LA CROSSE COUNTY BOARD PROCEEDINGS

PLANNING MEETING

MONDAY AUGUST 11, 2008

The La Crosse County Board of Supervisors Planning Meeting was held on August 11, 2008 in the Administrative Center, Room B410.  Chair Steve Doyle called the meeting to order at 6:00 p.m.  The County Clerk, Marion I. Naegle, took attendance.  All supervisors were present except as noted:

County Board Chair Steve Doyle

County Administrator Steve O’Malley 

Proclamation – COUNTY AGING MONTH

WHEREAS, the County Aging Unit provides information and assistance to all county senior residents; and,  WHEREAS, good nutrition is important to the community and is ensured through two dining programs; and,  WHEREAS, home-delivered meals provide an opportunity for a low cost first intervention to allow residents to remain living independently in their own homes; and.  WHEREAS, quality of life of aging residents is ensured through transportation programs, support groups, organized activities as well as assistance in filing forms; and,  WHEREAS, all staff of the La Crosse County Aging Department work together to provide a healthy and safe environment in the aging community.  NOW THEREFORE BE IT RESOLVED, that the La Crosse County Board does hereby proclaim the month of August as Aging Month and urges all residents to join in recognizing the valuable contribution of persons dedicated to ensuring that the aging residents of La Crosse have the opportunity to live a healthy life.

Motion to approve by Meyer/Burke passed unanimously with 5 excused – Wood, Kader, Flood, Manthei and Ebert and 5 absent – Geary, J. Johnson, Plesha, Medinger and B. Pfaff.. 

Preparation on Consideration of Contracting for Justice Sanctions Services & Comparison with Marathon County

Jane Klekamp – Justice Sanctions

Power Point – 2007 La Crosse/Marathon County Comparison

·         Justice Sanctions History 1995-2008

o        Studies

§         June 1993 – National Institute of Corrections – Local System Assessment

§         May 2000 – National Institute of Corrections – Planning of a New Institution

§         June 2006 – National Institute of Corrections – Report on Female Correctional Clients

§         May 2007 – the Carey Group – Justice Assessment

·         Justice Sanctions History 1995-2008

o        Programs

§         Jail Reduction

·         Electronic Monitoring (1995)

·         Bail monitoring (2002)

·         Community Service (2002)

·         Day Reporting (2004)

§         Behavior Modification

·         OWI Program (1997-2006)

·         Victim Impact Panels (1997)

·         Drug Court (2002)

·         BIP Screening (2002)

·         Day Reporting (2004)

·         OWI Court (2006)

·         DV Court Process (2006)

·         Women’s community Based Program (2008)

§         Justice Sanctions Program – Bed Days Saved Compared to the Jail Population

§         Justice Sanctions Connections (Diagram showing how each is connected to each other)

·         Court Ordered Referrals

·         Treatment Courts

·         Drug and Alcohol Testing

·         Community Service

·         Electronic Monitoring

·         Drug and Alcohol Testing for other Departments

·         Women’s community Based Program

§         Jail Population for Marathon County compared to La Crosse County – bottom line Marathon County has 325 inmates and La Crosse County has 183 inmates

§         Program Costs – 2007 Data

·         Marathon County total cost is $1,048,026

·         La Crosse County total cost is $1,530,785

§         Bed Days Saved – 2007

·         Marathon County – 45,053 beds

·         La Crosse County – 81,044 beds (80% more bed days saved)

§         Cost/Bed Day Saved – 2007

·         Marathon County cost per day is $23.26

·         La Crosse County cost per day is $18.88

·         Benefits of Selective Contracting

o            Principle services are maintained in a central location. (link between testing, EM, treatment courts, electronic monitoring, day reporting)

o            Secondary services can be contracted.  (electronic monitoring, drug testing – Health Dept. women’s program)

o            Staff retention decreases training cost.

o            Of the Drug Court graduates 43% were convicted of a new crime.  Of those expelled, 61% were convicted of a new crime.  Within the control group, 86% were convicted of a new crime.

Question and answer session ensued.   Speakers and questions answered by Honorable Judge Ramona Gonzalez, Honorable Judge Dale Pasell, Honorable Judge Elliott Levine, Human Services Director Jerry Huber and County Administrator Steve O’Malley.

Health Insurance Renewal and Innovative Strategies, Presentation by Mardi Burns Senior Benefits Consultant of Associated Financial Group

Power Point – Healthcare Renewal with Innovative Strategies

·         What drives Insurance Premiums?

o        Two components to Insurance Premiums – Claims & Administration

o        Majority of the cost is Claims

o        Administration Averages 7% to 14% (La Crosse County = 7%)

o        93% of your costs are Claims – hard to control

§         Demographic Factors

§         Attitudes = “I want the best because my insurance will pay for it”

§         Discounts and contracting (La Crosse County has the best discounts and contracts available at this time)

§         Employee Education

§         Wellness Programs

·         Renewal Costs

o        Admin costs

§         No increase in two years

§         Minimal increase for 2008

§         Current Administration Costs are below the benchmark

o        Stop Loss Insurance Renewal High due to Claims

§         10 employees with claims over $100K

§         10 more employees with claims over $50K

o        Medical Claim Trend still running 11%

§         Claims are well above the norm

§         Public Entities claims tend to run  higher than private

o        Pharmacy Trends are 14%

o        Total Costs are 65% more than the benchmark for this size group

·         Options we Looked At

o        Looked at all viable options

§         Fully Insured

·         Plan Design Issues to meet Union requirements

·         More costly and more restrictive in plan design

§         RFP from other TPAs

§         Marketed for Stop Loss Options

§         State Plan HMO vs PPO with lesser Plan Design

o        Saved money last year (2006) stop loss and deeper discounts by direct contract with Health Tradition

o        Saved Administrative costs by changing one of the TPAs

o        Lowered overall administrative costs

o        Developed a new low cost retiree option

o        Future

§         Medical tourism

§         Continue to look at lower cost Rx plans for new plan  design options

·         La Crosse County Membership plan and Cost Graph

·         Healthcare Utilization Patterns  Graph – 75% of Claims come from 12% of members

