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From YouTube: Benefits Committee - Feb. 9
Description
Video of the meeting held on Feb. 9 by the city of Clearwater Benefits Committee.
A
Good
morning,
everyone
it
is
wednesday
february
9th
it
is
904
and
it's
our
first
benefits
committee
meeting
for
2022..
Thank
you
all
for
coming.
Thank
you.
All
for
joining
online
sean
is
here.
Sean
fleming
from
the
garin
group
is
here
to
discuss
our
claims,
experience
and
some
other
discussions
that
we
need
to
have
to
begin
the
year
and
then
there'll
be
time
for
some
questions
at
the
end.
So
sean
go
ahead
and
take
it
away
thanks.
B
Well,
good
morning,
everybody
happy
2022,
I
think,
a
little
bit
more
of
the
same
when
it
comes
to
coding,
but
we
wanted
to
get
everybody
together.
Give
me
a
little
recap
on
how
the
plan
finished
on
the
end
of
last
year
and
talk
about
some
of
the
discussions
that
we've
been
having
for
the
upcoming
year,
obviously
in
february.
So
we
have
a
lot
of
this
year
left.
B
But
do
you
want
to
look
at
how
things
are
going
talk
a
little
bit
about
globally
and
kind
of
what
we're
seeing
in
the
market
you
know
and
how
that's
impacting
the
city
of
clearwater
and
kind
of
talk
about
a
couple
different
timelines
with
that?
Just
give
you
guys
high
level
overview
of
the
plan
and
what's
going.
B
B
B
That's
about
19.5
million
just
to
give
everyone
an
idea
of
that
19.5
million
932
000
for
the
year
went
to
cigna
to
administer
the
plan,
so
I
always
like
to
hit
on
that
when
you're
self-funded,
you're,
really
paying
cigna
or
whoever
the
carrier
is
it's
similar
in
your
case
a
fee
to
administer
the
program
if
you're
fully
insured,
which
is
what
a
lot
of
entities
are.
You
pay
them
that
whole
premium
if
the
plan
costs
less
than
that,
they
made
money
and
cost
points
kind
of
the
same
with
being
self-insured.
B
The
difference
is
the
city
retains
that
money
when
the
plan
finishes
positive,
so
about
932,
000
out
of
the
19
million,
goes
to
administer
the
program.
So
please
follow
me.
The
next
piece
is
what
we
call
stop-loss
or
pre-insurance,
and
that's
our
protection
against
anybody.
That
has
a
catastrophic
length.
B
I
always
choose
the
example
of
a
premature
baby.
You
know
premature
baby.
That's
born
in
the
nicu
could
easily
be
a
million.
The
two
billion
dollar
claim,
so
the
city
is
the
first
300
000
of
any
individual's
claims
and
anything
beyond
that
is
picked
up
by
the
reinsurance
that
that
reinsurance
coverage
costs
the
city
about
1.5
million
last
year.
If
the
city
wants
to
take
more
risk,
you
know
and
say
hey:
we
want
to
take
half
a
million
on
each
claim
that
premium
goes
down,
but
you
take
more
risk
and
vice
versa.
B
If
you
want
to
take
less
risk,
that
premium
goes
up,
you
know
and
that
insurance
carrier
pays
earlier,
so
that
costs
about
1.5
million
for
the
year
and
we'll
look
at
some
of
what
they've
paid
out
on
that
this
year.
It
kind
of
varies
your
year,
some
years
they
make
money
some
years
they
lose
so
medical
claims
is
our
next
column.
That's
your
claim
for
anything,
except
basically,
a
retail
pharmacy
retail
mail
order
department,
medical
claims
we're
at
15,
just
shy
of
15
million
and
pharmacy
claims
are
about
4.8
million.
B
When
we
put
all
those
together
and
then
if
you'll
you'll
see
a
line
pharmacy
rebates,
so
those
are
rebates
that
are
paid
generally
on
the
higher
cost
brand
name
drugs.
So
if
you
see
it
during
a
football
game
or
a
golf
tournament,
as
a
commercial
there's,
probably
a
rebate
being
paid
on
that
drug,
the
city
got
back
about
one
point:
just
shy
of
1.1
million.
B
B
The
plan
in
that
year
finished
positive
about
1.30
million.
So
if
we
go
back
to
the
first
page,
I'll
hit
a
couple
things
and
then
we'll
kind
of
talk
about
what's
going
on.
If
you
look
a
little
summary
cheat
sheet
on
the
right,
you'll
see
a
couple
bar
graphs
and
you'll
see
medical
and
pharmacy
claims.
B
So
the
first
thing
I'll
I'll
tell
you
on
that,
and
then
we'll
talk
a
little
bit
about.
Why
is
we
took
all
of
our
clients
to
get
claims
experience
we
dumped
into
a
system
called
madmen.
We
dumped
all
the
claims
and
we
ran
a
report
for
last
year
and
I
don't
remember
the
exact
number,
but
it
was
like
a
28.5
increase
across
all
our
clients
and
claims
last
year.
B
B
I
I
know
I
haven't
talked
with
jennifer
and
her
team
specifically
about
this,
but
pretty
much
every
client
that
we're
at
right.
Now
they
have
vacancies,
they
they're
looking
to
build
positions.
So
when
that
happens,
you
know
people
have
waiting
periods,
so
that
tends
to
lead
to
lower
enrollment.
I
imagine
you
guys
are
experiencing
some
of
those
workforce
challenges.
So
that's
that's,
probably
the
big
driver
between
enrollment
being
down.
