e e e e e after Justin C ex director teacher Association Gordon lher CTA president Jim staff Association Heather Frederick Chief Financial Officer Nancy Bolton director risk and benefits management Tim kubri chief of Human Resources uh Jordan tares CEO of people on health lean Lano benefits manager Germaine English manager Labor Relations Carol session school police PBA route all right and so online we do have Jesse Brown president of asop and and Joseph brener uh Chief negotiator for SEIU uh and Danielle Williams from our legal uh general council's office so thank you all for being here uh in person or online uh we got a pretty packed schedule today so with that I'm going to turn it right over to Nancy Bolton to get started with our presentation okay good afternoon ladies and gentlemen just to um update you briefly with um the uh data points that we've discussed in the past P so just uh topics to cover today plan year 2024 and 2025 performance as of March um rate change options these are you know just sketches to talk about what could be possible to cover the deficit uh proposals on how to slow down uh increases in the future and then um a presentation from people one Health uh Jordan terod Das introduced himself he's the CEO and founder um of one of the options uh that we're exploring that we believe has some promise so we wanted to have you see it as well and um just our Redline changes which are just updating dates timeline and discussion so forgive me again for this very small font um but the good news about this if there's any good news to share is that March was a little bit better um we're advised by our actuary that early in the year when we see these big variations month-to month they have a larger impact on the forecast um because they affect the current year in a couple of ways March for example was probably $3 million less than the actuary forecast in the beginning so that is simply an improvement uh but the 3 million Improvement in a rolling 12 month forecasting mechanism or view which kind of looks at a year in Focus so you know march to March April to April May to May um brings our roll in but but the good news in March brings the whole 12 months down by about a point and a half um and that Improvement affects the forecast for all the remaining months of the year and so early in the year that affects a lot of months right so as we get deeper into the year that piece of the projection uh will be less pronounced and the forecast for 2025 is all driven by The Rolling 12 and so this does look better a little bit and it does impact a little bit uh the forecast that we discussed when we met in March and so if we have better months this year the forecast will improve and then we if we don't you know it won't and so of course we can't predict the unknown but it is still projected to go up I just want to after all that it is still projected to increase and we are going to have some good months and we're also going to have some bad months but it is overall we are trending the same way that we were trending last year right so that is important for me to quickly go to this slide because although the numbers you know instead of 39 million for 2024 the projected shortfall just in breaking even and 54 million is less than 39 uh million as of February and 59 it's still significantly um more cost anticipated than funding to cover and the point to look at here on this slide is that blue trend line which still has us below the state's required 60-day Safety Harbor threshold um of claims both years so even you know adding these increases to the plan just to break even still leaves us at a funding deficit for both years as predicted so the recommendations um you know now we're looking at a range in that 54 54 million to 59 million the 59 is familiar this is a you know a range that is unpredictable we don't know how the rest of the year is going to go uh to reach the 59 million as we discussed this is a recap the necessary premium increase based on current enrollment which for March was 19,99 to employees is that 248 per month per employee which is 24 per paycheck but if we recommended a minimum of 55 million increase uh split 50/50 between the district and employees then that figure would be uh 116 per month per employee 58 per paycheck for a 25 pay period and where the 55 is coming from is that we do expect that we're going to have good months and bad months but the shortfall in 2025 is going to be somewhere between 50 and 60 million so that's why we're just G to you know split the difference and say that that we're going to need $55 million to just break even in plan year of 2025 and so when you look at the second bullet point there that is the per employee per month um but we're looking the total amount that's needed uh but we are uh looking to split that uh with the employees and so that's where the the difference that's where you see the the 116 per month per employee represents 50% of that $55 million and that would be $58 per paycheck that's a good point okay so last year you'll remember that we did rate scenarios um we looked at two options just for illustration one was just a flat across the board increase regardless of what tier the employee um chose whether they were individual or whether they had a child or a family and so these two red boxes show that $116 a month increase just flat rate to rate and then the column next to the red boxes show the rate reduced by full health rewards participation and I do want to thank you for collaborating with us because we did see an increase of a thousand members in our health rewards last year and so hopefully we'll see even more because of the you know the indicators going from five to three so just um an illustration here and then last year we looked at kind of tweaking the rates to consider the actual cost so as an individual I cost um a factor of one you know that's what I cost but if I have a child then my rate is 1.64 where if I car if if I cover one adult spouse then it is uh 2.1 for just based on the cost of the plan um this is for illustration the rates have not been drilled down by the actuary to really uh look at the true cost per tier uh these are existing rates based on the actuary's recommended factors but what it really has the um what it has the outcome of doing is just kind of if you look at the far right red box it just shows the amount of monthly increase so instead of 116 there in that high HMO individual it's $96 of an increase you know a 91 for an employee and child and then more cost is on the employee plus spouse or employee plus family because you're covering more people so just this is just an illustration is what could be possible if you wanted to uh talk further about that sort of approach the math ends up the same