September 21, 2011 —
(Update on September 22: County lawmakers voted seven to one to move forward with moving to a self-insured health-care plan.)
With health insurance costs spiking year after year with no let up in sight, officials in Sullivan County government have been studying the option of changing insurance plans. Currently, the county is enrolled in the New York State Insurance Program (NYSHIP). On September 15, two employees of a company called EBS-RMSCO gave a presentation at the government center in which the county would become self-insured as it was in the past, but this time using a third-party administrator to handle the details.
Steve McCarthy, a vice president of the company, said that part of their method to keep down costs involves aggressive early detection. He gave the example of a woman who was sent four notices that it was time for her to get a test done; when she ultimately followed the advice, a stage one disease was found. The cost of the cure was $27,000, but had the disease advanced to stage two, the cost for a cure would have been $127,000.
County chairman Jonathan Rouis said the opportunity of members in the plan to take advantage of the wellness program that would be available would also hold down costs over time. He said also, because any savings would stay in the county plan, county employees would feel more like partners in the program.
The projected cost of NYSHIP in 2012 is $18.5 million. The cost of the EBS plan would be capped at $16.8 million, representing a savings to taxpayers of $1.765 million.
But there were skeptics in the audience. County treasurer Ira Cohen expressed concern that a high number of claims might come in one month and the county would be unable to fund them.
McCarthy pointed out that there would be reinsurance policies in place that would cover expenses on any individual member that went above $250,000 in a single year, and overall expenses beyond the $16.8 million.
Nannette Grosso, an account executive with EBS, which acts as a third party administrator for 10 other municipalities in the state, said the number of people in the plan insured that there would not be wide variations in claims from one month to the next.
On another matter, union representative Sandy Shaddock and lawmaker David Sager, who is also a chiropractor, were concerned that the plan would use Group Health International (GHI) as a network. Sager said GHI has a reputation of paying very low rates, and Shaddock said it has a reputation of denying claims.
McCarthy said that GHI would only be used as a network so that members could get their negotiated discounts. He said GHI would not be making decisions about which claims are denied.
As to the question of reimbursement rates, county manager David Fanslau sent an email after the meeting saying, “EBS has told me that the GHI Network is competitive in reimbursement rates to other players in the marketplace such as Blue Cross
or United Healthcare.”
At the meeting, lawmaker Ron Hiatt said he is satisfied with the plan EBS is offering and he is prepared to vote for the change. The matter is expected to be voted on and passed on September 22.