B
You
know
if
somebody
leaves
when
you
fill
that
position,
even
if
you
failed
it
right
away,
it's
a
little
bit
before
they're
on
the
insurance
because
of
the
waiting
period.
So
then,
if
that
you
know
if
that
position
is
open
two
months,
you
know
there
might
actually
be
four
months
that
he
didn't
have
someone
on
the
insurance.
So
that's
probably
what's
driving
me
the
decrease
in
enrollment.
B
I'd
like
to
point
that
out,
because
it's
not
people
saying,
oh,
I'm
jumping
off
the
plan
for
some
reason
or
another.
It's
probably
those
open
positions
and
that
time
lag
affecting
that.
If
you
do
look,
you
will
notice
that
if
you
just
kind
of
eyeball,
those
numbers
december
was
actually
the
highest
month.
B
B
There's
no
way
to
track
that
we're
going
to
talk
a
little
bit
about
that.
I
will
tell
you
steve
on
the
I'll
say
this
without
getting
political,
but
I'm
sure
if
you've
watched
the
news,
you've
heard
people
talk
about
hospitalizations
for
gopher.
Right,
like
all
you
have
to
do,
is
turn
on
the
news
and
hear
you
know
one
side's,
you
know
the
left
and
the
right
are
fighting
over
what
defines
the
hospitalization
I'm
not
getting
into
that
argument.
B
B
Those
same
concerns
are
actually
trickling
to
insurance,
because
now
the
hospital's
over
coding
things
is
coping
and
and
what
we
have
is
I'll
say
it
this
way,
I
don't
know
how
accurate
some
of
the
data
is
in
terms
of
what
part
is
actually
covered
and
what
part
is
the
other
stuff,
because
all
those
things
are
going
up.
The
other
thing
is
with
the
original,
which
was
the
artboard
or
cares
act.
I
can't
remember
the
first
one
I
think
it
was
it
cares.
B
Who
cares?
Who
cares
so
with
the
cares
act?
There
was.
There
was
also
a
lot
of
stuff
that
went
to
hospitals,
which
was
treating
coven,
so
I'm
not
going
to
say
that
any
hospitals
were
unethical,
but
the
concern
that's
been
brought
up
is
where
they
incentivized
to
code,
something
that's
covered
to
get
more
government
rights.
B
B
B
It's
like,
on
top
of
all
our
regular
costs
and
we'll
look
at
some
of
it.
The
prevailing
kind
of
industry
thought
slash
concern.
Is
that
a
lot
of
what
we're
seeing
is
delayed
as
a
result
of
delayed
care
because
of
covet
so
things
that
were
put
off
things
that
maybe
got
more
severe,
especially
in
the
cancer
realm?
B
They
haven't
gotten
to
a
point
yet,
where
they've
correlated
all
the
data
fully
together,
but
I'll
tell
you
like
almost
everywhere
I
go.
We
talk
about
that.
Somebody
in
the
room
goes,
I
know
so,
and
so
that
skipped
their
mammogram,
and
now
they
found
stage
four.
You
know
so
you
hear
it
anecdotally,
we're
still
waiting
for
them
to
kind
of
finish.
The
full
data.
C
B
So
pharmaceutical
has
been
rising
at
rates
in
that
line
almost
year
over
year.
You
guys
the
year
before.
If
you
look,
your
pharmaceutical
was
up.
If
you
look
at
that
same
cheat
sheet,
your
pharmaceutical
was
up
24.8
year-over-year
different
things,
driving
that
cancer
meds
are
probably
the
biggest
single
category.
Diabetes
is
probably
the
second
and
we're
gonna
we'll
talk
about
that
in
some
of
these
subsequent.
B
Yeah-
and
I
I
think
you
know
if
you
look
at
the
second
half
of
the
year-
and
this
is
consistent
with
a
lot
of
our
groups-
I
think
the
prevailing
thoughts
mid-year
last
year
is
a
lot
of
actuaries
thought
that
we
have
got
the
month
in
the
first
half
of
the
year
from
kind
of
those
to
catch
up
and
that
it
would
really
trickle
off
the
second
half
of
the
year.
It
seems
with
most
out
that
has
not
been
the
case.
It's.
B
Some
of
that
we're
having
to
have
a
cost
with
that.
The
other
thing
to
remember
when
we
look
at
you
know
projecting
forward
we're
always
looking
at
medical
inflation
right.
Medical
inflation
last
five
years
in
the
state
of
florida
has
been
better
than
it's
been.
You
know
15
years
ago,
but
it's
still
eight
eight
nine
percent
a
year
that
was
when
regular
inflation
was
j
prize
better
number
than
me
right,
one
person
right
so
now
the
the
reason
I
say
that
is
what
did
they
say
in
december:
seven
percent,
regular
inflation.
B
So
it
doesn't
necessarily
correlate
that
that
you
know
immediately
adds
on,
but
that
that
inflationary
pressure
is
definitely
going
to
hit
the
medical
market
as
well
as
there's
major
staffing
shortages
on
medical
care
right
now.
So
all
those
things
are
going
to
drive
up
that
they
also
you
know
their
supply
and
demand
for
the
care.
If
the
doctor's
offices
are
short
staffed,
they
can't
get
as
many
people
in
do
they
miss
somebody
that
you
know
do
they
catch
them,
and
I
will
tell
you
a
personal
story.
B
B
B
C
B
C
B
We
look
at
those
for
last
year
pretty
much
from
what
I
remember
they
made
money
on
you
this
year.
They
lost
money
next
year.
It
could
be
the
same.
