Health plan features changes [Odessa American, Texas]

Nov. 23—The Benefits and Risk Management Department at Ector County ISD tries to be proactive in keeping the district's 4,200 employees healthy and keep costs reasonable. This year, though, costs are going up.

During open enrollment, Benefits and Risk Management reviews trends with the Medical Plan Committee. Director Yolanda Gordon said if they see high claims for certain medical conditions or prescriptions, they try to maintain the benefits that will keep the employees healthy with education and information.

"In a district of this size with 4,200 employees, we deal with (varying) amount of medical conditions. We meet quarterly with a medical plan committee, and determine what we need to do in order to maintain, not just the benefits that we have in place, but also the financial integrity of our medical trust," Gordon said.

"We are partially self-funded, so our goal is to maintain the health of that medical trust. In doing that, we basically try to provide as much as we can, as far as allowing our staff to have more than one option, not just having to go to their normal family doctor, but our ECISD Wellness Center," she added.

Premiums will increase this year for the first time since 2019. Gordon said for an employee only on Option 1, the most used plan, is going up $25.

The Health Savings Account went down to zero.

The item that went up the most is employee and spouse, employee and family, employee and child and employee and children. They also take stop-loss insurance to help offset a lot of the larger claims.

One of the larger segments is diabetes. Some 40 percent of district employees, spouses and dependents on the health plan are diabetic. Dr. Ramachandra Chemitiganti, regional chairman and associate professor at Texas Tech University Health Sciences Center in Odessa, said it is alarming for the people that are diagnosed with the disease and for the district because it affects their healthcare budget.

Chemitiganti said it is alarming for the community, as well.

Nationally, he said, diabetes runs anywhere from 10 to 15 percent. In East Texas, some parts of South Texas and West Texas, it hit 14 percent, "so 1 in 7 or 1 in 10, depending on where you are looking, is a Type II diabetic. But 40 percent seems to be a significantly higher number," Chemitiganti said.

Looking at the state and national data, he said, for every one that is diagnosed as diabetic, there are three pre-diabetics.

It's not just one factor that plays into the rate of diabetes. It's sedentary lifestyle, lack of physical activity, limited access to quality food and mental stress.

"These are all common threads; then having Hispanic ethnicity. Having one parent increases the risk; having two parents significantly increases the risk," Chemitiganti said.

Currently, he is working on a grant looking at food insecurity.

"Depending on how often they had to compromise on food choices, depending on the lack of resources and if you have food insecurity then we are talking about higher chance of diabetes. Diabetics who have food insecurity will have significantly worse diabetes," he added.

Gordon said they have tried to keep costs low to be competitive benefit and cost-wise.

This allows staff members and families to evaluate what works best for them. ECISD's benefits do not change just because medical conditions do. Gordon said they are not going to increase costs just because they have more employees with a certain condition than they did last year. Premium increases occur based on the financial health of the medical trust. They want to keep it financially capable of supporting the needs of staff members and families.

Gordon said they always keep employees updated on changes to benefits through their benefit booklet and on the website.

The district offers Recuro, the telehealth benefit, an employee assistance program where staff members get six sessions for free. After that, it's a sliding scale.

They also have virtual mental health counseling three times a week at the Wellness Center. Gordon said they are searching for someone on-site, as well. Gordon said they also provide a lot of mental health support through Aetna and Recuro also provides it.

"Recuro is one of the promising optional benefits that we have, because even if the staff member only has coverage for themselves, their families can still use Recuro. It's a matter of just registering on their system, scheduling an appointment and then either by telephone or Zoom, they can be seen by a physician and that is a plus-plus for us because oftentimes family that our staff may only have coverage for them, but they may have a husband that becomes ill. They can still use the Recuro for their family unit," Gordon said.

They have tried to get the word out about Recuro to make sure the staff is aware. This is done through the ECISD website under benefits and risk management. There is also a newsletter via Associate Superintendent (Athletics / Human Capital / Operations) Anthony Sorola that goes out to ECISD leaders who then issue it to their staff and campuses.

The Benefits and Risk Management Department also showcased Recuro in its October newsletter. A newsletter also is provided to staff every third Friday.

