Chesterton Tribune



Consultants, renewal dates fluster Commissioners over health plan

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Changes made two years ago to the Porter County Government health care insurance plan has made a web that County Commissioner President Jeff Good, R-Center, finds a bit too much to unwind.

Good showed agitation Tuesday as the Commissioners for more than 90 minutes mulled over renewing the contracts in place. That included its reference-based pricing network INETICO, organ transplant insurance firm AIG, stop loss insurance provider Sun Life Financial, pharmaceutical benefit management provider Magellan RX and third-party administrator Benefit Administrator Systems (BAS), all with different renewal dates.

“The presentation you just heard concerns anywhere from six to nine consultants and has around $1 million of (administrative) fees associated with it. You just heard different term dates which makes it almost impossible to manage. I know our board is an important cog in the wheel to manage this program and it’s very difficult. It’s extremely difficult,” said Good.

At one point, Good criticized the consultants involved for not informing the Commissioners of details such as if contracts are set up to automatically renew.

“I’m just blown away that we have to back in to a decision like this and I’m not very happy about it,” he said.

Presentations started with Troy Scott of R&R Benefits reporting that the County is seeing its costs in insurance claims decline to where they were almost a decade ago, with 2016’s ending figure at less than $8 million, close to what it is in 2008.

The County’s plan costs peaked in 2011 with more than $11 million paid out for claims. That amount stayed at about $10 million before dropping to about $9 million in 2015 when the Commissioners signed with INETICO, Scott said.

“Anywhere throughout the state would have loved to see the turnaround you had from 2014 to 2016. I’m unaware of anything like it, reducing costs by about $3.5 million in three years,” said Scott. “With the medical trend, that is quite an accomplishment.”

Good asked Scott if his 2016 figure included administrative and brokers costs. Scott said it didn’t.

“That’s not a real number,” Good said. “I want to see an all-in number for (2015 and 2016).”

Commissioner Jim Biggs, R-North, agreed saying that when the administrative costs are added, “that changes the whole story.”

The County’s servicing agent Mike Anton, of Anton Insurance, and Scott talked about how INETICO has kept costs down through the reference based pricing model, along with negotiating claims upfront at a much lower cost, some up to 70 percent less, versus what other networks in the industry typically do by taking a percentage.

“It’s a combination of risk mitigation, clinical and analytical claim’s repricing. It’s generated very aggressive contracts and direct negotiations has brought us success,” said Scott reading a report from INETICO.

Anton and Scott along with representatives from BAS presented costs for renewing the current plan.

County Attorney Scott McClure wanted to know what actions would be required from the Commissioners at the meeting to keep the plan running smoothly as a combination of agreements would need approval by April and some by May. A longer discussion was prompted when the Commissioners called up their groups service consultant hired earlier this year to look at the health plan, Tony Bontrager of RE Sutton and Associates, to present a comparison plan.

Bontrager’s report compared the current plan with what it would look like using UnitedHealthcare (UMR), which has a wider network than the INETICO network. The rates for the deductible with Sun Life would not reset if the Commissioners happened to change to UMR.

Getting down to brass tacks, Bontrager said that the BAS plan would be $8,742,000 in costs for this year with a maximum cap of $10.6 million. Comparably, UMR’s costs would be $8,978,000 but with a maximum cap of $10.5 million.

“Your fixed costs would be the same and claim costs would jump a little bit. Our estimate is 2 to 3 percent but you would gain that national network as well (with UMR),” Bontrager said.

McClure said there are pros and cons to either plan. “The numbers are close but we have the competing philosophies here with the more traditional united healthcare with a larger network or we keep going with what we have been working with which is the INETICO cost plus benefit system,” he said.

The County health plan could keep its contract with Magellan Rx if it switches to UMR, Bontrager said. Its choice pharmacy benefits manager however is OptumRx.

The meeting ended with Commissioner Laura Shurr Blaney, D-South, motioning to renew Sun Life for the stop loss insurance. The motion passed 3-0.

A special Commissioners meeting to consider the remaining contracts up for renewal with INETICO or change over to UMR is set for next Tuesday, March 21 at 10 a.m.

Good afterwards restated his frustrations, alleging that all of the consultants have failed to notify the Commissioners about the renewal dates for the contracts.

“This is the problem that I have with this insurance. There are too many fingers in the pie and nobody is talking to each other and nobody is addressing and talking to this board,” he said.

Good mentioned he voted no two years ago when the Commissioner board contracted with INETICO. It was approved at that time by Blaney and former North County Commissioner John Evans.



Posted 3/16/2017




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