The
good
news
about
stop
loss
increases
is
stop
loss.
If
you
remember,
you
know
it's
a
very
small
piece
of
the
pie.
So
even
if
we
get
a
15
increase
on
the
stop
loss
that
doesn't
directly
correlate
to
the
plan,
they
also
flip
for
all
their
groups.
So
it's
more
of
a
full
product.
B
B
We
haven't
seen
that
on
your
plan
in
the
past
couple
years,
not
that
we've
never
seen
it
before,
but
we've
generally
seen
one.
You
know
this
year,
you
got
five
six
and
then
you
have
a
lot
of
other
ones
still
in
the
high
hundred
thousand
two
hundred
thousand
dollar
range.
So
that's
largely.
What's
driving
plan
calls
so.
D
Yep
just
one
question,
because
I'm
trying
to
remember
if
you
said
this
in
a
previous
meeting,
if
someone's
in
involved
in
the
stop
loss
for
whatever
the
medical
claim,
is
and
does
that
stop
loss
continue
to
the
next
year
or
do
we
do
another
three
hundred
thousand
dollars
worth
of
cost
resets
january?
So
it
does
reset
each
year,
okay,
yeah.
B
Resets
january,
one
on
your
contract,
it's
based
on
the
date.
The
claim
is
paid.
Okay,
so
you
know
there's
ways
to
do
it,
based
on
the
data
that
occurred,
but
sometimes
that
a
claim
comes
in
six
months
later
and
it's
a
whole
nightmare.
So
yours
is
just
based
on
not
necessarily
to
claim
paid,
but
when
it
incurred,
you
know
we
saw
with
with
one
of
your
claims.
B
It
didn't
actually
occur
the
year
before.
But
when
you
have
a
claim
to
that
number,
you
know
they
negotiate
with
the
hospital
they
fight
it
down,
so
it
can
take
a
while
for
it
to
catch
up.
So
if
you
guys
go
to
the
next
page
is
a
graph
just
as
it
claims
currently
per
month.
You
can
see
kind
of
that
upward
point,
but
if
you
skip
that
page
in
the
next
page,
there's
one
that
says
top
10
physical
health
conditions,
I
really
want.
B
A
E
We
pay
attention
to
this
stuff.
We
don't
just
bring
you
bad
news
and,
like
I'm
dropped,
so
we're
going
to
need
to
raise
premiums.
We
try
really
hard
to
combat
that
kind
of
stuff
and
identify
our
problems.
It's
been
diabetes
for
a
little
bit
since
I've
been
involved
in
the
plan.
We
just
rolled
out
the
amateur
program
which
we've
had
a
great
response
to.
I
mean
a
better
response
than
other
organizations
have
had,
but
that
is
specific
to
diabetes
prevention
and
it
is
an
amazing
program.
E
E
E
And
them
actually
no
cost
to
plan
unless
it's
successful,
so
I
mean
like
so
it's
an
amazing
program
and
when
you
have
numbers
like
this
and
claims
like
what
we
have,
I
mean
like.
These
are
the
things
that
we
need
to
do
like.
We
need
to
an
active
role
on
prevention
and
then
maintenance
too,
and,
like
I
said
so,
we
we're
doing
our
part
trying
to
find
programs
to
counter
our
problems
and
then
get
those
two
employees
at
an
affordable
rate.
This
is
free,
it
doesn't
get
more
affordable
than
free.
E
So
you
know
we
need
the
help
in
getting
those
words
out
and
the
comfort,
and
I'm
also
telling
some
of
the
people
who
are
practical
that
have
signed
up
for
it
to
you
know
be
champions
of
that
in
terms
of
their
success
as
well.
The
program,
also
in
terms
of
the
second
one,
which
is
just
a
particular,
can
be
for
a
lot
of
different
things,
but
it
also
you
know:
model
program,
compounds,
obesity
and
blood
pressure,
all
those
things,
so
those
are
two
components
of
that
program.
E
So
you
know
again,
it's
not
just
about
claims.
It's
about
having
a
healthy
workforce
and
making
sure
that
we
have
those
programs
for
our
employees,
so
any
help
that
you
can
do
and
suggestions
on
how
we
can
do
a
better
job,
maybe
like
email.
You
know
we're
doing
we're
having
a
lot
of
talk
about
text
messaging,
because
people
read
their
text
messages,
but
then
I'm
also
more
concerned
about
employees
being
upset,
like
you
know,
kind
of
a
thing,
but
we
want
to
get
these
messages
out
because
of
how
important
it
is.
E
B
You'll
see
the
plan
paid
about
1.2
million
for
diabetes,
only
133
000
of
that
was
an
actual
medical
claim,
so
1.1
million
of
that
was
a
pharmaceutical
and
there
were
211
individuals
that
are
in
that
diabetic
category.
So
the
jennifer's
point
the
omada
program.
It
is
pretty
amazing
program,
a
lot
of
the
hr
staff
tested
it.
It
is
largely
targeting
more
pre-diabetics
than
actual
diabetics.
B
That's
diabetic,
there's
going
to
be
another
one
that
is
pre-diabetic
and
does
not
know
it,
and
so
so
the
group
of
individuals
in
this
category
think
about
the
fact
that
there's
you
know
probably
at
least
another
200,
some
odd
individuals
that
are
in
that
category,
where
maybe
we
can
keep
them
from
ever
getting
to
this
and
that's
what
the
omada
program
is
largely
about
such
a
jennifer's
point,
the
more
that
you
guys
can
do
to
promote
it.
It's
a
really
really
cool
program.
