►
Description
A meeting of the city of Clearwater Benefits Committee on April 19, 2022.
B
C
Out
there-
and
he
says,
welcome
you
few,
but
faithful
so
unfaithful
today.
I
don't
know
why
that
line
always
stuck
in
my
head.
I
just
wish
I
could
know
what
maybe
it
was
so
what
we
want
to
do
today.
Thank
you.
All
for
coming
is
give
a
little
update,
as
you
guys
know,
when
we
met
last
claims
as
we're
seeing
sort
of
globally
claims
are
on
the
rise
and
they've
continued
to
stay
at
some
little
bit
higher
levels.
C
C
What
I
thought
I'd
do
is
actually
might
go
in
reverse,
because
we'll
spend
a
little
bit
more
time
on
the
claims.
If
you
want
to
go
to
the
back,
there's
actually
a
timeline.
I
want
to
just
we'll
hit
on
that.
First.
As
far
as
you
may
remember,
when
we
met
last,
we
talked
about
basically
not
done
an
rfp
in
a
while
for
for
the
carrier
for
the
medical
plan.
So
we
are
doing
an
rfp
this
year
and
I
wanted
to
talk
about
just
make
sure
the
committee
really
understands
kind.
C
Remember
you've
been
around.
You
know
this
committee
for
a
long
time
were
fully
insured.
There
were
times
were
bidding
almost
every
year
and
there
was
every
carrier
had
a
network
change
and
a
schedule
of
benefits,
change
and
pharmacy
was
different
and
all
those
things.
So
I
want
to
start
with
the
rfp
and
then
we'll
dive
into
claims,
because
that's
kind
of
the
bulk
of
the
discussion
so
real
high
level.
The
rfp
goes
out.
This
friday
is
the
targeted
date.
So
what's
in
that
rfp,
the
big
thing
in
that
rfp
obviously
is
the
medical.
C
You
guys
know
that
a
very
small
portion
of
what
you
pay
for
the
overall
program
goes
to
that
third
party
cigna
in
this
case,
to
administer
the
plan
for
you
and
then
there's
reinsurance,
which
you
have
in
the
buy
through
cigna,
but
you
don't
have
to
buy
them
through
sigma.
You
buy
it
from
any
insurance
company.
It's
just
signal's
been
competitive
and
there's
some
advantages
and
that
they
automatically
do
all
the
accounting.
C
So
if
you
have
a
big
claim
come
in,
you
don't
have
to
send
all
the
data
to
a
third
party
and
wait
for
a
reimbursement
check,
saying
that
just
does
it
automatically,
but
that's
really
the
bulk
of
your
costs
to
that
third
party
under
a
self-funded
medical
plan.
The
bulk
of
the
spend
is
your
claims
right.
So
with
the
claims.
What
are
we
looking
at
because
that's
really
the
most
important
part
of
the
rfp?
C
What
we're
going
to
be
looking
at
is
a
couple
of
things:
we're
going
to
be
looking
at
the
network
of
providers
right
so
who's
on
the
network.
We're
going
to
compare
everything
compared
to
what
you
currently
have
and
there'll
be
a
very
detailed
analysis
on
that.
We're
going
to
compare
all
the
pharmaceuticals
on
their
drug
list
to
say:
hey,
they
say
they're
cheaper,
but
do
they
only
cover
80
of
the
drugs
that
are
current
formulary
coverage?
Yeah?
That's
why
they're
cheaper
because
they
don't
cover
those
things.
C
So
we're
going
to
go
through
that
process
in
that,
but
the
biggest
thing
we're
really
looking
at
is
what
is
the
discount
they're
achieving
at
the
facilities
where
your
employees
are
going
all
right,
so
you
know
discount
for
just
to
refresh
what
does
that
mean?
Let's
say
I
go
have
an
outpatient
test
that
the
retail
rate
they
would
charge
you
off.
The
street
is
a
thousand
dollars
on
average
insurance
carriers
are
getting
about
a
60
to
65
discount.