at the bottom line so so they're good illustrative points and then just comparing um the current to the flat across the board to the Actuarial kind of factor option to and then just the comparison again I thought I was brilliant with the options in Gray there but now I realize they're kind of hard to see so I apologize they're just reflecting what I just showed you on the previous slide but again the story Remains the Same these numbers are updated from the last meeting because orange had to impose Orange County schools had to impose an increase that was widely reported um St Lucy kind of also tweaked their coverage it looks like they just they they grandfathered their more Rich uh HMO plan and now they're doing High deductible plans uh only so they have three different versions of those but the story is the same that the district remains very um rich on the dependent coverage side as compared to our peers uh these are just school districts that have faced what we're facing today and this is how they've um come out you know where they're uh putting more coverage on individuals and and Broward for example doesn't provide any coverage for dependents uh so they just you know they cover their individuals regardless of what plan they choose uh we though you know we're a family business we're very uh we subsidize dependent rates historically so that to me is the main difference of this slide okay so cost changes over the past five years um the left slide talks about our our uh prescription drug costs and as you know the rebates have been getting larger over the past six months or so and so even though our costs are going up and our costs are considerable uh for our prescription drugs the the increase is smoothed a bit because the rebates are larger but still you know that's a lot of brand drugs in that experience uh the medical claims those are that that's a little bit um more pronounced the increase um over the past five years and of course covid factors in that so and also medical inflation and postco that we discussed last month you would ask for the enrollment over time so there it is with our 2019 enrollment was the average was 20,600 and currently well I guess I didn't update that for March but we're at 19 uh8 something right now 82 right yeah and then when you're looking at this too I mean it it helps to point out what we talked about in the in our our last um discussion is that it's over prices are just going up just generically so if you're you're looking at your your cost of your prescription rebates you look at the per employee per month you know that is the amount just keeps increasing um looking at the medical claims in general you know it's not just claims are spiking because um enrollment is spiking it's the per employee per month uh you can see how that um is just increasing each year because looking at our enrollment our enrollment has actually uh declined and is now finally starting to to bump back up again in 2020 uh we're in plan year 2023 so it is starting to bump up a little bit we're at the 19,800 but still well below where we were in 2019 yep and I see that I did add that little footnote down there with the 1982 um so we asked United to kind of because you were all you all had said you know what's causing these increases and we of course follow you in wanting to know what's causing the increases so um United provided some Coster I just a a couple of slides uh this one shows inpatient ad admissions you know hospitalizations year over year and you see that I mean there's there's really costs are going up every single year um admissions per 1,000 though were actually higher in 2019 than they were in 2020 3 but the cost is higher um you know and the the amount of days are actually lower uh by six the average days per 1,000 hospitalizations but the cost of course is higher five years later average length of stay is a little longer um the average paid per admission there's a jump there over five years uh 20,000 in 2019 to 25,000 you know um which is really high numbers hospitalizations are very very very costly to the plan um you know admission paid per day the per day uh figure has has also increased I mean it doesn't tell a story you're not expecting it to tell um you know the total cost has gone up there's nothing unexpected about this slide and you know what we found is that there's really no um particular cost driver everything is increasing year-over-year outpatient events these are all separate um we asked United if emergency room you know or an urgent care where something was lanced maybe does that count also within the outpatient surgery numbers but no these are all individual costs so outpatient surgeries paid uh you know it's a big cost driver to the plan uh 20,000 $20 million in 2023 up from 7 17 million uh in 2019 ER visits as we discussed they have gone up um visits per 1,000 from 184 5 years ago to 220 almost 221 in 2023 um paid per visit numbers have increased um you know the per member per month cost and total ER paid in 2019 was just 11 just $1 million and you know 17.6 in 2023 Urgent Care also going up but it's a much less um lesser of a number and now I'm questioning those numbers that the urgent care because those I'm sure that we paid more than 13,000 there no it it was a million so I think we lost I think we lost we lost yeah so we will correct that for the record but you could see during the covid period how there was a a swap between the ER and the Urgent Care and now we're kind of going back um to back to having a higher um we have an higher emergency room versus urgent care because those are actually a Millions on the bottom there yeah one of the um observations that United made was that it seems to be people in their first year or two of employment that in in larger numbers seek the emergency room so education I think is an important um um opportunity for us to help to drive drive people to the lower cost options Urgent Care their you know their PCP and so toward that end um emerg emergency room potential steerage you know in other words if you're going to the ER where would you be better off going for the cost of the plan and even for your experience because gosh going to the ER is sometimes not pleasant so in 2023 visits per 1,000 were about 100 and the total visits in plan year 2023 were just over 8,000 and we paid 17.6 million so there were 21 diagnoses that United uh identified that had the potential to be redirected to a lower um level s settings so the examples are upper respiratory infections um United indicated that 95% of the time those could be treated equally at an emergency or at an urgent care or a a private physician personal physician viral infections 80% of the time abdominal pain 10% of the time and if those things if those visits