►
Description
The following is an excerpt from the Board of Commissioners Regular Meeting from Tuesday, July 13, 2021 on County employee health insurance.
A
A
She
is
our
benefits
administrator.
So
I
want
to
make
sure
that
you're,
aware
and
and
who
really
is
doing
a
lot
of
the
work
behind
the
scenes.
Larry
will
be
doing
the
presentation
in
just
a
quick
second,
but
I
did
also
want
to
let
you
know
that,
starting
next
week
we
will
be
having
informational
meetings
with
our
staff
on
what
we're
proposing
to
you
all
today.
B
B
Let's
go
yep
there
we
go
so
I
I
think
everybody
on
council
has
a
a
printed
copy
with
the
material
and
I'll
just
quickly
go
through
the
agenda.
Before
I
can
take
my
a
big
big
topic
today,
we're
going
to
run
through
the
state
of
the
union
on
the
self-funded
health
insurance,
so
medical
and
pharmacy,
and
how
that's
been
performing
we'll
take
a
a
quick
state
of
the
union.
Look
at
it
msk
is
muscular
skeletal
pt
as
physical
therapy.
I
think
this
group
knows
about
that.
B
Those
programs
have
been
remarkably
successful,
we'll
take
a
minute
and
dive
in
on
that
speak
to
some
favorability
on
those
programs.
Then
we
have
a
benchmark
comparative
study
for
you
at
a
very
high
level,
but
it
speaks
to
the
benefit
plan
design
and
then
we'll
look
at
a
two-year
strategy.
Migration
of
that
plan
design
and
the
draft
alignment
based
on
the
survey
data
and
the
market
research,
then
a
completely
separate
topic
related
in
the
sense
that
it's
still
about
the
medical
program,
but
more
the
the
managing
of
care.
B
We
can
really
help
that
one
percent
it
can
have
an
impact
as
a
self-funded
plan
sponsor
on
your
experience.
So
I'll
just
offer
that
as
a
backdrop
to
some
of
the
things
I'm
going
to
share
today,
roberta
if
you'll
go
to
great
so
financial
performance,
how
are
things
going
plan
year?
20
was
favorable,
actual
cost,
so
net
medical
cost,
prescription,
drug
cost,
reinsurance
or
stop-loss
premiums
and
administrative
fees
were
down
11
and
20
compared
to
the
same
data
for
19..
So
that's
favorable.
Now
that's
about
a
three
and
a
half
million
dollar
favorability.
B
So
let's
talk
about
this
year,
fiscal
year
july
through
may
so
11
months
into
the
fiscal
year
we
had
a
budget
forecast.
So
our
forecast,
our
underwriting
projections,
turn
into
your
budget
and
essentially
that's
30
million
to
26.
So
you've
got
another
little
over
3.6
million
dollars
in
favorability
again
about
11
to
12.
So
things
are
running
good.
However
little
bump
in
the
road
and
I've
got
some
red
font
here
just
to
call
out
when
you
see
blue
font,
that's
my
suggestion.
B
Things
are
favorable
red
fine,
my
suggestion
things
are
not
favorable
for
the
three
months.
I'm
sharing
that
because
this
is
being
recorded,
I'm
told
and
be
reshared
yep
community
wide.
So
I
thought
that
might
be
a
helpful
hint
on
consuming
information
three
months
year
to
date.
Most
recent
three
months
excuse
me
march
through
may-
are
not
favorable
they're
flat.
B
So
just
something
to
keep
our
eye
on
three
months.
Doesn't
a
year
make
but
not
favorable.
At
the
moment,
good
news,
fiscal
year,
21
22
everybody
in
the
room
knows
there
was
no
recommended
increase
to
budget
and
we
also
recommended
no
increase
to
employee
payroll
deductions,
beginning
1-122
so
calendar
year,
22.,
and
we
had
previously.
I
I
previously
have
been
in
front
of
this
governing
body,
and
we
had
talked
about
some
plan
design
changes
a
few
years
ago,
I'm
back
again
to
resurrect
that
discussion
and
and
reconvene
on
what
that
might
look
like.