I
think
in
the
way
it
works.
B
I
I
think,
there's
a
lot
of
there's
a
lot
of
discussions
out
there
about
what
the
future
of
wellness
programs
look
like.
They're.
Definitely
changing.
A
lot
is
more
of
a
virtual
program,
but
a
connected
virtual
program.
So
you
get
a
digital
scale.
You
have
a
health
coach
more
on
your
terms.
It's
not
like
you
need
to
go
to
the
clinic
or
you
need
to
come
to
hr
to
meet
with
the
coach.
You
have
to
do
on
your
terms.
B
I
think
you'll
see
more
of
those
type
programs
in
the
future,
there's
plenty
of
them
out
there,
but
we
go
through
a
lot
of
work
really
like
trying
to
vet
them
and
say
what
makes
sense,
because
we'd
rather
have
a
couple
good
programs
for
the
employees
instead
of
40
and
you
go.
I
don't
know
what
to
pick
you
know,
but
this
is
where
we
know
we
can
make
a
big
difference.
B
So
if
you
look
down
and
then
I'll
show
you
some
broader
categories
on
the
next
page,
congestive
heart
failure
is
your
second
highest
overall
category
and
then
on
this
page,
your
cancers
get
broken
out,
so
the
malignant
neoplasm
as
cancer
breaks
it
down
by
different
regions
or
parts
of
the
body,
so
breast
cancer.
You
had
21
claimants
that
cost
the
plan
about
783,
000.,
you'll
notice,
not
more
not
much
in
pharmacy.
B
This
is
one
with
psoriasis
that
we've
seen
in
psoriasis
is
on
your
list
really
jump
up.
It's
not
that
there's
more
individuals,
with
the
condition
than
there
were
in
the
past,
they're,
treating
it
differently,
they're
using
the
humeras,
the
emperors,
which
can
be
six
seven.
Eight
ten
thousand
dollars
a
script
where
originally
it
was
only
for
rheumatoid
arthritis,
now
they're,
using
it
for
psoriasis
for
ulcerative,
colitis
and
crohn's
some
of
those.
So
that's
where
you
see
on
the
inflammatory
bowel
disease
about
six
hundred
thousand
in
partnershi
spent.
B
If
you
go
down,
psoriasis
is
on
there
as
well.
You
had
63
skin
cancers,
but
what
you
probably
had
in
there
was
probably
one
or
two
major
ones
and
the
rest
were
probably
your
very
small
done
in
a
dermatologist's
office,
a
basal
cell
or
something
like
that.
But
you
had,
I
think,
one
or
two
that
was
actually
to
the
melanoma
stage
of
marsh
serious
so
again
skin
cancer
checks
in
florida.
That's
another
thing:
we
really
yeah
it's
preventable
or
it's
avoidable,
somewhat
preventable.
E
That
you
can
get
ahead
of
it
and
not
have
an
issue
so
another
opportunity
to
do
fun.
Remember
we
have
the
motivate
new
program
which
pays
you
guys
to
do
the
girls
things
that
you
should
already
be
doing
200
bucks
a
year
and
it
covers
dermatology.
You
know
you
can
get
paid
for
doing
that
mammograms
for
women.
You
know
I
mean
so.
A
E
E
Claims
and
help
take
care
of
our
employees,
so
we
have
a
fire
department.
We've
sent
that
out.
You
know
who
you
know,
doesn't
appreciate
the
programs
yet
and
so
where
we
have
room
to
make
improvements
and
that's
where
this
committee
really
comes
in
place,
making
sure
that
you
understand
those
things
it's
200
very
easy
to
get
and
in
any
form
that
you
wanted.
You
could
not
without
cash,
it's
not
cash,
but
you
can
get
a
music.
You
know
debit
card
publix,
I
mean
there's
a
hundred.
B
D
D
New
medicine
commercials
that
you
see
on
tv
are
some
of
the
new
medicines.
I
know
humira
and
stuff
like
that,
is
being
repurposed
for
other
things,
but
there's
a
lot
of
other
new
medicines.
Are
you
seeing
more
claims
and
more
costs
increase
because
of
those
people
getting
them
as
new
medicines?
For
those.
B
In
the
diabetes
category,
absolutely
because
you
got,
I
mean,
there's
a
new
commercial
for
a
new
diabetes
drug
almost
every
day
and
the
challenge
with
the
diabetes
ones,
and
I'm
just
not
an
expert.
I've
just
learned
this
from
listening
to
experts
talk
over
the
years,
you
know,
historically,
what
you
have
was
you
had
people
off
the
metformin
which
was
very
cheap
and
my
understanding
is
most
people,
though,
when
you
took
that
you
had
to
test
a
lot.
B
B
B
B
You
know
if
you
get
two
three
hundred
people
doing
that
so
cigna
or
any
of
the
carriers
really
they're,
pretty
good
in
regards
of
putting
pretty
strict
sort
of
step,
therapy
requirements
or
trial
requirements
on
the
providers
and
the
member
you
I
get
diagnosed
today,
I
can't
go
in
and
just
start
on,
a
thousand
dollar
a
month
where
they've
got
to
show
that
I
tried
the
first
one
you
know
and
have
a
reason
for
it,
but
the
doctors
have
gotten
pretty
good
at
finding
ways
to
weasel
around.
You
know
some
of
those
requirements.
B
Make
the
control
the
diabetes
better
and
to
help
control
the
cost
of
long-term
care
yeah.
I
think
we'll
see,
and
you
know,
there's
a
lot
of
you
know
you
listen.