C
So
that
means
that
the
plan,
after
whatever
your
co-pay,
is
and
pays
about
350
to
400
before
that
service.
Oh
and
then
that's
what
your
cost
share
is
based
on.
So
what
we're
looking
at
more
than
anything
is
that
network
and
the
network
discounts
what
the
funding
ultimately
needs
to
be
to
cover
the
plan
is
really
if
everybody
had
the
same
network
discount.
Let's
say
if
everybody
has
the
same
network
discount
the
funding
shouldn't
change
from
carrier
a
b
c
to
b,
because
your
claims
are
expected
to
cost
the
sale.
C
A
C
Sometimes,
when
people
hear
there's
an
rfb
out,
they
they
freak
out
and
instantly
think.
Oh,
it's
going
to
mean
we're
going
to
change
carriers,
or
so
I
just
like
to
give
you
guys.
If,
if
any
of
your
team
members
ask
you
like
hey
what
does
this
mean
for
us,
so
you
can
at
least
kind
of
explain
what
the
city's
looking
at.
C
C
C
C
If
you
want
to
go
just
to
that,
you
know
first
column,
it's
total
plan
funding
based
on
enrollment.
We
have
about
1.6
million
going
in
and
then
I
know
jay's
off
today,
but
quarterly.
I
think
jay
is
checking
this
against
all
of
their
stuff,
just
to
make
sure
numbers
bounce
up
of
that.
Just
looking
at
march
of
that
1.6
million.
C
C
D
C
C
Rebates,
which
is
an
offset
to
that
which
was
just
shy
of
1.3
million
so
1.277
last
year,
just
to
give
you
an
idea
that
was
a
million
and
75.,
so
the
pharmacy
rebates
what
we
estimated
in
the
projection.
We
just
used
last
year's
pharmacy
rebates,
so
we
don't
assume
an
increase
kind
of
year
over
year.
So
it
does
pick
up
a
little
bit
of
money
to
help
offset
some
of
the
higher
claims
we're
going
to
dive
into
some
of
the
areas
of
utilization
in
a
minute,
but
a
question
on
that.
C
C
C
So
we'll
talk
about
some
of
the
city's
specific
numbers.
Just
to
give
you
a
little
bit
of
an
idea,
you
know
globally.
Your
guys
trend
here
is
pretty
consistent
with
what
we're
seeing
in
the
market.
I
know
that's,
not
good
news
and
doesn't
really
make
anybody
feel
better,
there's
a
couple
prevailing
thoughts.
I
talked
about
a
little
bit
at
the
last
meeting,
but
we've
seen
a
couple
things
one
is
we
had
towards
the
end
of
last
year
and
beginning
of
this
year
we
had
a
number
of
increased
costs,
predominantly
due
to
delta
variant.
C
C
C
So
it's
pretty
egregious
now,
I
think.
Overall,
when
we
look
at
some
of
the
testing
numbers,
I
think
more
and
more
people
are
just
testing
at
home
because
the
home
tests
have
become
so
readily
available.
As
you
know,
the
insurance
plan
is
required
to
cover
those.
Now
you
guys
may
have
seen
that
there's.
You
know
you
can
get
those
through
the
insurance
plan,
but
obviously
you
know
I
think
most
of
those
tests
average
about
ten
to
twelve
dollars.
C
So
there's
big
savings
there.
If
people
use
those
you
don't
have
to
go,
get
online
somewhere
all
those
things,
but
the
biggest
kind
of
area
that
the
underwriters
and
actuaries
feel
is
driving
costs
is
the
backlog
from
covet.
So
all
the
stuff
that
didn't
get
done
during
the
second
half
of
2020.
First
half
of
2021.
C
C
And
you
know
they
just
didn't
end
up
going
that
way.
You
know
so
they
went
a
year
later.
You
know
for
my
family,
I
remember.
Luckily
everything
was
fine,
but
we've
heard
a
lot
of
stories.
I
didn't
have
my
colonoscopy
that
year
I
put
it
off.