B
So
that's
pretty
much
a
financial
update,
so
just
comparatively
now
not
against
your
own
budget
or
not
against
your
year-over-year
performance,
but
you
to
somebody
else.
How
is
buncombe
county's
historical
performance
compared
to
a
benchmark
in
the
southern
us
for
municipal
clients,
and
your
consumption
is
going
to
be
something
on
the
magnitude
of
of
16
versus
a
13-5.
If
we
look
out
at
21.
B
that
black
line's
around
13-5
or
a
little
north
of
that
so
conversationally
you're
running
about
15
to
17
unfavorable
to
a
southern
norm,
lots
of
reasons
for
that
we'll
cover
some
of
them.
We've
made
some
improvement.
When
I
look
at
this,
I
see
some
nice.
You
know
you
don't
like
18
over
17
19
appears
more
favorable
than
the
trend
that
18
occurred,
and
then
we
made
some
great
strides
in
20.
B
can't
say
that
that's
all
due
to
the
population,
health
and
other
strategies
that
we've
deployed,
we
also
get
a
little
lucky
with
not
as
many
shock
claims,
it's
a
combination
of
both,
but
you
need
to
be
doing
both
and
the
journey
right
now
with
20
is
things
are
moving
back
in
the
wrong
direction.
So,
if
you're
looking
at
this
like
a
salary
analysis,
because
basically
you
spend
money
on
health
care,
it's
a
dollar
that
would
be
spent
somewhere
else.
This
is
a
little
unfavorable
in
that
respect,
and
it's
consistently
been
that
way.
B
B
So
we
gave
you
two
benchmarks
to
look
at.
We
could
probably
try
it
out
five
more,
but
these
are
statistically
valid
benchmarks.
I'll
call
your
attention,
because
the
conversation
is
going
to
hone
in
on
changing
or
considering
a
change
to
deductible
and
out
of
pocket.
These
are
singles
so
just
to
keep
the
grid
a
little
less
complicated.
I
get
there's
a
lot
on
here,
but
family
is
not
presented.
B
B
I
don't
think
that's
news
to
anybody
in
the
room,
but
I'm
just
kind
of
putting
a
and
b
together
so
that
the
story
holds
then
the
the
rates,
the
employee
contributions.
I
think
we
already
made
the
recommendation
no
increase
to
22.
here
they
are
for
21..
If
that
was
the
will
of
this
governing
body,
then
they'd
be
flat
for
22
as
well,
so
there
they
are
in
that
respect.
B
Well,
I'll
keep
us
going.
Thank
you,
so
the
summary
of
why
you
might
consider
changes.
So
we
started
this
journey
a
few
years
ago
and
we
provided
a
strategic
document.
Then
that
was
basically
some
of
the
planned
designs
on
the
previous
two
pages.
But
what's
going
right
since
we've
been
able
to
help
with
your
reinsurance
or
stop
loss,
we
marketed
that
across
a
wide.
That's
not
on
the
id
card.
It's
not
in
the
open,
enrollment
guide
so
who
you
buy
reinsurance
from
and
how
you
buy.
B
It
is
something
that
doesn't
impact
employees
at
all,
so
it
allows
you
some
leverage.
It's
not
a
blue
cross
thing:
it's
not
changing
carriers,
nobody
has
to
change
docs,
it's
a
behind
the
scene,
financing
mechanism.
So
that's
gone
favorable
for
you,
your
prescription
drug
terms
have
gotten
remarkably
more
favorable
and
then
the
musculoskeletal
program
and
the
physical
therapy,
things
that
have
been
done
have
been
very
helpful.
B
So
a
lot
of
things
going
right
and
I
think
that's
why
there
hasn't
been
a
budget
increase
for
the
last
two
cycles,
but
time
to
come
back
and
look
at
that
because
of
the
three
three
most
recent
months
and
kind
of
where
you
guys
are
in
future
forecasts.
Healthcare
trends,
seven
to
eight
percent.