were directed There could have been 2,300 of the 8,000 that would have gone to urgent care for example and of that 17 million um potentially um you know there could have been a 3.8 million um potential reduction in the future uh cost of er visits so this is just a sketch of what could be possible I think that um there is a huge difference between the emergency room co-pays and the Urgent Care co-pays now and so I think education is our opportunity there and so as you know um we are not currently proposing uh plan design changes as we sit here today but we are looking at how do we slow down um increases in our future plans you know fiscal year 2026 and Beyond what can we do to try to bend the trend so if we're trending at 8% how can we reduce that to 4% or you know lower than that so we look we're looking at several things uh we have uh Mr terod Ash here from people one and he'll share a little bit more about his um program uh there could be some estim you know there could be an opportunity to reduce some of our cost and shift away from higher cost options like the emergency room and um brand name drugs and other things uh we're also looking at there's a there's kind of a new provider here in Palm Beach County uh HSS perform and I keep forgetting what it it's a Hospital specialty uh surgery I think is what that acronym stands for but they are a worldclass or Orthopedic um they're ranked number one in the treatment of MUSC musculoskeletal disorders and that's one of our cost drivers and so they have lower episodic costs they boast Tiger Woods physician postar accident for whatever that's worth um but they offer he healed fast yeah he did he did they offer kind of a concierge so if you if you use they're a center of excellence and they would um potentially um maybe provide surgery less often and and also help with uh continuation of care and they are a United participating provider so we are looking at partnering with them at no cost to the plan just um sort of an access education um concept that that drives people to the SE uh Center of Excellence also United has enhanced their Diabetes Care Program and it's it's really it's this concept of the thing you know that you putting your arm the inter what is that I I don't remember the sub skin little circle the little disc that we see a lot on people and it actually is connected to an app that connects you to personal care where the you know the goal is to keep you healthy and to manage your uh disease more productively so that our diabetes colleague our colleagues with diabetes are trending about 13 or 14% um as compared to the 8% or the 5% that we've talked about before and so that the intention here is for those comorbidities to be better managed so that in the future those people stay well and those costs don't escalate as they do and then we had talked about prescription drugs you all had mentioned U mandatory mail order uh there's new legislation that May challenge that as a possibility under the plan you know if you do mandatory mail order you also have to do mandatory 90-day retail so there's some considerations there that we're discussing with our our Consultants the anticipated savings um you know or or impact of the cost is not as you know not as remarkable as some of the other potential things you know I think 250,000 was a potential impact to next year's costs for mandatory mail order if it is something that we can do Under the plan uh United though talked about a different platform now this is just I'm sharing this with you just for the just for your knowledge but it would be a a retail a a prescription drug platform shift from the current formulary to a a different formulary that would have the impact of you know moving certain drugs into different tiers uh of coverage and so there would be different cost points for some of them about a hundred of our currently covered drugs would be excluded but it would there would be an opportunity for doctors to kind of plead the case to get them covered and so there could be an opportunity there um the the future cost impact was um when when looked at under our Reb schedule was you know maybe around the $2 million potential impact so you know it's just something that I'm sharing with you uh as a information point because I think we have to consider everything now and uh so at this point I think um if Jordan would jump in and um let me kind of see how we can get your presentation loaded so okay there we go and there a PDF on the bottom PDF on the bottom right here yep that was easy and just make it there we go okay you could that that'll work right there it might not be a clicker it's okay it's it's a PDF oh works perfect okay hi everybody I'm Jordan tares CEO over at people one Health appreciate so much the opportunity to chat with you all uh just a quick background before I dive into the details of how we might be able to support uh your your members in your plan um uh my mother was a health and phys teacher in the New York City public school district for 31 years uh to this day a proud member of her classroom Teachers Association uh Union so I personally benefited from all the work that you all do here every day and it's become uh my and our company mission to provide the highest level care that we can to your folks while potentially helping to mute the impact of some of these increases that you see year after year so uh thanks for the opportunity I'll walk you through this but please ask me any any questions you have along the way um the overall theme of this presentation you see in the top left here is you deserve better and this is a royal you uh every single person in this room and all of your members we we fundamentally believe you deserve better in terms of care and quality and let me walk you through how we do that um this is just a quick summary of what Nancy walked you all through here right over the last decade healthare costs have gone up 53% uh the average fam is approaching $110,000 in outof Pocket expenses um by 2033 uh the estimates are the total family premium is going to be equal to 100% of the median fam's income and Health Care expenditures so I'm sure you could all see how that's just fundamentally unsustainable um about 40% of of folks in our country are what are called functionally uninsured meaning they have an insurance card but they can't afford to use it because of co-pays deductibles and co- Insurance because they make choices to buy their children baseball bats and dresses for prom and whatnot and those are decisions that we don't think anybody you know in our country should have to make and then for all those cost increases you've all experienced this where you go to the doctor you spend more time in the waiting room than you do in the actual uh care uh and you