I
did
this
and
they're
finding
higher
prevalence
rates
and
cancers
and
when
you
find
them
later,
the
cost
sometimes
triples
like
a
stage
three
versus
stage
one.
You
know
it's
not
just.
C
Oh,
it
went
up,
you
know
a
little
bit
because
it
actually
became
quadruple
and
that's
setting
aside
just
you
know
the
side
of
survivability
and
some
of
those
things
and
that
when
you
talk
to
people
a
lot
smarter
than
me
about
what
they
think
is
going
to
happen,
they
believe.
Second,
half
of
this
year
we
will
start
to
see
more
of
a
return
to
normal
utilization
patterns,
but
we
just
don't
know
100,
but
I
would
say
about
80
of
our
clients.
C
Their
claims
experience
looks
very
similar
to
this
right
now.
So
it
is
a
little
bit
of
an
industry
trend,
but
unfortunately
that
doesn't
you
know
that
doesn't
really
soften
the
blow.
The
other
thing,
obviously,
that
is
impactful
like
there's
some
protections
with
contracts
for
the
hospitals
and
doctors,
but
what
was
the
last
inflation
number
eight
point:
five
percent.
You
know
you
guys
remember
that
when
inflation
was
two
percent,
medical
was
always
eight
so
think
about.
If
regular
inflation
is
a
the
impact
that
starts
to
have
on
the
health
care
system.
C
D
C
Think
the
first
year
we
submit,
I
think,
jay
was
able
to
submit
some
stuff
to
the
county
and
I'm
I'm
so
bad
with
all
the
acronyms.
But
I
think
there
were
ultimately
was
it
two
or
three
different
acts
that
they
came
out
and
there
were
some.
We
we've
had
a
couple
clients
that
had
potentially
used
some
of
those
funds.
For
that,
when
I
would
ask
most
clients
about
it,
they'd
spend
it
already
on
other
things,.
D
C
One,
but
it
wasn't
harpa
again,
I
can't
remember
all
the
acronyms.
I
know
one
school
district
you
know
submitted
to
the
state
to
use
some
of
it
to
like
offset
an
increase,
but
I
can't
remember
if
that
was
like
a
specific
one
for
schools
you
know
or
how
they
could
allow
it
so
that
we've
seen
some
different
things,
but
for
the
most
part
that
first
year,
when
there
were
a
bunch
of
testing
costs,
a
number
of
entities
submitted.
Most
of
them
was
40
50
000.
C
The
hard
thing
with
some
of
like
the
bigger
claims
is-
and
I
think
there's
this
is
partially
driving
claims
in
some
regards
so
I'll,
say
it
delicately,
but
there
were
there
were
some
incentives
to
hospitals
to
go
to
things
right
where
they
got
different
funding
and
reimbursements
and
they
got
higher
reimbursement
rates
and
they
were
able
to
charge
more,
and
I
think
that
you
know
not
to
be
political.
But
if
you
watch
the
news
over
the
last
year
where
they
talk
about
you
know
what
was
the
actual
prevalence
of
covet.
You
know.
A
C
They
contract
coveted
in
the
hospital
and
now
they're,
calling
that
whole
thing
a
copic
claim.
That's
kind
of
the
other
problem
with
trying
to
submit
for
reimbursement
is
like
now
you've
got
to
dig
in
and
go
well.
That
was
actually
a
knee
surgery
that
the
person
just
happened
to
get
covered,
but
maybe
the
coconut
didn't
even
impact
them,
but
then
they
were
coding
in
his
code
in
that
regard.
So
that's
one
of
the
other
challenges.
C
C
C
C
Just
to
give
you
a
moving
average
there,
so
cameron
put
together
some
on
the
next
page,
just
some
utilization
data
from
our
benchmarking
and
data
analytics
system,
which
takes
a
look
at
some
of
the
different
utilization
numbers
and
on
that
page,
which
is
labeled
page
one
of
the
data
analytics,
so
the
per
thousand
that's
per
thousand
members.
That's
a
number,
that's
cut.
The
number
on
top
of
that
is
your
actual
number
of
visits.