So
a
do
nothing
strategy
which
suggests
the
baseline
increase
in
a
30
33
million
dollar
35
million
dollar
spend
is
seven
and
a
half
percent.
B
So
that's
basically
like
saying
consumer
price
index
inflation.
When
I
say
health
care
trends
run
in
seven
and
a
half,
the
do-nothing
strategy
is
going
to
cost
account
every
client
every
plan
sponsor
municipal
corporate
privately
held
health
care,
inflation,
health
care
trend,
seven
and
a
half
percent.
So
do
nothing
strategy.
Your
costs
are
going
to
go
up,
seven
and
a
half
so
overall,
just
kind
of
making
the
point
now
translating
a
previous
page.
B
That
was
a
graph
chart
that
you
saw
the
differentiator
differential
between
yourself
and
a
normative,
and
now
we're
trying
to
quantify
that
15
to
17
percent,
that's
about
four
or
five
million
dollars,
so
why?
Why
is
buncombe
county
spend
a
15
higher
than
normative
data?
You
cover
more
dependents
because
the
payroll
deductions
are
more
favorable.
I
don't
think
that's
news
to
anybody
in
the
room.
You
have
a
very
low
cost
share.
B
The
plan
designs
are
favorable
and
the
risk
profile
of
the
group
is
improving,
but
we're
on
that
journey
and
health
doesn't
change
overnight,
and
people
still
need
to
be
treated
and
sometimes
there's
gaps
in
care
that
are
identified
that
were
untreated,
so
the
correct
treatment
and
when
the
pt
and
the
clinic
and
the
things
we're
going
to
talk
about
today
are
really
running
for
a
low
turnover
environment.
You
want
to
invest
in
those
things
because
you're
help
helping
people
improve
their
health
in
long
range
that
that
will
save
money.
B
So
that's
the
summary
of
why
we're
suggesting
some
of
the
things
so
here
are
the
changes
21.
These
are
the
deductibles
and
out
of
pockets
that
you
saw
in
a
previous
slide,
so
300
hours
for
standard
plan
400
for
buy
up
and
650
for
core.
If
you
let
your
eyes
go
to
the
middle
of
the
page,
you
would
see
the
suggested
changes
so
in
in
this
example.
For
a
single
person
or
an
individual
deductible
goes
from
300
to
525,
that's
an
increase
of
225
dollars.
B
I
think
you
guys
get
it,
and
so
you
can
kind
of
see
the
buy
up.
400
goes
to
600
core
goes
650
to
750.
and
so
a
little
bit
less.
It's
not
the
same
number
incrementally
there's
a
little
method
to
the
madness
trying
to
keep
those
in
line
or
in
a
way
that
is
plausible
for
the
three
to
still
have
a
shelf
space.
B
If
I
could
have
made
the
chart
work,
I
guess
I
would
have
put
the
hdhp
stands
for
high
deductible
health
plan.
Pretty
prevalent
in
america,
pretty
prevalent
municipal
america,
hsa
stands
for
health
savings
account.
That's
basically
like
an
ira
for
medical,
that's
what
it
affectionately
is
referred
to
often,
but
we
would
introduce
that
plan
as
a
third
option
and
standard
would
be
sunset
if
you're
trying
to
consume
it
in
the
lineup
mentally.
I
would
just
have
you
kind
of
pick
it
up
in
your
mind
and
stick
it
over
there
past
core?
B
Okay,
it
would
be
less
rich
than
core
not
to
be
as
rich
as
standard
you'll
notice.
The
footnote,
if
we
did,
if
it
was
the
will
of
the
governing
body
and
and
the
leadership
of
the
county,
to
launch
a
high
deductible
health
plan
and
sunset
stand
standard,
you
could
offer
your
employees
hsa
money.
This
might
be
very
appealing
to
a
certain
portion
of
your
employee
base,
because
they'd
have
dollars
that
would
be
funded
by
the
county
to
set
aside
for
future
costs.
If
they
didn't
need
those
dollars
and
they
were
super
healthy.
