TAB, Mark McIntyre:" blank on the word, but you know there's preferential tax treatment for employee benefits premiums in terms of that they're taxed damaged.

So I guess one of the questions I have that I asked yesterday that I wasn't able to get an answer to is that, so right now we've got the County paying the full premium to Dean. Some of the proposals shifted a portion of that premium onto the employee. So that kind of presents two different questions. One is the first question is the County reducing how much of the premium they're paying. Does that have a background impact on taxes that the county owes?

I don't believe so. I would say I want to defer to an accountant. I'm not a tax professional, but my understanding is that the money is tax deductible. So if they're not spending money, that would change the end number, but it wouldn't change the tax rate or something around it from going from 90% or 100% to 90% or something. Does that make sense?

Yep. I mean, yes and no. I'm just trying to figure out, you know, because the county is saying, okay, we're going to save this much on premiums. My question is, are they also, are there additional either savings or expenses related to taxes because the amount the county is paying is different?

I don't believe so. Outside of just purely from the dollar amount impacting it.

Okay, fair. You didn't know you were getting a tax pop quiz this morning. Other question related to taxes. So then when we think about from an employee's perspective, paying premiums, that's reducing their taxable income. And so how much that reduces their taxable income and then how much they are then paying in premiums kind of can feel differently. You can feel different depending on how, what tax bracket you're in. So, right.

Steve, are you following? I think so. Yeah.

So when we then layer on tiered premiums, which was the county's, the county's second proposal, just to recap for anybody who did not watch, we can confer yesterday was a four to 7%. premium based on what quarter of the county's earnings you fell into. However, so my question, you know, so then we're looking at these tiered premiums. So then you've got people in the higher tier that are paying slightly more, but their taxable income is then coming down. And in some ways, then they're having an impact on their tax rate because they're in a higher tax bracket. So the cost of the premium can be less. Am I making sense? I might need to write it out.

Yeah, I see what you're saying in terms of if you're someone making $100,000 a year, the taxes, all that step piece, you're all paying the same in that first $50,000 in terms of where that sits, but then there's a progressive increase as you get higher where those folks are gonna be experiencing a little more savings.

I don't think that's a super meaningful number.

Maybe that's just me being ignorant there as far as the difference goes. Or really, it's hard to look at that as a, I guess I'm trying to think of where that would come into play or how you would try and change it.

Well, and that was my question is that, you know, when an employer is trying to figure out kind of what's fair and how to stagger something that's tiered like that, because I don't know how many places actually have a tiered premium structure like that.

And that is not a common structure. I'm not aware of any art groups that there's some that might do like a slightly different piece for executives or something along those lines, but a true like tier based on

Well, and I think that proposal of the tiers of the four, five, six, seven was more of a response to some discussions that has happened before where the lower paid people shouldn't have to pay as much for their premium as the higher paid people because the higher paid people can afford more than the lower paid. I think that's one of the only reasons why there was a tiered proposal at all.

Okay. Amy, do you have any understanding on I guess, nevermind, this was asked.

I know nothing about taxes. I mean, all the premiums are pre-tax. So clearly if someone making $150,000 is paying 7% of their health insurance premium, that is going to reduce their income because it's pre-tax. But does it do it so significantly that their tax bracket goes from 22% to 20? I really don't know. But again, I think it's each individual person's taxes are based on all kinds of other things in their personal lives than just pre-tax premiums for health insurance. like child care, all kinds of other stuff, Roth IRAs or pre-tax deductions to the section or the 457 plan can greatly reduce your taxable income. So, I mean, there's all those other factors that go into people's taxes, not just the premium. So I think it's hard to answer any tax question directly just about health insurance premiums.

Yeah, no, I see what you're saying. And I don't disagree. I think what I had been reading more about was how excluding the premiums ultimately ended up being worth more to taxpayers in the higher bracket. Because when you look at somebody who might be at the lower end of the bracket, and if you've got the premiums that are comparable, say $1,000 a year, Somebody might, you know, off that $1,000, if you're in the lower tax bracket, you might have, you know, $250 less in taxes owed because that $1,000 was removed. And somebody else in the higher bracket would have $300 some less in taxes owed. That had been what I'd been reading about. So I was just trying to understand.

I couldn't see that. I didn't want to talk to a tax professional.

Right. But not as biased. I think my point is not by as much as it might first seem because there's a subsequent gain.

That's all. At Damie's point, you can't really figure it out. You don't know spousal incomes. You don't know, you know, they're maxing out the 401k. They're all each other ways to reduce that burden.

Okay. Worth talking to an accountant about. I'll add to my list.

Okay.

I mean, just when I did the math yesterday, as they were kind of talking about the percentages, if someone is in the bracket that they have 7% of the premium cost, that's $217.13 a month that they would pay. So take that times 12. That's $2,605 for the whole year. That would be... pre-tax that would be taken off of their total salary.

That was for the family plan, Amy?

Yeah, for 7% HMO. HMO single for 7% is like $92.40. Okay. Oh, I see. All right. Thank you.