They spotlight optional benefits, medical reminders and reminders about open enrollment.

"We also have provided this year, our financial readiness sessions. We've also done for the first time this year, a health fair where we had our PCRX, which is our pharmaceutical management team. We had Aetna, which is our third-party administrator for medical benefits. We had Airrosti, which is a pain management provider which we have a partnership because what they offer is covered by our benefits. They were here doing consultations so that if somebody in our units ... whether it be here at the administration building or any of the campuses that made it to our health fair, were able to have that conversation with those particular therapists," Gordon said.

United Supermarkets provided flu shots, which was a benefit, as this was the first year they had this particular fair.

"We had nearly 200 participants. For a first time. I'm really super-excited. So hopefully we'll do that annually, now. That was our first and hopefully we'll have more. We just had our mammogram event, which is an evening event that we have from 4 to 6:30 for anyone who's interested. We just had it on the 23rd of October," Gordon said.

They try to spotlight self-care and show current benefits and the website has the 2024 medical plan year.

"We provide all this at the fingertips of all our staff. Our staff basically just clicks on benefits and risk management and then we have just a slew of icons that are very easy to access. Then it gives you anything you want to know. If I wanted to get information about telehealth ...," Gordon said.

They currently have Recuro, which used to be Wellvia. Clicking on the icon offers information on what services Recuro provides and setting up a telephone call to schedule appointments.

"We also still have a Minute Clinic that is covered at the CVS here on 42nd close to the mall. We have that available to our staff, as well. That is an Aetna affiliation. They can basically do a walk-in or schedule an appointment," Gordon said.

There is also the Ector County ISD Health & Wellness Center at 221 N. Sam Houston Ave. The clinic is available in person, virtually or by phone. They also have the Aetna microsite.

"We basically wanted them to know everything they do for the district. One of the points is they have an actual website for us. This website is made for us. It's going to have everything we need. We literally have it set up to where once you register, you can go in, you can look at your deductible. You can print a card if you lost yours. Say I'm not feeling well and I forgot my card at home, I can easily go into my website, and I can just print one out so that I can go see a doctor," Gordon said.

"I can also find a provider based on whatever need that I have. It gives me so many options and then it tells me how much of my deductible I've met ... It's this easy," she added.

There are about 3,200 active staff members of 4,200 enrolled in the district plan. That doesn't include family.

There are 2,286 participants in Option 1 of the plan. That includes employees and dependents.

There are about 356 participants in Option 3, including employees and dependents.

There are about about 429 participating in the Health Savings Account plan, which is employees and dependents.

"That usually changes very minimally when it comes to open enrollment, but it will shift because they could have been on option three, and now have a higher need for medical care so they usually will change over to Option 1. Our Option 1 is our most utilized because it provides a higher premium, but lower deductible and then it facilitates copays. What I mean by that is you want to see your doctor you pay a $50 copay. If you want to go to our Wellness Center, it's a zero copay. You will meet the prescription copay a lot faster than on our other plans, so usually we see a shift every open enrollment based on that," Gordon said.

The younger employees probably don't think they are going to use the plan much and may take the higher deductible-lower premium option. They may continue that way for years and then decide to get more insurance.

"It's really hard to determine what their needs are going to be, but what we do is we generally provide as much educational pieces as we can to make sure that they feel comfortable with their choice. Our open enrollment process has First Financial representatives which we call enrollers, they go to campuses, and these enrollers have what we call a booklet guide," Gordon said.

They also provide more one-on-one attention. An Aetna representative also is at the benefits office daily.

"She's available to answer questions, especially on those new hires that are telling our Health Benefits Specialist Maria Melendez, that they're not really sure what they want to utilize as far as benefit-wise. ... Our process with new hires is we have an online orientation video that they have to watch. The reason that it's a requirement is because it provides information about cost; it provides information about what benefits stands for, as not just medical, but dental, vision and other optional benefits. We want everybody to have that equal amount of information in order to be able to make that decision because we never know. We're just going to let everybody see everything that we offer and then it's completely up to you as a staff member what fits your budget and your family needs," Gordon said.

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