B
The
law
allows
those
funds
to
be
used
to
pay
for
medicare
premiums
at
retirement,
so
hsas
are
popular,
I'm
sure
you've
googled
them,
I'm
sure
you
have
friends
that
have
them,
but
that
would
be
the
year
three
strategy.
If
you
wanted
to
go
in
that
direction,
the
savings
for
the
changes,
1
122
between
deductible
and
out
of
pocket
or
331
and
554.
B
B
Yes,
so
this
particular
benchmark
was
more
when
high
deductible
health
plans
are
deployed.
So
that's
when
we
were
showing
you
the
thousand
and
the
four
thousand
two
slides
ago.
We
showed
you
benchmark
usi
and
municipal
america
and
those
were
a
little
different
than
that.
One
thousand
four
thousand,
not
remarkably
but
slightly
different-
is
that
helpful
to
you?
B
B
Are
we
exercising
or
eating
right
so
hra's
health
risk
assessment,
and
I
think
most
people
in
the
room
know
because
buncombe
county's
been
doing
that
for
several
years,
but
I
need
to
get
the
flow
and
the
order
of
events
right,
because
I'm
about
to
share
something
with
you
that
will
first,
we
need
to
make
sure
we're
all
together
on
this,
so
health
risk
assessments
are
done
annually.
You
ask
your
employees
to
do
that,
they're
done
in
october.
B
D
B
October
20,
here
are
your
results
for
your
hras.
So
if
I
was
looking
at
buncombe
county
in
comparison
county
is
somebody
four
years
into
the
journey?
Okay.
So
where
should
I
expect
to
be?
Should
you
should
you
be
there
now?
No,
should
you
should
that
be
a
goal?
Yes,
so
the
aggregation
of
your
employees
and
adult
spouses
taking
health
risk
assessment
and
looking
at
their
results,
we
now
put
your
employee
base
into
three
buckets:
low
risk,
moderate
risk
and
high
risk,
and
so
let's
just
pause,
low
risk
at
58.
B
B
B
Our
people,
low
and
moderate
risk
unfortunately
had
some.
Some
slide
and
that's
why
these
programs
are
important.
That's
why
they're
repetitive,
that's
why
we
try
to
keep
it
front
of
mind.
That's
why
you
have
a
wellness
program
and
a
chronic
condition.
Management
program
now.
Remember
we're
trying
to
fight
seven
and
a
half
percent
trend
all
hands
on
deck
to
just
dial
that
down
okay.
So
that's
the
results
of
your
october
20
hra,
another.
D
B
B
So,
let's
translate
health
risk
assessment
results
year
over
year,
got
some
high
risk,
some
medium
risk
and
some
low
risk.
Now,
let's
translate
that
into
claim
cost
and
percent
of
members,
so
for
the
58
percent,
who
scored
low
risk
zero
to
one
their
claim
cost
on
a
per
capita
basis
is
sixty
three
hundred,
so
you
see
how
there's
a
direct
correlation
between
the
higher
the
risk
factor,
the
deeper
the
disease
burden,
the
larger
the
claim
spent
per
person
pretty
logical,
but
good
to
see
it
right.
B
B
So
wellness
visit
requirement
is
to
show
up
to
the
clinic,
let's
talk
and
and
maybe
there's
a
reason
why
you've
got
some
risk
factors,
and
what
do
we
want
to
do
about
those
for
those
with
two
today,
the
calendar
year,
21
requirement
is
for
them
to
come
to
the
clinic
once
we're
just
asking
it
to
go
to
twice
for
those
with
three
or
more
risk
factors.
They
see
the
clinic
once
we're
asking
that
to
go
to
three.
B
B
Okay,
it's
just
an
opportunity
to
talk,
maybe
understand
what
they're
consuming,
how
they're
consuming
it
or
maybe
not
at
all,
maybe
there's
a
gap
in
care
that
needs
to
be
closed.
They
don't
have
to
go
to
the
clinic
if
they
have
an
affinity
to
go
to
a
personal
physician,
that's
they
would
just
need
to
get
a
printed
copy
of
that,
bring
it
into
the
clinic
and
that's
whose
record
keeping
on
whether
we
got
the
two
done
or
the
three
done.