C
The
per
thousand
is
kind
of
a
moving
average.
If
that
makes
sense
where
the
the
number
on
top
you
see,
1699
office
visits
versus
almost
11
000
a
year
before.
That's
because
there's
only
a
couple
couple
months
of
data
so
that
one
that's
highlighted
is
more
accurate.
Overall,
you
see
office
visits
are
up
just
so
everybody
knows,
because
the
clinic
submits
data,
even
though
at
zero
costs
and
medicine
office
visit.
Those
clinic
visits
are
also
captured
in
this
as
well.
C
C
C
C
C
So,
and
you
know
in
this
system,
we
don't
have
all
that
data,
yet
so
it's
going
to
be
skewed
at
the
beginning,
but
that
one
will
wash
out
more
towards
the
end
of
the
pharmacy
yep.
Just
like
you
said
on
the
office.
Is
this
the
clinic
counts
when
we
get
medications
from
the
clinic?
Does
that
count
towards
us?
Also?
It
does
just
be
at
zero
costs
because
they're
submitting
it.
C
Down
below
on
the
next
page,
what
we're
able
to
do
in
our
data
analytics
system
is
take
everybody
else
in
the
system.
So
it's
not
necessarily
all
public
sector.
When
cigna
does
their
annual
report
for
us,
it
will
be
all
only
public
sector,
but
that
dash
line
is
kind
of
a
benchmark.
What
is
everybody
averaging
in
that
system?
As
far
as
a
dollar
amount
for
office
visit,
so
you'll
see
that
the
city
is
quite
a
bit
lower,
so
some
of
that
says
savings
from
the
clinic
driving
that
difference
there.
C
C
C
So
now
what
you've
seen
is
my
doctor
to
this
during
the
pandemic
is
that's
the
easiest
way
to
say
it's
like
I
was
doing
a
telehealth
with
them
that
definitely
will
go
through
as
an
office
visit.
If
you
do
that
with
them,
the
md
live
or
amwell
or
those
I
have
to
double
check
how
it
gets
coded
into
the
system.
I
believe
it's
going
to
be
it's
going
to
be
outside
of
this,
because
this
is
going
to
be
more
of
a
regular
office
coded
visit.
C
C
This
is
the
one
that's
kind
of
interesting
to
me
and
we
want
to
I'll
go
backwards,
the
actual
numbers,
but
you
guys
remember,
on
the
last
couple
we
went,
we
looked
at
the
city
below
right.
The
dodge
dashed
line.
Those
are
dashes
right.
The
dashed
line
was
on
top
remember
in
the
city
was
below
it,
which
was
a
positive.
A
C
C
I
think
you
know
reminding
people
and
constantly
having
that
message
out
that
the
er
is
we
want
er
to
be
for
emergencies.
Is
is
really
important
in
that
regard.
Now
it
can
fluctuate.
Year-To-Year
I
mean
all
it
takes.
Is
a
couple
people
having
I
mean
use
this
as
an
example.
If
I'm
having
you
know,
if
I
have
even
something
where
I
need
minor
stitches
or
something
if
it
happens
at
noon,
I
can
go
to
an
urgent
care.
I
can
go
to
the
clinic.
C
Maybe
I
can
go
to
all
those
places
if
it
happens
at
midnight,
I
got
a
lot
less
choices,
mostly
urgent
carers.
I
think
close
at
nine
or
ten
o'clock,
they're,
not
24
hours.
So
all
of
a
sudden,
like
my
options,
are
reduced.
So
a
couple
things
like
that
can
fluctuate,
you
know,
as
you
see,
but
throughout
the
year
I
mean
overall
we
see
the
er
utilization
trending
a
little
bit
higher
than
we
would
like.
C
So
it's
just
always
important
to
kind
of
keep
that
out
and
remember
in
that
regard
and
the
er
visits
you
see
quite
a
high
cost
in
that
visit,
so
just
want
to
keep
that
out
there
for
everybody
to
remember
that
the
er
is
a
very
expensive
place
to
go.
We
also
see
problems
where
you
know.