·         La Crosse County Chronic Disease Impact Graph

·         La Crosse County Annual Cost Summary 2008

·         Brutal Truth About Your Healthcare Cost

1.      Your employee claims drive the majority of your healthcare costs (as opposed to arbitrary decisions by insurance companies)

2.      The way to reduce costs fall into one of two categories

o        Shift costs to employees

o        Reduce overall claim costs by either reducing utilization or accessing lower priced services

·         Reasons Driving the Increase in Cost

o        Trend factors in healthcare

o        Graying of the population

o        Political influences – (i.e. unfunded mandates)

o        High benefit levels

o        Low consumerism by patients & employees

o        Out of control Rx drug usage and costs

o        Healthcare provider cost shifting

§         Medicare/Medicaid Reimbursements

§         Medical Technology

·         Actions considered or Started with the Health Department

o        Make Employee Education on a Regular Part of the Culture

§         Form an employee/management committee to review healthcare issues

§         Regularly communicate information on wellness and prevention

§         Regularly communicate information on your medical plan and how to use it

o        Consider Establishing an Aggressive Wellness Program

§         Start with an onsite “Management Supported” comprehensive health risk screening process

o        Consider Implementing a Disease Management Program

§         From analyzing your claims data, identify specific disease categories that are driving your costs and contract for a specific Disease Management Program from your insurer

·         Wellness Statistics

o        66% of all Americans are either overweight or obese

o        27% are tobacco users

o        Adult onset diabetes is the fastest growing illness in the country

o        Routine care is the key controlling large claim issues

·         Consumer – Driven Health

o        What are you trying to accomplish?

§         Reduce employer costs

§         Keep employee costs down

§         Introduce consumerism

§         Get members involved in health care decisions

§         Save for future medical costs

§         CDH is the vehicle to get you there!

·         Wellness – Invest now for long-term business health

o        Tools and Strategies

§         Offer an incentive or require Health Risk Assessment with bio-metric testing

§         Provide on-going coaching support for all participants

§         Develop a long-term wellness strategy by engaging the support and help of your employees

·         Can expect approximately 3 to 1 ROI over time

o        Health plan savings

o        Reduced absenteeism

o        Increased productivity

·         Benefits and Rewards of CDHP

o        Long term solution, not a short term fix

o        Lower trend in the cost of your insurance

§         Employee will spend their money differently that the Counties

§         “Skin in the Game” if they don’t spend it they can keep it for retirement

§         Employees will search for lesser cost services

o        Tax Free Medical retirement benefit

o        Lower cost while working and especially after retirement

o        Incorporate wellness education into the process

o        Appropriate use of providers, ER, etc.

o        Routine care encouraged

·         La Crosse County Needs Wellness Programs

o        Increase productivity of employees

o        11% of La Crosse County claims ($1.3M) are related to unhealthy behavior

§         Physical Inactivity

§         Poor nutrition

§         Tobacco use

o        14% of La Crosse County claims ($1.6M) could have been positively affected by early detection and disease management programs

o        Education and Early detection are critical components

§         Outside Vendors

§         La Crosse County Health Department

·         Results

o        From a typical health screening of 1000 people, 659 will have abnormal results because:

§          The person was unaware of the problem prior to the health screening

§         Over 90% of all health conditions are moderate problems

§         Early detection is important, 50 problems will be very serious and potentially life threatening

§         An average of 2 major health risks per participant will be found – these risk projects cause over $940,000 in cumulative health care expenses over the next year

§         342 people will be found to be high risk for having a heart attack or stroke in the next 10 years

§         366 employee health conditions will be discovered which affect employee productivity.  These conditions are estimated to cause a cumulative 3600 lost workdays of productivity over the next year (equivalent to about 18 FTEs) analysis.

·         Final Thoughts

o        Health costs will continue to rise dramatically: 305 years

o        Real solutions will be found in changing behaviors, not cost shifting tactics

o        CDHC plans are a work in progress with lots of options

o        Cost savings is dependent on design

o        There is a value proposition for many, but not all, workers – we need to answer the question “what’s in it for me?”

o        Asking employees to take on more responsibility without increasing information, tools and support is a recipe for disaster

o        Successful implementation requires a deliberate and well conceived strategy

After the presentation there was discussion and questions answered by Mardi Burns.

FUTURE AGENDA ITEMS

·         Don Meyer asked if we could get information on Park Plaza

ADJOURN

Motion by Sebranek/Brockmiller to adjourn at 8:08 p.m. passed on a unanimous voice vote with 7 excused – Wood, Flood, Medinger, T. Johnson, Ebert, L. Pfaff and Schroeder.

The above minutes may be approved, amended, or corrected at the next Board meeting.

I, Marion I. Naegle, La Crosse County Clerk, in and for the County of La Crosse, Wisconsin, do hereby certify that the foregoing is a true and correct copy of the Journal of Proceedings of the La Crosse County Board of Supervisors at the Planning Meeting held Monday, August 11, 2008 and that it is the whole thereof IN WITNESS THEREOF, I HAVE HEREUNTO SET MY HAND AND AFFIXED THE OFFICIAL SEAL THIS 12^th DAY OF AUGUST, 2008.