B
Okay,
that's
the
recommendation
and
the
suggestion
now
we'll
call
out
there's
27
percent
of
the
members
697
adult
members
who
did
not
complete.
You
know
it's
a
cohort.
I
gotta
have
you
in
period
one
and
period,
two
to
measure
anything.
You
got
697
on
the
sidelines
and
some
of
that's
due
to
new
heart,
but
someone.
That's
just
due
to
people
not
wanting
to
do
it.
27
is
kind
of
high
for
that
I'd,
say
you
get
about
in
any
given
benchmark
study
about
10,
maybe
12,
just
not
interested
I'll
pay.
B
B
Okay,
this
is
health
improvement
incentives.
So
this
is
how
a
plan
sponsor
like
buncombe
county,
tries
to
encourage
a
consumer
to
engage
okay.
So
what
you
have
so
we're
not
recommending
any
change
for
22
to
employee
premiums
already
said
that
I'm
going
to
say
it
again
because
we're
not
recommending
it
for
wellness
either
no
change
for
22..
B
B
B
So,
there's
always
a
way
to
get
the
preferred
plus
for
someone
who's
willing
to
come
along
in
the
program.
Okay,
that's
what
I'm
trying
to
say
the
regular
does
go
up
a
little
bit
and
the
preferred
stays
is
a
little
more
favorable
than
the
regular
and
the
preferred
plus
stays
the
same
as
the
current
discounted.
B
So
why
tonight,
why
are
we
telling
you
about
the
the
23
journey,
because
this
has
got
to
be
communicated
sometime
in
21?
The
consumer
will
take
action
in
23
and
then
the
implications
of
those
actions
will
take
place
january
1
of
I
said,
excuse
me
sometime
in
22
and
then
the
payroll
deduction
change
would
be
in
23..
I
apologize.
I
made
a
mistake
in
the
dates
a
lot
to
keep
up
with,
okay,
so
hey
larry.
Why
why
the
increase
in
the
regular
rate
that
last
bullet
point
remember?
B
B
So
now
we're
going
to
segue
again,
this
is
just
an
update.
Musculoskeletal
program
is
going.
Great,
claims
are
going
to
bounce
you
had
3.6
million
and
1
in
18,
4.5
million
and
19,
and
now
we're
down
to
three.
I
would
love
to
tell
you
five
months
into
your
musculoskeletal
program.
You
may
we
made
1.5
million
disappear.
B
We
did
not
if
things
are
going
well,
but
I
would
say
that
your
moving
average
on
muscular
skeletal
spins,
probably
closer
to
a
high
threes
low
four
number
and
the
favorability
that
you've
got
in
the
pt
programs,
probably
worth
fifty.
Seventy
thousand
dollars
a
month,
that's
basically
what
this
is
saying
through
march,
you
have
285
members
just
just
to
help
help
you
make
sense
of
it.
The
county's
probably
got
about
3
800
enrolled
members,
adult
members
are
probably
3
200
and
so
to
have
285
join
the
musculoskeletal
program.
B
B
So
we
estimate
the
program
savings
to
be
north
300
and
our
original
projection
was
three.
That's
some
of
the
reason
for
the
favorability.
That
was
just
an
update
for
the
good
of
the
group.
We'll
keep
going
wrong
so
condition
care
program,
and
I
know
we're
really
getting
deep
in
the
weeds,
but
stay
with
me.
Ppcn,
that's
the
old
asheville
project,
so
most
folks
probably
been
around
long
enough
to
remember
and
know
that
it
I
think
it's
been
good
for
the
county
good
for
the
city.
B
I
think
it
might
have
seen
its
life
cycle
clinical
care
programs
need
to
be
updated
and
evaluated
if
it's
about
engaging
people
and
saving
money.
I'd
say
this
one's
seen
better
days.
There's
low
engagement
right
now
and
there's
not
good
evidence
of
savings,
there's
probably
a
better
way
home.