run out of there with another prescription and another specialist visit and it's just not the best experience to say the least um okay so this is what we attack this is why we get up every day so I'm going to run through kind of this compare and contrast this is a little bit of what we don't do and what we do and I think this helps tell the story the number one most important thing on the top left here is we do not replace your health insurance your health insurance plan stays in place exactly as it does this is an enhancement to that health insurance plan and the care that you folks get um all of or the vast majority of the costs that you're seeing there run through the current health care system which is under fee for service fee for service is a volume based incentive meaning the more care your folks receive in the system the more Revenue that system makes we personally feel the incentives should be backwards there's the other way that the uh the healthier your people are the more money the system should make and the less healthier folks are the less money so the incentives should be aligned right you folks should be paying for your people getting and being kept healthy that's how we are compensated people want Health if we choose to partner with us is paid in a flat rate meaning unlimited access for one set dollar amount uh full transparency my organization makes more money the healthier I get and keeper people that's how we make money um we don't build on-site clinics that are just for employees because usually about half of the covered folks on your plan don't come to work at your buildings uh each day they covered spouses and family members so we build multiple offices spread throughout your community in partnership with you so these are accessible to all family members as well as your employees this is not urgent care or a hospital system but as you saw in nany's presentation there's a whole lot of care going to urgent care and ER and fundamentally that's because people can't get into Primary Care they don't have a relationship it's impossible to get in the Services I'll show you have been shown to reduce Urgent Care utilization by 75 plus% for members who are using it and uh ER utilization by 25% because people can actually get into primary care and get the care where they should be and the last point this is a lot more than primary care I I'll show you that in a second here okay there's a lot on this slide my apologies I'll walk you through this slowly and the colors are pretty vibrant um so for each community that we serve we build these community- based health centers in the community and if your members choose to engage and I say choose because this is completely voluntary none of your folks will ever be forced into this they get to raise their hand but if they do this is the service they'll get they'll have unlimited access to their primary care physicians our physicians see no more than 16 patients a day so that means your members are going to have 30 minutes 45 minutes an hour real time slotted for their care to be heard and listened to and cared for and navigated through the healthcare system not these 7 Minute appointments um they're going to have a deep one-on-one relationship some of you folks are uh have gray hair like I do remember the days when your family had a primary care physician that knew your mom and your dad and your whole family this is that type of primary care it is a deep relationship with your members and their family um generic drugs if folks engage in this uh either dispensed at the office Community Pharmacy or mail ordered are all included there is no cost to your members for those and there's no cost to the plan uh 99.9% of labs they're drawn at our offices you don't have to go to another facility for that all included Your members will pay nothing for those the plan pays nothing and then this bottom Point care coordination about 30% of folks in a primary care office or really any Healthcare office are doing billing and administration and insurance there's no such thing in our office so our people are doing Healthcare navigation for your folks making sure they can help get those appointments guiding them through their care experience okay that's the top level there any questions on the blue box before I go to the other two how many locations in Palm Beach County uh none as of today so what we will do for you folks is uh if we choose to work together you'll see this a little bit later we see where your folks live and work through heat mapping and then together we will start locating our location so they are convenient for the folks we're proposing to start with facilities in and around your county here thank you for that okay I told you my big secret I make more money the healthier I keep your folks so that means you're going to get a primary care physician you're going to get a registered dietitian and a health coach you're going to get a licensed clinical social workers part of your team we are preventively screening everybody for substance abuse and behavioral health challenges that that is under our care so if anybody is screened High the primary care physician and the social worker come together give a brief intervention and get your folks into the care they need immediately we don't just send you off and say good luck and getting into therapy we are managing your healthare and your Behavioral Health together clinical pharmacist uh can you afford your medications are you filling your prescriptions do you have adverse interactions you have this concierge care team guing your folks through all of this care um specialty consults you've all experienced this right you've have to go to different Specialists that takes months to get in there there's more co-pays in the deductibles if your members are using people on health our Primary Care Physicians have access to 75 sub specialist to do curbside consults that means your blood work comes back a little bit off we don't just send you out to an endocrinologist your primary care physician is going to consult with an endocrinologist and say can I manage this through primary care or do we really have to send them to a specialist so we're not sending your folks around through the Carousel of care we are managing it every step of the way for your folks um okay green bucket any question on the green bucket okay the bottom ET I have no idea what color that is but um this is where we go farther mustard okay it's mustard this is where we go even farther so if your folks need outpatient Behavioral Health Therapy uh Physical Therapy Advanced Imaging CT scans MRIs x-rays cardiac testing are like stress tests pulmonary services are like sleep studies durable medical equipment cpaps wheelchairs braces all of these