You
know,
there's
a
lot
of
talk
around
you
know.
Do
we
have
more
nutritional
counseling
available
on
plan
some
of
those
things,
because
a
lot
of
this
kind
of
diet
is
tied
to
exercise
right?
Can
you
prevent
some
of
these
things
and
if
you
really
start
researching.
E
E
E
B
E
Know
so
foodsmart
is
the
one
that,
because
our
partner
with
cigna
they
asked
if
they
could
do
test
test
text
messaging
and
we're,
we
told
them
to
hold
off
on
it
right
now,
because
I
don't
want
to
have
any
negative
associations
with
this
stuff
right,
because
I
want
to
get
the
information
out,
but
I
don't
want
people
to
get
my
phone
number
now
they're
a
partner
with
our
health
insurance.
So
if
I
enroll
in
all
insurance
is
how
they
got
it,
there's
no
selling
of
information
or
anything
like
that.
E
D
D
E
Text
messaging
seems
to
be
like
the
wave
of
communication,
so
you
know
at
some
point
it's
something
that
we
might
end
up
doing
just
because
you
know
people
aren't
going
to
read
their
emails
and
we
obviously
can't
do
face-to-face
stuff.
You
know
as
much
as
we
want
to
you
know.
That's
just
another
way
to
communicate.
Just
be
thinking
about
that,
because.
B
The
other
thing
is,
you
can
always
send
an
email
to
everybody
and
say
you
know,
starting
next
month,
you're
going
to
get
text
messages
unless
you
write
it
now.
I
know
a
lot
of
people
won't
read
it,
but
at
least
you
die.
You
know
I
don't
know
I
mean
I
get.
I
get
unsolicited
text
messages
now
on
my
cell
phone.
B
You
know
and
I
think
it's
just
becoming
the
way
over
the
world.
I
was
talking
to
somebody
the
other
day.
We're
like
you
know
the
biggest
thing.
I
don't
know
why
apple
and
whoever
why
they
haven't
added
something
where
you
can
mark
and
text
them
right,
because
that's
my
problem,
somebody
texts
me.
I
read
it
I'm
in
a
meeting
and
then
I
totally
you
know
I
get
12
other
texts
and
it
goes
to
the
bottom
of
the
list.
So
why.
D
D
E
E
F
Is
did
you
see
an
increase
last
year
because
after
our
meeting
I
said
what
is
she
talking
about?
I
went
over
there.
I
went
since
I'm
in
cid.
Now
I
went
around
and
I
know
for
a
fact
everyone
I
talked
to
did
what
they
did
and
they
were
all
thanking
me
and
then
I
sent
I
sent
slaughter
and
email
to
send
out
and
I
was
curious.
F
E
E
So,
like
I
said
so,
yes
be
happy,
we
didn't
have
an
increase,
it's
just
there's
still,
so
the
other
thing
that
the
city
offers
is
that
you'd
be
surprised
that
people
have
no
clue
what
I'm
talking
about
yeah,
and
so
I
don't
know
if,
if
you
guys
all
need
to
come
up
with
graphics
and
create
a
poster
and
put
them
all
over
where
they
belong
or
just
keep
relying
on
email.
Well,
I,
like
I
said
so
we
do
the
bathroom
stall.
You
know
mean
because
that's
you
shouldn't
have
divided.
E
Time,
clocks
and
stuff-
like
that,
I
know
I
don't
have
that,
but
you
know
we
have
things
posted
as
there
as
well.
So
those
are
the
other
types
of
communication
and
then
we're
also
hoping
that
you
know
supervisors
are
having
those
conversations
with
employees
during
you
know
their
you
know
because
their
meetings,
their
staff
meetings.
You
know,
however,
that
is
happening,
so
those
are
the
tools
that
we
have
and
certainly
open.
You
know
to
more
and
then.
D
A
A
E
F
E
E
And
you
know
we
are
hoping,
as
covenant
stays
on
the
downhill
trend
that
you
know,
because
we
are
a
wellness
person
with
left
cigna,
so
we're
in
the
process
recruiting
for
that
position
again
that
they
can
do
more
out
in
the
field
kind
of
in-person
meetings,
which
will
help
a
lot.
We
haven't
been
able
to
do
that
because
of
coped,
but
we
hope
to
be
able
to
increase
that
as
well,
because
then
you
have
more
of
that
personal
interaction
here,
all
the
worldview
I
mean
like
that
kind
of
stuff.
D
B
B
So
if
you
had
on
the
prior
page,
you
might
have
had
you
know
joint
degeneration
of
the
back
and
media's
separate
categories.
They
all
get
lumped
together
in
this.
So
this
gives
you
probably
a
slightly
more
accurate
snapshot
of
broad
categories,
so
cancer,
when
you
look
at
all
the
cancers
together,
cancer
is
your
top
cost
driving
category
over
2
million.
It
claims
heart
disease
and
stroke
over
2
million
and
so
think
about.
B
You
know:
15
million
in
medical
claims,
and
in
these
two
categories
you
probably
have
about
four
and
a
half
million
just
in
those
categories,
one
of
those
situations
where
things
are
happening
in
the
doctor's
office,
so
maybe
the
pharmacy
claims
are
actually
going
towards
medical
there's.
A
lot
of
cancer
costs
yeah
during
that
chemo
and
stuff,
like
that,
and
I've
seen
that
pharmacy,
those
are
going
in
a
facility,
probably
so
it
comes
through
as
a
medical
clinic.
Yes,
that's
why
the
cancer
medical
cost
is
so
low.