So
one
of
the
recommendations
is
that
you
sunset
that
program
there's
implications
to
sunsetting
that
program.
You
have
390
some
people
enrolled
in
wellness
program
with
the
county
today
that
get
partially
subsidized
drugs,
because
they're
enrolled
in
that
program
that'll
go
away
on
january
1..
B
So
the
recommendation
is
that
you
sunset
this
contract
I'll
leave
that
to
staff
and
leadership
on
when
that
exactly
happens,
but
we
would
sunset
the
three
plans
that
those
390
people
were
enrolled
in
on
january.
That's
the
time
to
do
it
in
the
blue
cross
cycle.
You
were
new
january
1.,
so
that's
when
that
would
take
place
so
a
little
bit
of
a
downside
to
those
people,
but
it's
not
having
the
effectiveness
that
you
want.
Those
dollars
could
be
better
spent
by
the
county
in
a
different
way.
B
So
I'll
talk
about
that
now,
there's
a
new
approach
planned
member
advocate.
So
let
me
just
put
a
couple
of
facts
on
the
table
you
had
so
so.
The
county
had
346
people
identified
for
case
management
this
past
year,
the
case.
So
what
could
that
be?
That
could
be
post-surgery
and
I
wasn't
engaged
that
could
be.
I'm
a
diabetic
and
the
data
says
I'm
non-compliant.
I
haven't
had
an
a1c
exam
in
a
while.
B
B
You
had
13
members
at
192,
inpatient
stays
complete
a
post-operative
or
or
a
post-inpatient
stay
call,
so
neither
one
of
those
would
be
favorable
statistics,
I'm
making
a
case
for
behaving
a
little
different.
We
think
you
can
get
some
lift
and
we've
had
that
number
validated
by
blue
cross
about
a
half
million
dollars.
If
we
could
get
case
management
up.
Our
recommendation
after
going
to
market
and
talking
to
some
other
partners
is
synergy,
would
become
your
your
primary
advocacy
group
and
conditioned
care
and
care
navigation
partner.
B
That's
a
mouthful,
but
they
would
do
a
lot.
You'd
have
an
rn.
Ccm
stands
for
certified
case
manager,
they're
quasi
clinical,
and
they
know
about
behavior
change,
a
lot
of
behavior
change,
so
I
might
have
a
chronic
ill.
I
might
have
crohn's
disease
and
before
we
can
ever
create
drunk
treat
the
crohn's
disease.
We've
got
to
treat
me
emotionally
and
get
me
in
a
place
where
I
want
to
make
changes,
and
I
accept
what
that
lifestyle
change
might
be.
I
have
to
eat
different,
have
to
consume
some
pharmaceuticals
that
have
a
side
effect.
B
I
don't
like
the
side
effect
I
like
to
eat
what
I
eat.
I
don't
like
side
effects,
so
rn
and
certified
case
manager
are
really
important.
Ingredients
on
the
change
journey
think
high
school
coach,
whoever
piano
teacher,
whoever
leaned
in
and
really
helped.
You
make
a
behavior
change
and
with
shoulder
to
shoulder
that's
what
we're
talking
about
here
is
just
clinical
this
time
the
cost
for
this
program
is
going
to
run
you
about
191,
000
bucks
and
the
roi
is
going
to
be
a
net
roi
of
about
350.
that
needs
ramp
time.
B
So
that's
a
12
month
journey,
but
that's
the
recommendation
to
the
group
and
we're
informing
you
that
one
autoimmune,
so
everybody
knows
lupus
autoimmune
diseases,
there's
a
broad
spectrum
of
autoimmune,
three
big
ones:
ms
rheumatoid
arthritis,
psoriasis
and
crohn's
inflammatory
bowel
disease.
So
why
are
we
singling
out
autoimmune?
B
If
you
know
anybody
with
autoimmune
and
you
have
any
inclination
of
their
healthcare
journey?
It's
a
mess.
It's
self-guided,
it's
difficult,
they're,
four
or
five
different
attending
and
treating
physicians
nobody's
really
quarterbacking
care
and
they
go
for
care.