Somebody
knows
they
need
a
couple
of
tests
to
maybe
get
to
a
next
step
and
if
you
go
to
the
er
they're
going
to
do
them
all
right
there
right.
C
C
Well,
you
know
those
tests
in
the
er
cost
five
times
standalone
and
having
that
done
so
that's
kind
of
one
of
the
challenges
there
and
not
to
say
that
you
might
not
have
even
needed
all
those
to
still
get
to
the
same
results.
So
that's
one
of
the
problems
we
see
on
page
six
hospital
admissions
just
looking
at
occurrences
per
thousand
slightly
higher
than
the
best
part,
but
nothing
that
really
alarms
me
there.
C
C
C
C
C
That's
probably
the
case,
but
there's
no
way
for
us
like
individually,
to
look
at
somebody's
claims
and
say,
oh
that
they
put
that
off
and
should
have
had
it
done
a
year
ago,
but
that's
the
prevailing
bond
as
to
what's
driving
that
so
hopefully
we
start
to
see
some
normalization
next
year,
so
that's
kind
of
it.
We
just
wanted
to
give
you
guys
a
couple
of
the
areas
that
we
see
some
some
things
a
little
bit
higher
than
normal.
C
B
C
C
You
know,
there's
a
set
cost
almost
like
an
old
hmo
plan
for
every
service,
there's
no
annual
cap,
so
some
people
are
drawn
to
that
because
one,
the
cost
is
typically
lower
for
the
premium,
but
then
they
kind
of
know
what
their
costs
are
going
to
be
the
the
downside
of
that
those
have
typically
been
it's.
Normally,
your
private.
You
know
family
practice
and
that's
what
you
want
to
call
it.
They
typically
don't
take
it
because
they
don't
want
to
be
be
tied
to
that
fee
schedule.
C
B
C
C
C
You
I
have
seen
more
of
in
pockets
is
and
I'll
say
my
doctor
did
it,
but
so
my
doctor's
model,
when
I
had
to
switch
doctors
is
he
has
four
nurse
practitioners
that
work
for
him
and
then
he
handles
some
of
his
more
long-term
patients
and
the
more
complex
cases,
but
for
your
annual
check-up,
you
see
the
nurse
practitioner
right
and
he's
more
there
as
the
overall
kind
of
consultant
he
went
and
I've
seen
this
he
went
to
you
have
to
pay
it's
an
absurd
number.
It's
like
2500.
C
just
to
be
able
to
see
him
as
a
vip
type
thing.
So
my
wife
and
I
looked
at
him
like
wait,
so
that
would
be
five
thousand
dollars
and
they
called
me
and
they
were
trying
to
sell
me
on
this
and
I'm
like.
Well,
you
know
you
don't
you
want
to
do
this
and
I
actually
stopped
him
on
the
phone.
I
said
you
see.
No
I've
never
actually
met
the
doctor,
like
I've
always
seen
the
nurse
practitioner.
So
I'm
not
going
to
pay
5
000
to
see
someone.
C
I've
never
met,
but
what's
interesting
is
when
they
do
that
they're
still
billing.
The
insurance,
when
you
see
them
so
that's
just
like
an
access
fee.
We
have
seen
some
providers
go
that
route
where
they're
going
more.
This
is
like
there's
one
called
mdvip
and
there's
a
couple
of
them.
We've
seen
some
of
the
general
practitioners
go
that
route,
because
it's
the
only
way
they
can.
D
D
D
C
D
D
C
C
B
D
A
C
You
know
utilization
is
definitely
up.
So
that's
you
know
generally
reflective
of
the
morning
issues
going
on.
You
know.
Hopefully
we
start
to
see
that
stabilizer
or
come
down
the
next
couple
months
and
we
have
you
know:
we've
seen
a
lot
of
groups,
not
everybody,
obviously
kind
of
has
this
effect
at
the
same
time,
but
we
have
seen
some
groups
that
an
increased
increase
that
are
now
we're
starting
to
see
a
little
bit
of
positive
trends.