You
know,
and
then
you
look
at
diabetes.
B
You
know
asthma,
a
little
bit.
You
look
at
some
of
those
and
you
see
pharmaceutical
is
the
driving
cost
factor.
But
if
you
look,
you
know,
as
we
look
and
say,
what
do
we
promote?
What
do
we
structure
and
motivate
me
around?
This
is
sort
of
like
our
what
kind
of
guides
us
to
say.
Okay,
cancer
screenings.
You
know
some
of
these
things.
Those
are
the
areas
I
think.
As
you
look
at
you
know,
the
joint.
B
E
B
Yeah,
so
I
think
my
initial
thought-
and
you
guys
jump
in
here
with
any
of
this-
I
think
the
one
thing
where
I
hear
complaints
from
people
of
weight
watchers
is
it's
very
specific
sort
of
two-way
watchers
right.
They
have
their
own
system,
and
some
of
that
I
think,
as
you
look
at
the
like
the
omada
program
or
some
of
those
other
programs
they're
more
they're,
not
structured
around,
like
I
think
weight
watchers
is
a
point
system
still.
B
You
know-
and
I
know
weight
watchers
are
somewhat
both
in
that,
but
a
lot
of
times
employees
with
weight
watchers.
We
get
complaints
about
either
the
ongoing
costs
or
kind
of
the
complexity,
but
it's
definitely
something
we
can
look
at.
It
comes
back
to
that,
though,
how
many
programs
do
you
end
up?
Having
do
you
have
a
bunch
of
programs
to
do
more,
people
find
appeal
with
20
different
programs,
or
is
it
better
to
just
have
one
and
kind
of
guide.
B
The
next
page
is
just
your
top
facilities.
I
just
always
think
this
is
interesting.
There's
not
a
whole
lot.
You
can
necessarily
do
about
they're,
mostly
daycare,
but
it
just
gives
you
an
idea
where
your
guys
people
are
going
when
it
comes
to
hospitalizations,
just
kind
of
interesting.
So
what
I
want
to
jump
to
next,
if
you
guys
want
to
look
at
the
timeline,
we've
had
some
discussion
prior
to
this
meeting.
B
If
we
were
to
just
say
we
had
to
set
our
rates
for
a
couple
months
ahead,
based
on
the
claims
right
now.
Actually
that
would
probably
come
out
somewhere
in
the
12
to
15
range.
As
far
as
increasing
it
now
we're
quite
a
bit
away
from
that
from
actually
setting
risk,
so
we'll
see,
claims
could
stay
the
same.
They
could
get
better,
they
could
get
worse.
We
didn't
bring
a
full
projection
for
listening,
because
it's
so
early,
a
big
component
of
that
is
medical
inflation.
B
You
know
when
you
start
projecting
for
two
years
of
medical
inflation.
It
can
make
it
look
how
long,
but
that's
probably
somewhere
where
the
projection
would
land
right.
Now,
if
you
just
reviewed
as
is
no
changes,
not
saying
that
scare,
anyone
just
trying
to
set
kind
of
expectations
of
what
we're
going
to
be
watching
over
the
next
six
months
in
that
regard.
B
So
with
that
you
know
looking
at
a
couple
things,
it
has
been
a
while,
since
you
guys
have
been
you
know,
we
did
talk,
it's
good
to
fit
the
contracts
periodically
I'll
say
something
before
we.
We
say
that
when
you're
self-funded,
some
of
you
all
remember-
and
you
were
here
backward
or
bidding
fully
insured,
it
was
like
hey
this
rate's
two
percent
lower
and
one
of
those
benefits
when
you're
self-funded.
B
A
lot
of
that
goes
away
right,
projection's
not
really
going
to
change,
because
what
we're
largely
bidding
is
the
administration
and
the
reinsurance
and
then
we're
looking
at
discounts
on
the
claims.
What
I
do
know
from
having
done
a
lot
of
bids,
but
we'll
still
do
a
bit
for
you
guys,
is
that
discount
wise,
the
most
competitive
carriers
are
all
pretty
much
in
the
same
line.
Why
do
I
say
that?
B
Because
I
don't
think
what
we
did
somebody's
going
to
come
in
here
and
say:
oh,
we
can
get
you
10
more
of
your
claims
cost
because
they,
just
all
the
hospitals,
talk.
They
negotiate
with
all
of
them
everybody's
pretty
much
in
line
pinellas
county
just
did
last
year
they
left
united
and
went
to
cigna,
so
they
just
kind
of
went
through
that
process.
So
we
know,
sigma's
rates
are
extremely
competitive
in
the
area
and
nobody's
gonna
come
in
and
lock
them
out.
B
B
C
B
Going
in
somebody's
going
to
say
well,
did
we
look
at
the
market,
so
we
figured
since
it's
been
a
number
of
years.
We
will
do
a
bid
this
year
for
the
administration.
You
know
just
looking
at
self-funding.
Looking
at
what
the
market
has
that
timeline,
it's
sort
of
a
rough
draft
at
this
point
we're
going
to
meet
with
person
to
kind
of
finalize
some
dates,
but
this
is
kind
of
a
timeline
of
when
we
would
have
the
big
release
when
we'd
be
looking
at
what
we're
going
to
do.
B
While
that
goes
on,
do
you
want
to
jump
in
what
we're
going
to
do
while
that
is
going
on?
Is
we're
not
going
to
do
anything
different
as
far
as
the
committee
in
terms
of
still
looking
at
claims,
still
looking
at
cost
projections
going
forward
we're
going
to
kind
of
operate
with
the
committee
as
if
for
now
nothing's
changing,
because
we
don't
want
to
put
everything
we're
doing
on
hold
just
because
we're
done
this
bit
so
yeah.