It's
complex,
they're,
a
complex
patient,
they're
not
easily
identified
and
diagnosed,
and
what
this
program
does
it
says?
Okay,
you
got
151
of
them,
but
by
the
way
we're
getting
better
at
diagnosing
them,
so
they
were
probably
always
there.
B
They
just
weren't
that
I
say
we,
the
clinical
community,
is
getting
better
at
diagnosing
people
with
autoimmune
disease
and
so
because
of
that
you
already
had
that
patient
that
employee
that
covered
spouse,
but
they
were
bouncing
around
in
the
healthcare
system,
with
no
diagnosis
and
we're
finally
getting
better
at
it
as
a
country
as
a
clinical
community
and
you're
spending
around
2.6
million
dollars.
Today,
1.6
that's
on
pharmaceuticals,
and
so
I'm
going
to
scare
you
a
little
bit
and
tell
you
that
32
people
spent
that
1.6
million
yep
so
stay
with
me.
B
151
people
have
it:
32
are
taking
drugs
for
it.
You
spent
2.6
million
with
131
people
151
people,
but
of
that
2.6
1.6
million
was
drugs
and
only
32
people
spent
that
money.
Remember
the
beginning
of
the
meeting,
I
said
one
percent
of
people
spend
five
percent
of
the
money.
This
is
part
of
that
one
percent
right
here
you
got
four
thousand
belly
buttons
covered
and
we're
talking
about
151
of
them.
Okay,
so
specialty
medications,
average
50
grand.
So
this
program
is
entirely
designed
to
lean
in
to
the
people
with
an
autoimmune.
B
I
wish
we
had
this
program
for
every
disease.
There
is
we
don't
right
now
and
this
one's
marginally
beyond
pilot
phase,
there's
six
clients
doing
it
anyway.
We
think
you
might
be
interested
and
it
might
be
a
wise
investment
to
consider
deploying
this
program
for
your
folks
who
would
like
to
participate,
not
mandatory,
not
required
they're
individually,
outreached
too,
and
if
they'd
like
to
join
the
program,
it's
free
to
them
as
a
consumer.
B
So
this
is
designed
to
kind
of
center
that
ground
it
put
a
net
around
it
and
start
to
effectuate
change
with
some
people
who
designed
some
pretty
smart
clinic
dr
hanaway,
designed
the
program
through
the
cleveland
clinic.
If
you
know
the
cleveland
clinic,
that's
like
saying
mayo
right,
it's
legitimate!
B
B
we
tossed
autoimmune
in
there,
but
I
want
to
be
very
specific
right
now:
there's
no
savings
associated
with
autoimmune,
so
you
could
delay
that
program
and
just
you
spend
what
you
spend
kind
of
like
you're
doing
right
now.
It
doesn't
make
it
a
good
or
bad
decision.
It's
just
an
alternative,
but
if
you
deploy
it
you
could
effectuate
change
downstream
and
hopefully
some
of
those
32
and
151
join,
but
together
those
two
are
estimated
at
saving
a
little
over
a
million
dollars
in
a
calendar
year
on
on
a
generally
conversationally
speaking
budget
of
35
million.
B
B
We
just
got
to
have
all
hands
on
deck,
to
try
to
drive
it
down
and
and
here's
a
million
that
maybe
takes
out
three
points.
So
I
am
grateful
for
your
time
tonight.
I'm
sorry.
I
tried
to
move
at
a
decent
pace
and
cover
quite
a
lot
of
ground,
but
it's
been
a
pleasure
to
be
here,
I'm
happy
to
take
questions
or
whatever's
best.
C
All
right,
thanks
larry,
that
was
a
lot
of
information,
and
I
think
you
did
a
great
job
covering
it.
Commissioners.
Are
there
any
questions
at
this
time?
We're
not
voting
on
anything
tonight.
Of
course
we're
just
this
is
to
share
information
with
the
commission
and
there's
going
to
be
a
process
to
get
more
engagement
with
county
employees
and
then
so
it's
just
starting
the
process.