services are included for your folks if they choose to engage in this model they pay nothing for all these Services your plan pays nothing more all said and told all of these services are about 88% of all of the healthcare that your folks may need in a year is all through this concierge model it's about 40% of the total cost that's typically hitting your plan is now pulled out and all encompassed in one flat per member per month rate okay I said a ton there any questions other questions I can answer for you on all of this yeah is the uh Hardware also covered under that stuff like uh your CPAP is included yes it is all all included in this the whole point of this model is remove the barriers so your people can get the care they need take away those barriers okay I can come back to this at any point so to your point sir on the left side here everything I just described for your members there's no co-payments there's no deductibles there's no paperwork or bills we're removing the financial barriers because the more your folks use the services on the left here the less likely they're going to be in the urgent care or the the emergency room or have ongoing chronic disease so we want them to get those Services we remove the barriers on the right side though God forbid your folks need to go to the hospital or the emergency room they still have their health insurance plan it is still fully in effect you just have this concierge model that's helping them through the day-to-day stuff put those two together you have all the healthcare needs for your folks okay sounds good to be true yeah it does right I'll show you some data that proves that it's not okay um let me give you a little story here about fundamentally what this feels like for your members who choose to engage so this is theoretical Danny and imagine Danny's one of your uh employees here at the school district and after school one day she was playing with her kids and she hurt her shoulder uh typically you know the experience Dany cannot get into primary care so she ends up in in an urgent care center there's a co-pay with that she gets a pain medication then they refer her to an MRI weeks to get in there more expense and then Physical Therapy more expense more time uh overall the total cost of that episode is about $765 to uh Danny and about $2,800 to your plan if Danny chooses to be a people on health member this is what it'll feel like for her she will get into her primary care that day same day next day we will get your folks in she will pay nothing for that experience the the P medication that she needs nothing for that if she needs an MRI we are setting that up for her with proprietary access with our partners she will get in there when she gets there she pays nothing for that MRI it's already included in the bundle the plan pays nothing more for that let's say Danny does need Physical Therapy instead of the the plan saying you get 12 sessions there is no plan in the middle here the physician and Danny will decide when that care is done and then that's how many sessions there is no limit on it no cost to Danny so on the bottom right here you see how the economics of this potentially work Danny pays nothing for this entire care experience and an entire year for Dany in this model is is $1,800 so you can start seeing how some of this really potentially saves money for the plan and saves money for Danny I want to be clear the $1,800 is paid for by the plan that yearly membership is paid by the plan not by your membership okay um this is the aspirational goal right really enhancing all of the experience for your folks their the wellbeing the prod productivity and furthering your plan of attracting and retaining the best folks out there I have like two more slides and I'll stop but um okay forget about all the math and the jargon that I just threw at you let's just talk about how your people will be cared for so the average net promoter score customer satisfaction score of a of the Health Care System right now is 35 it's kind of okay uh the average net promoter score of a health system-owned Primary Care office is three it's quite poor cable TV uh customer service is the only thing that's worse than that that's not a joke that is a literal fact um uh our members rate our Care at 87 uh it is the fact that your members will be heard and listened to cared for advocated for that's the real disruption we want to bring to your folks the cost savings and potential of that whatnot is really a byproduct to the care that your folks deliver uh and deserve okay I have some numbers to share with you all but any questions I can answer for you all kind of overall about how this works before I show you some numbers good so far okay thank you all right so this is this analysis is based on your actual claims experience from January to the end of of last year um okay there's a lot of numbers on this so let me walk you through this U nice and slow so this is about the potential future impact on cost increases so you see the year after year after year you know about 8% increase the idea here is that if this um uh coming together can be you know a support for your your school district and your members it's a potential to blunt that so I'm not going to say it cost won't go up but potentially instead of 8% they go up 2% so let me show you how that works and the top left corner here with only about 10% of your membership opting in saying we would like to do this the plan would potentially save about $1.8 million and your members would potentially save about 2.4 million because all of those Services we went through there is no out- of pocket anymore you can see 10% 20% 30% it's pretty linear as more of your folks choose to engage the savings the potential savings to your plan increase and the potential savings to your membership increases all the way up to we modeled 30% here because um historically with other uh school districts that we've partnered with and deeply partnered with the administration and and and labor to drive engagement we see aspirationally we can get 30% of folks in year one potentially engaged if that is the case um the potential impact to the plan is about a $5.2 million savings and the potential to your members is about a 7 .2 million savings because that wipes away all of those out- of-pocket expenses for all those Services a lot of numbers on here any anything I can answer for you on all of that okay um this is just one more graph so the top is really just illustrating the top line is what happens if your plan expenses continue to go up at about 8% year-over-year over the next 5 years the blue bar is if we partner together and start engaging folks in this higher value concierge model is the blunting of that so the cost increase at about 2% so