E
We're
doing
the
good
stuff
to
make
sure
that
we're
competitive,
we're.
Looking
at
all
those
things,
we
did
an
rfp
and
did
a
bid
for
broker
services
that
was
completed
last
year,
of
which
you
know
gearing
group
came
out
as
a
successor
on
that.
So
we're
looking
for
everything
we
possibly
can
to
control
what
we
can
right
and
then
put
programs
in
place
for
the
things
that
we
can't.
A
F
E
So
that's
what
you
know.
I
just
want
to
make
sure
that
I've
been
communicating.
That's
what
we're
trying
to
do.
Nobody
likes
to
hear
about
interesting,
it's
deteriorating
for
lots
of
people
to
most
people,
and-
and
so
I
want
all
of
the
messages
to
be
done
in
terms
of
all
the
things
that
we're
trying
to
do
all
the
programs
that
are
available.
But
then.
F
D
So
again,
being
self-funded
all
our
money
that
we're
paying
in
goes
in
the
pot
home,
I
mean
that
paying
out
goes
out
of
the
pocket
and,
if
I
remember
from
previous
years
in
meetings
and
such
we
talked
about
new
process,
new
carriers
say
united
or
or
whatever
it
is
that
for
the
most
part,
what
we
were
looking
at
was
the
administration
costs
on.
It
was
the
main
difference
and,
and
that's
pretty
much
about
the
same
across
the
board.
D
Maybe
a
few
thousand
dollars
a
month
difference,
but
pretty
much
the
same
across
the
board
for
the
administrative
and
strategic
costs,
the
biggest
issue
that
takes
into
consideration
when
we're
bidding.
This
is
something
that
we
heard
a
lot
about
outcry
about
when
we
went
to
the
lesser,
affordable
health
care
plan
of
cigna,
which
decreased
our
costs
and
such
somewhat.
D
B
So
in
that
process,
when
we
do
the
evaluation
and
all
that
there's
going
to
be
a
number
of
things
we
look
at,
but
one
of
them
is
going
to
be
network
disruption,
so
signal
will
give
us
a
restorative
of
every
provider
and
their
tax
id
and
any
carrier.
That
bids
is
going
to
go
in
and
say
yes,
that
doctor
should
network
and
and
essentially
say,
okay,
it's
a
you
know
if
you
go
to
an
xyz
carrier,
no,
but
it's
only
a
90
percent
match.
B
So
that's
a
problem.
The
other
thing
we
do
is
we
ask
them
to
reprice
claims,
which
is
where
they
take
all
the
claims
you
had
in
the
last
year
and
say:
if
you
were
in
our
system,
here's
what
that
would
cost.
I
will
tell
you
that
there's
and
then
we'll
just
ask
them
overall
about
their
network
discounts.
The
reprice
is
probably
the
one
area
where
carriers
can
get
slightly
sneaky,
so
some
of
them
exclude
certain
categories.
B
B
We
just
know
you
know
the
big
thing
is
you
have
you
know
if
you
look
at
who
a
lot
of
the
groups
around
you
are
in
charge
with,
you
know,
you
know
who
the
big
players
are,
and
you
know
that
there
is
some
safety
in
the
sense
that
they've
all
done,
that
same
claims,
analysis
and
they've
kind
of
ended
up
where
they've
ended
up
and
that's
something
that
we
take
into
consideration
as
well.
Once
we
do
that,
I.
B
D
B
B
B
Had
come
in
and
said
this
is
all
we
could
do,
it
wouldn't
have
been
as
bad,
but
it
was
still
it
was
bad
and
I
think
overall
you
guys
have
had
good,
pretty
good
experience
with
sigma.
I
mean
nobody
loves
any
health
insurance
carrier
all
the
time.
You
know
if
you
do
they're,
probably
paying
too
much,
because
they
just
approve
everything
committee.
I.
E
B
So
really
so
that's,
where
kind
of
my
conversation
about
we'll
kind
of
be
concurrently,
doing
two
things
as
far
as
the
bid,
so
remember,
you're
self-funded.
So
let's
say
you
make
your
job
make
a
random
number.
If
I
make
my
deductible
go
from
500
to
a
thousand
right,
it
in
theory
should
not
be
any
different
between
united
blue
cross
saying
that
a
humana.
If
you
do
that
right,
it
should
be
the
same
impact
because
I'm
still
going
to
the
doctor
either
way.
B
You
know
no
matter
what
the
carrier
now,
when
you're
fully
insured
like
what
you
guys
have
in
the
past,
is
you
know
xyz
carriers
say
hey
if
you
take
your
deductible
from
500
to
a
thousand
I'll,
give
you
three
percent
off
and
the
other
carrier
says
I'll
only
give
you
one
because
it
was
their
money.
You
guys
said:
okay,
we'll
go
with
the
one
that
gives
us
three
percent
off
you're
self-funded
we're
just
we
have
all
your
claims.
B
We
don't
care
what
the
carrier
says
it's
worth,
because
we
have
your
actual
claims.
That's
the
best
estimate
we
can
make
so
from
the
bid
point
of
view
steve.
What
we'll
probably
do
is
we'll
just
say,
assume:
you're
matching
the
current
plan.
As
is
and
tell
us,
if
there's
anything,
you
can't
do
right.
So
an
example
is,
maybe
you
have
a
copay
on.
