Healthcare. In case you haven’t noticed, it is a topic of conversation today. Access and affordability, what to cover and who pays are issues that every business, government and individual must wrestle with continually. Tazewell County is no exception, but we have taken steps to mitigate our exposure and still provide comprehensive healthcare for our employees.
First, a little background. We are a “self-insured” county, and thus have more flexibility in designing our plan. This also means we are susceptible to dramatic swings in overall costs from year to year depending on our claims. With nearly 500 employees, Tazewell County paid over $2.6 million in medical claims and prescriptions in FY2008. Additionally, we also purchase reinsurance that kicks in when an individual medical claim exceeds $100,000. We have gradually increased this threshold number over the past several years in order to hold down our costs.
With the common purpose of holding down costs and ensuring access, the employees and management took health insurance out of the collective bargaining process several years ago. The “Insurance Review” committee was then formed to help develop a health plan that everyone was comfortable with and provided the best value. The committee consists of board members, representatives from each union and various appointed department heads. Health insurance premiums are paid for jointly by the county and the employees, so we both have “skin” in the game. We discuss options, look at costs, see what we will gain or lose, and then decide on the best course of action. Trust is a key element in this process.
One success is that our size has given us some bargaining power in negotiating contracts with our local hospitals, where we have seen some significant savings. We do mandate that employees use specific hospitals so they achieve market-share gains for their discounts.
While only representing 20 percent of claims, prescription drugs is an area in which we have seen dramatic savings. Our total drug spending has been on a downward trend for the past three years with the implementation of a “Preferred Drug Step” program. Participants are usually started on lower-cost, high-value drugs, and in return, they have a much smaller co-payment. If the product does not work, patients then move up to a higher-tier product. Tazewell County also offers a prescription drug card program through the National Association of Counties. With no cost to the taxpayers, patients are offered discounts at area pharmacies. This card is free and is similar to the program offered in Peoria County.
One lesson we have learned is that employees would rather have small, steady increases in premiums than have no increase one year and a dramatic jump the next. We are also committed to rebidding our health insurance every three to five years to ensure we are maximizing savings.
Finally, we are increasing our emphasis on wellness. We have partnered with the City of Pekin for the last two years in sponsoring a health fair for all of our employees. We also provide on-site mobile mammography and other preventative tests.
These efforts will only take us so far, and we are unsure of what the future holds. We are confident, though, that by working together, we can hold our costs to a reasonable level and still provide quality care. iBi