Any other tax questions before I ask a different question? Nate's going to find exciting, I'm sure. You know, with all the health insurance conversations going on, I think we all probably have many different people approaching us with different ideas and creative solutions. One thing that has come up that I'm not sure i fully understand the purpose of but i'm wondering if nate you have any idea is the the trend of minimum essential coverage plans being layered on top of an employer plan have you heard about this

so i would say that you know we did see a push for for mech plan so kind of the level set a little bit under the the aca there's different requirements we have fun acronyms we get to layer in there in order for coverage to really meet the uh the tests to you know avoid penalties um and i can pull up our aca guide but really the big things are it needs to be minimal central coverage minimal valuable coverage would be a affordable, kind of how I look at it. And generally, we see those minimal essential coverage plans be offered in industries that are very low paying, very low wage, aren't offering core health insurance coverages. And they're doing it as a way to say, we just want to make sure we're not going to get a sledgehammer penalty and have to pay a penalty across the board. but anything else is going to cost you there and those plans don't meet the valuable coverage side so there's a way to use those but it's not something we generally see in public sector employers it's mostly like staffing firms nursing homes things in that space that's helpful I mean I think

What I was reading about that, you know, for the people that are pushing that is that they were offering it layered on top of employer coverage as something you're using first for some of your preventative care that's then reducing your utilization and that there were also tax benefits because by having the premium of that, it had a tax benefit to folks. I don't, I'm not, saying it's realistic for us.

Just share what you're looking at and I can take a look at it and run it by some of our teams. Generally, we see those MEC plans just a way to make sure they're offering something to 95% of employers. It doesn't necessarily satisfy and avoid the tack hammer penalty if someone goes to an exchange and gets a real plan, but it is enough to stop the really onerous penalties where they're applying it to all your full-time employees.

And then The other thing I've heard about is direct primary care. Is that something that we would be?

So not in a fully insured environment. So direct primary care, DPCs, are something that we are seeing be deployed in some circumstances. And essentially what you're doing there is standalone provider to offer primary care for your people, you're paying a fixed fee in order to do that. So you're saying we're going to pay you X dollars for every member per month, regardless of whether they come and see you or not.

Like a boutique factor.

Yes. So it's something we do see there. There's a couple different folks in the space. Something like AdvocateMD is the one that jumps out. And they're on the side of some buses and running around there in a self-funded environment that could make sense in order to do that. It's something that my colleagues have some folks that are leveraging that and take advantage of. Same thing with like we've looked at doing like an on-site clinic. It's a little different piece, but the DVC is something that if you're adding it onto a fully insured plan, you're just adding cost. is it does make for a good member experience in terms of folks being able to go to their doctor and they're able to ask tons of questions and don't have that fear of, well, if I ask a question, they might charge me a copay. Where it really struggles is those docs aren't well connected to the systems. So if someone does have cancer, it's not solving that. So it's helping... member experience gets but it's an important thing to be able to get folks to go see a doctor if you encourage utilization there that can help but in the fully insured world it's initially just just a cost and it doesn't help with the really large expensive claims that are really driving this but certainly that's something you wanted to have someone come present and talk about a dpc or something

No, it's interesting. And as you're talking about that, it's making me think about how the county as a workforce is, is very diverse. And so the needs vary, depending on in some ways, worksite. And so when we talked earlier about kind of one thing, if we were to be self funded, you know, one way to really kind of help, you know, improve things is trying to get people to actually do preventative care. You know, and then we've got different groups within the county, you know, maybe the deputies, for example, maybe the folks at highway, you know, are there groups that, you know, just aren't necessarily accessing the way that other groups are, you know, I think we've, we know that there are studies that show women access care more than men, for example. you know, men who have a wife at home who is encouraging them to go to the doctor are more likely to do that than the man at home who does not have the wife pushing him. And, you know, so I just wonder if there's Because I think, I guess what I've heard is that there can be some employers in, you know, in Madison that have the clinic or the doctor that's coming to, you know, it might be the construction, the places that are kind of having people struggle to go do their own care.

So, you know, on-site clinics are a thing. And so I know we looked at a little bit trying to see what would make sense to establish or working with Dean. I think the thing about the DPC and where we see it there, And it's kind of the struggle with a lot of the more aggressive ways to save money in health care is the member experience. And, you know, we're in a city where we have a number of strong health systems to go to. So you can go to, you know, if you're a dean member, you go to SSM and they're shriveling your care from A to Z. You go in to see your doc. relatively seamless. Now, the downside of that is you paid more to get that lab down the hall than you would have had you said, hang on, time out. I'm going to go to MH Imaging and get that to how the health system is designed like a dpc their kind of whole model is we don't want to go and we don't want to have you go to a dean clinic and then go see dean people we want to have you go to these people and then you're going to get referred outside to imaging where it's less expensive and then we might have you use like so the alliance has their preferred value providers and say we'll rinse and then send you to go to Rockford to get this, to get this thing done. And it's, it's a lot cheaper, but the member experience is different. It's not, I don't want to say it's necessarily bad. Um, I think it's really hard when you have a plan, like the county's plan that does cover, you know, almost everything for the memory or that, you know, maximum amount of pocket and cost sharing to get someone to say like, well, all right, I do, you know, everything I do this year is $250 for my medical care. I don't want to go to Rockford to do that because in the end, I'm still going to end up spending the same amount of money. Does that make sense? So it's something we see with high deductible health plans where it's like, hey, you're on the hook for $2,000 for this MRI or $600 if you got it done with 9-inch imaging. $1,400 is enough for a lot of people to say, I'll go check this out.