B
You
know
an
imaging
type
service
and
they
say:
oh
the
only
way
we
can
administer.
That
is
deductible
and
co-insurance.
We
want
to
move.
We
want
to
look
at
that,
but
we're
not
really
worried
about
them
being
able
to
match
because
most
of
the
carriers
aren't
very
precise
they
can
just
match.
So
what
we
want
to
know
is
hey
for
what
we're
getting
now.
B
What
are
you
going
to
charge
us
for
admin?
What
are
you
going
to
charge
us
for
reinsurance
and
what
does
your
network
and
network
discounts
look
like
and
then
what
kind
of
stuff
are
you
going
to
add
in?
I
think
sigma
gives
you
the
wellness
position
and
some
of
those
things
you
know.
What
else
can
you
do
in
that
regard?
That's
really
what
we're
asking
for
so
a
lot
of
ways.
B
It's
an
easier
bit
but
it'll,
be
there'll,
be
it'll,
be
a
little
difficult
in
the
sense
that
most
insurance
companies
have
not
lost
much
business
in
the
last
two
years
with
copenhagen,
but
they
also
haven't
gained
much
so
they're
all
getting
pretty
desperate
right.
You
know,
so
you
know
somebody
may
throw
some
crazy
offer
at
you
and
that's
where
we
really
have
to
look,
though
they
can't
make
the
claims
any
lower.
B
They
really
can't
make
the
so
it's
like.
Okay,
if
they
caught
even
if
they
caught
a
hundred
thousand
dollars
off
your
admin
fees.
You
know
that's
where
we
all
have
to
look
and
go
well.
Is
it
worth
it
because
it's
a
hundred
thousand
out
of
twenty
million
yeah,
you
know,
is
a
hundred
thousand
worth
it
to
disrupt
every
single
employee
to
have
to
get.
You
know,
reprocess,
all
the
all
that
and.
C
D
And
that's
my
one
concern.
Obviously
we
need
to
do
the
rebuilding
every
now
and
then
it's
a
good
thing
to
do
the
re-bidding,
that's
just
by
one
concern
looking
at
the
city
in
general,
they
tend
to
go
with
a
lower
bidder
as
opposed
to
so
that's
that's.
I
think
what
we
really
need
to
be
able
to
take
a
look
at
this.
A
E
E
When
david
talked
better
than
I
could
in
terms
of
how
many
times
you
asked
me,
do
you
have
to
go
but
not
have
to,
but
the
lowest
bid
is
what
is
selected
but
from
an
hr
perspective
that
that
has
not
been
our
experience
before.
Have
we
gotten
any
pushback
from
council
when
we
haven't
done
that?
Like
I
said,
I
have
all
those
examples,
you
know
to
say.
B
B
The
one
caveat
with
that
is
stop
loss.
Sometimes
they
won't
lock
in
that
far
ahead.
The
other
thing
that
they
could
happen
with
stop
loss
which
really
doesn't
affect
anybody
is
we
don't
have
to
have
our
stop-loss
with
sigma
you
we
can
have
cigna
but
have
our
stop-loss
with
you
know.
I
have
groups
all
the
time
that
haven't
carved
out
the
employees.
Don't
even
know
the
employees
don't
even
know
we
have
stop-loss
right
now
other
than
you
guys.
A
B
B
The
check
has
to
get
cut
to
pay
the
claim.
Then
we
have
to
file
for
reimbursement.
You
know
30
within
30
to
60
days.
They
give
the
city
800
000
back.
So
if
somebody's
50
000
lower
on
stop
loss,
but
it's
not
integrated,
is
it
worth
it?
Yeah
somebody's
five
hundred
thousand
dollars
lower
on
stop
loss,
yeah,
we'll
we'll
deal
with
the
process
of
manual
claims,
so
it's
all
kind
of
that.
What
is
this
worth
to
me?
B
B
So
that's
where
this
bid
is
a
little
different
than
you
guys
have
done
in
the
past
year.
Just
when
you
you're
talking
numbers.
Why
does
it
say
your
announcements
report
may
vary
from
city
financials
and
receptions
change?
What
what's
the
plus
or
minus
percentage?
Are
we
talking
about?
Oh
negligible?
So
the
reason
we
have
that's
the
city,
so
we
get
a
report
that
says
here's
all
the
claims
that
were
paid
in
the
month
of
january
right.
B
Well,
when
the
city-
let's,
let's
give
it,
let
me
give
you
an
example:
let's
say
december
30th,
you
had
a
surgery
that
was
ten
thousand
dollars.
The
city
won't
actually
pay
that
claim
until
january,
but
on
the
signal
report
right
because
it
was
december,
30th
jay
gets
a
weekly
claims
bill
daily
daily
and
that
yeah
right
so
like.
If
that
claim
doesn't
hit
for
a
couple
days,
jay's
report
is
going
to
show
the
claim
that
he
paid
it
in
january,
but
sickness
is
going
to
show
december.
So
it's
stuff
like
that.
B
B
If
jay
runs
it
and
he
goes,
I
get
19792,
you
know
it
could
be
because
of
those
small
tiny
differences,
so
we
just
put
that
on
there,
so
somebody
doesn't
try
and
match
this
up
to
their
reports
and
drive
themselves
nuts,
because
it'll
never
line
up
exactly,
but
it's
not
a
million
dollars
or
a
hundred,
it's
probably
three
four
or
five
thousand
dollars
out
of
20
million.
So
it's
negligible.
In
fact,
just
this
past
year
we
went
back
with
them
and
reconciled
like
the
last
seven
or
eight
years.