you see costs are still going up but they're not going up nearly as fast which is obviously a benefit to the plan and to your membership on the bottom is the cumulative impact in essence the difference between those two lines you can see year after year the cumulative impact of blunting that uh increase between 8% and keeping that down into a 2% range okay any questions on this okay um sir to your question uh this is a heat map of where your folks live throughout the region so we will partner with you all on saying hey where is the right place to start let's let's place the first four offices and regions that are convenient uh to your the greatest uh percentage of your membership and that will help Drive the voluntary engagement in this that's where we'll start these are um multip mle employer shared offices so the you do not pay for the expense to build these we pay for the capital cost that does not come out of your budget that comes from us and we look to build more and more uh critical mass in in a region as we partner with more and more of your folks I think there is that's it that's so that's all I'm happy to answer any questions I can for everybody and thank you so much for the time so the reason why we presented this today was you know give this as an option it is strictly voluntary if it is something that uh you wanted to pursue we would have to guarantee 10% participation of our membership um so that would be about 4,000 because it's total membership it's not based on employees so we have about 35,000 members 38,000 members right now um and so we wanted to gauge your interest as to whether this is something that we would want to pursue because it's where in the slide it talks about employer um costs or employer you know potential reduction in costs it's really the plan and we're trying to and this goes to what Mr Cat said mentioned in in the last meeting is you know it's not sustainable to have these 8% increases each year so what can we do to try to get back to where we were which is we were having two and 3% increases in the plan each year which is much more manageable um this is something that orange is pursuing um what other districts do you work with in Hillsboro uh so uh school district of Oola county is a current client Orange County Public Schools is a current client those are the two school districts currently as clients in the State of Florida and it would take nine months um in order to you know find the locations and actually get this started so we wouldn't be able to see um you know any potential reduction in costs until plan year of 2026 is what we would be looking at but like I said we'd have to make sure that there is an actual um uh that you would actually want to participate this is something you'd want us to purs pursue because we would have to uh we would have to guarantee a a participation of 4,000 and if we didn't have that participation of 4,000 it is still a plan expense each year that would come out of the health plan so clarify for me if I'm understanding if someone were to choose to utilize this service they do not have United Healthcare they they do they do okay so it it is they would pay the monthly or annual that you mentioned the $1,800 for the for this we pay that well it would come out of the plan it would come out of the plan okay and so instead of you know where they were looking at the cost because right now we reimburse United healthc care for the actual cost of whatever the claim is and so with this one we would now be restricted to the claim is only the $1,800 per person per year and so that way it's you know if if they were to go and use which they still would have the opportunity to use any doctor that they wanted in United Healthcare um but if they were to just stay within this within this program if the the cost out utilizing outside the United Healthcare could have been $55,000 but we're capped at the 1,800 okay so I have United Healthcare I opt into this the district pays the plan pays the plan pays the $1,800 understood so it's but the by opting into this I don't pay as the user no and then you have no co-pays as long as you go through as long as you go through this yes so if in a scenario that I need emergency room care I injured myself my knee needs all sorts of surgeries um what is the cost to the plan nothing above the 1800 yeah so that that's a wonderful question the surgery would fall on the right side here so that would hit your plan just like it does today identically so the plan would just pay identical however importantly let's say um before that you needed some MRIs before your surgery that would already be included that's included no cost to you as a member no additional cost to the plan you need physical therapy after your surgery that's already included so there's no additional plan so it really Narrows your plan's exposure to these variable costs and it reduces the exposure to your membership from cost understood you had mentioned earlier in the presentation that something to the degree of 80% of care falls under what would be the plan's $1,800 whatever the the fee coverages that is correct I I do want to add one other piece the one the guarantee membership is only for the first year after that that is on us so it's only a onee guarantee so going back in Justin pretty much asked the questions I had but so we're going to need people to make a commitment that they want to go toward people want so what we're saying is before we can actually make a deal with people one well I would say we would want to gauge the interest you know because we don't want to all of a you know only have a thousand people want to participate or 500 and we're guaranteeing that first year the 4,000 so if it's not something that the membership is at all interested in then I don't know that it would be something we'd want to pursue I'm sure you have another response to that but um we've been doing this for for 12 years um uh many school system uh Partners many public sector partners and some private sector Partners the unfortunate reality is even before the pandemic 55% of folks did not see a primary care physician they couldn't get in didn't have a relationship when you give your folks the option because it is completely an option to join this concierge like model and it removes all the cost barriers that's why we modeled 30% we're going we typically see 20 to 30% of folks say I I'm going to give this a try and do this so 10% historically is a very modest uh voluntary uh optin that we see and then you keep using this word concierge um I just might be cautious with that because me as a we'll say as an average person receiving care when I hear concierge I hear someone tell me I got to pay $6,000 extra a year so concierge sounds like something that's