Okay. Well, I mean, that's interesting. You know, I think it's, it always seems to be something new popping up and it's sometimes hard to know what's worth looking into more and what's, what's not. So I appreciate the, the background. Other questions or things people have heard about related to health insurance for, for the Q and a here. All right. Then I will move us on to the reports to committee. I think we just said a very quick, we're winding down here, folks. The retiree outreach. Shannon, Nate, Virginia, and I have a meeting planned to work on the retiree outreach. I think it's that next Monday. Yep.

Yep.

All right. Next Monday, we're going to meet to talk about that with a target of doing a mailing out to the current retirees and an offer of a presentation that will take place hopefully end of September, early October date to be determined. But the four of us are continuing to work on that. Amy, I did mention this to Shelby yesterday. I don't know if she had a chance to mention it to you yet, but I had mentioned to her about the mailing and if we would be able to do it on county letterhead. No offense to M3, but I figured that the retirees would be more likely to open something and read something that was from the county on county letterhead. And so if Shelby hasn't mentioned it to you, she probably will just to brainstorm kind of who we would, you know, ask to sign the letter and period.

So.

Yeah. Any questions? She didn't mention it to me.

She did. She did not.

She did not.

She's probably a little busy, but I bet she will at some point. So there's your preview. That's. That's it.

I did reach out to Heather to request a census on Monday. So we'll have that list too.

Perfect. Thank you. I can't imagine there's dramatic changes in a month. So perfect. Nate's getting the list from Heather. So we'll have it.

All right. Do we know how many people it is? For retirees? Is it a couple hundred?

it's about 200 total, I think, you know, then we'll need to figure out, and I don't know if you can answer, is the census going to be broken down by those that are Medicare eligible and not?

So the file that they can run will have ages on it. So you'd be able to figure that out. I don't think it has a flag. I don't know if it has a flag. Because I think we'll just need to...

determine if we want to target all two. It's slightly over 200 is my recollection and it's pretty evenly split with the under 65 and over 65. I think our outreach presentation is primarily targeting those over 65 who would be eligible for a supplement. So I don't know if we're going to want to just extract them from the list or send it to everybody because some people might be close enough that they would find it of interest and would help them with their planning anyway. So any thoughts on that?

I think we do want to include additional people. I mean, as many as we can, making the statement in the letter that if you're not near Medicare eligible age, this may not apply. But I think having people be aware before they get to the Medicare age and knowing how to plan once they get there is better than delaying it.

Yeah, I agree. And they may have a spouse that's over. 65 too, you know, people are different ages in a household. All right. I mean, yeah, all it's going to cost us is some extra paper and stamps.

Well, I'm assuming that this mailing will end up being the responsibility of my office, employee relations, because we're the ones who do insurance. So my question is just administratively, is now Linda and I going to be the ones stuffing envelopes for 200 people or are people going to be willing to come help do that?

I think we could, if we're looking for help, we could work together to try to find some help.

Yeah, that would be appreciated because it's gonna be mine or Linda's time doing mailing labels, printing envelopes, printing all the letters, stuffing all the letters for a couple hundred people.

I mean, this really seems like something that we could get help with from somebody else at the county.

Or maybe, I don't know, maybe we have some light duty people that are something that we could assign this work to them for.

I think we could work together.

You find us some light duty deputies who are sitting at a desk. We can have them do mail stuffers. Yeah, I'm not opposed at all of the notice going out by the county because I do agree that they would open it more from us than they would from M3. They're going to think that's junk mail because they don't know who M3 is. But I just would like some assistance in it. Yeah, no offense, Nate, but...

I agree, Amy, I think we in general, we need to spread the wealth of some of these additional duties. And I think we can definitely collaborate and try to help find.

Yeah, so we'll let we'll just keep that in mind of how we logistically make this happen when the time comes.

Yep. Fair enough.

Thanks.

Any other questions or thoughts on the retiree outreach? Otherwise, we'll report back after. We'll have more updates next time. All right, future meetings. We are scheduled to meet at the beginning of September here in hybrid again. Any other public comment or other business?

No public comment.

All right, thank you. All right, looking for a motion to adjourn.

Tischer will move.

I don't think we need a second. I don't even know that we need all in favor, but we'll do it. All in favor?

Aye.

Thank you so much for your time, everyone. I really appreciate it. Have a good rest of the day.