going to cost me more money rather than give me a better deal or uh we'll say uh completely limit uh my out- of pocket expenses I think I think one of the things that would be important to the people around this table is who's making a decision to go to people one are we making a recommendation from this group or is this something the board and staff is going to make a recommendation on I mean ultimately it it is all up to the staff and the and the board in order to make that decision uh but we want to gauge the interest for participation purposes I know that when I when I watched this presentation I went into it you know not expecting to be impressed and I walked out saying you know if you can do exactly what you say you're you're going to do it's impressive to not have any co-pays for the employees to have everything covered that would be a a nice benefit for our employees group um so it's it's more gauging we will have to in some way I would say send out a survey I think that's that's what you said they've done before um to employees to see if they would be interested in it it is a a communication yes and and getting to our employees and being able to communicate to all all of our employees I think will be the challenge the main challenge you know hearing it um everyone that we've talked to about it within the district has been very excited about the potentials for this program and I agree with you Heather I think I think the issue you know Nancy repeated several times education I think the only way this works is if we educate the the our employees so that they're going to be uh receptive to this because that you know and you know I what's the word I want to use most people are skeptical to change their Direction when you talk about their healthare I mean I I'm old guy so I remember 100 years ago we went from uh uh I forget what it was even called perb provider to HMO you made people make choices and no one knew whether they were making good choices or not I think that's really what's important here is making sure that people understand whether they're going to make the good choice of uh what's going to be best for them you know obviously anytime we talk about less money out of pocket and Quality Service people are going to be interested but I think it's going to take a lot of communication a lot of Education to get people to understand really what this is going to be I I couldn't agree with you more and although it's like at some point it's like nine months we'd love to get going part of what's good about the nine months is really us partnering with you and getting into community events talking to your folks letting them meet our physicians because that communication and engagement is so crucial and your feedback on coner right that's why I need you to tell me here's the words here's the partnership it's your partnership and the language and the experience and the the marketing campaign that's really what we need to partner with you all to do so I could not agree with you Mora the other thing will be important for the people that want the health care services when you look at your heat map is where those PE where those places are going to be located you know this is a big geographical District that serves a lot of people that live in a large area you can see that by that map and surely when we look at it you see hot spots of Wellington and Royal Palm and things of that sort but if you ignore the the North and the South you'll fail you're going to have to figure out a way to get get them involved too so appreciate all that feedback one last point because this is not health insurance to your point sir um each month folks can opt into this so let's say the first month a bunch of folks opt in they're going to go experience it and talk to everyone at the schools the next month more people can come word of mouth is truly our number one spreader of this service it's not limited to it's not limited to just once a year you can opt in and out throughout the year I forgot that's an important thing to share because people are afraid to you know we make a decision and I stuck in this decision for the next 12 months so to to know that you can basically waffle around and and make it work for you and your family I think that'll make a difference in whether people accept it thank you for your feedback and then also other sites would be added based on um the amount of participation at each site right so once you reach a certain utilization you would automatically add another site which would then not be an additional um uh burden uh for the for the district plan at all that would be absorbed other than the additional members that are participating selling Point's going to have to be okay we're going to have to increase what individuals are going to have to pay for services I mean that's clear from what we see how are we going to you know less money out of pocket for services is going to have to be a biggie because that's the only way you're going to sell this you know look I'm paying $112 more than I paid last year something like you you know that's going to you know fry some people's minds so when when they they need to know how they're going to to have less money coming out of their pocket well I I think this is a perfect example of that right so with increased premiums but when you're talking about going to the doctor not having to pay a co-pay not maybe one MRI makes up a huge chunk of it right um no your prescriptions things like that and actually like you said being able to get in to see a doctor or get a regular physician is something that's kind of difficult to do right now mine mine retired two years ago still don't have one so and if if I could just quickly hearken back to the the point that United make made that the new employees seem to be the ones going to the emergency room and as a relatively new employee two and a half years now so I can't you know claim new much now but I've had a hard time finding a PCP under our plan and the ones that I have found have wanted the concierge payment so um you know I I just to share those two data points I think it's important it could be an indicator [Laughter] yes um so two questions one maybe for the district um and then another one regarding the service did the in reference to the question that was asked about who makes this decision you said that this would be a and I'm just asking this I'm not reflecting a position or anything you said this would be a unilateral decision between the board and the administration not the coalition yeah this is not something that would need to be bargained as part of the Coalition it would just be GA gauging interest understood and then I guess a question asked to the statistics and the potential savings I think it said that if if 30% of the employees or or not the employees but the 30% people covered employees dependence shifted to this the savings would be in the in this realm of 12 13 million but 30 like I I know it's not like a dollar for dollar transaction if 30% of people get this it reduces cost by 30% but it seems like in a in a $220 million self-insurance plan with escalating costs that if a third of the people leave is it because people who or people who I use the word leave I'm sure that's not exactly what it is I get that um is it that the most expensive costs like emergency room which don't fall under this like you know those people are still those 100 people because the way that some of this works from from how it's been described me over time is that we might have 30,000 Plus members on our plans but there might be like a hundred people with severe medical needs in a given year that drive like the majority of the costs those costs ultimately don't get mitigated by this because they're in that piece of the pie on the right hand side it's a really good nuanced question and I'm going to try to give you a nuanced answer if I could so let's go back to this slide here this is 88% of all of the Care but it's quote unquote only 40% of the cost because you can see the stuff on the left here is not open heart surgery right so we are disintermediating 40% of the cost out of the planned fee for service which is a significant portion of the cost we cut that cost about in half the plan would have paid about $4,000 for all that care in the typical system we're going to give it to you all for $1,800 and cap that I'm going to take the risk on the rest of it however if you do need open heart surgery or catastrophic cancer that stuff still hits the typical plan as it is that's about 60% of the cost so it that's why it's it's not as dramatic as you think out of the gate however because after year after year after year then we're going to start working on preventive medicine and controlling type two Di iabetes and hypertension that's why your urgent care and your ER utilization and all those Services those potential savings do accelerate out of the gate we're giving you a better price over a long run we're delivering Better Health Care to your folks does that kind of make sense how that comes together yes I appreciate that great question um within like within the realm of what's capable for for a government like the school district to identify employees who might mathematically benefit the most from this what can the district do to to do that without digging into people's medical histories but looking at costs maybe associated with names if that's information that like how how would we make sure that we targeted like somebody might not think they're interested in this but if you showed them a figure that you know it's clear you spend $6,000 a year but through this you would not spend that much yeah we C you can't do that you you can't Target into individuals because all of that information is it's confidential um so that that's not something that we can do but but so that's where the challenge is of educating people and then trying to give examples and that's what um when we when we saw the presentation I think we had three different examples of different cases of this is what it would look like if you had this type of injury this is what the out-of-pocket cost would be for you under your traditional plan this is what it would be under this uh program um but yeah I don't believe that we could actually Target individual people could the opportunity be presented generically to employees to sit down and discuss voluntarily if I wanted to evaluate the benefit of opting into this and in that meeting I I'm willingly discussing my medical needs and is that something that exist so there's actually a really um there's a really um uh data driven answer that fits right in between this so I don't have this slide I'll send it to you after because what you're describing sir the kind of think about the math you're saying like hey if I'm spending five $6,000 a year I'm I'm probably battling some illnesses and I'm spending a whole lot of money over here and then you all say hey here's an option to get all this care for nothing the data shows year after year we actually get the folks who are older sicker have more chronic disease and more medications because they're getting killed by the finances of the system so that's the natural migration in the beginning if all we got was your youngest healthiest folks I'd actually increase the cost of your plan in total so the good news is you actually don't have to do the targeting the economics of healthcare does the targeting for us and you'll see that and I'll send you the the Actuarial data on all that great I appreciate the responses that's a great question yeah so I have a question um since it seems like you have a lot of upfront uh costs that you're laying out um is there a term on the contract with you guys like you know is it a five-year term 10-year term because right now with the challenges of United Healthcare and the cost going you know through the roof on some level we don't even have the option to shop so um we have to wait for that contract to expire before we can even consider it so what would that be we believe in healthcare by choice not Health Hair by uh uh whatever you would call that the what you described so um although we are you know none of this is official we we typically look at a three-year contract but only that first year is when you're saying Hey to offset the capital expenditures we're going to guarantee this this minimum membership after that you the plan is only paying us for the folks who are saying I love this and I'm using it so financially although we're kind of saying hey we're going to commit to an initial three-year period the truth of the matter is in year two and year three you only paying for the membership that is saying this is right for me and my family so I don't know if that makes sense how those Economics work yeah yeah so so are we paying for the minimum amount of folks that have to sign up for you so if we dip below that level is there a cost increase so only for the first year because year one we're going to come in and spend millions of dollars open up these facilities hire care teams so for year one the partnership that we ask for is 4,000 members so it's a th000 members per office that's the kind of minimum so let's say only 2,000 people raise their hand you're still going to pay for 4,000 for that first year that's the quote unquote penalty or or minimum cost I guess you could say thank you yeah great question and then just to clarify with United Health Care I mean we are a self-insured plan so we have we went out for an RFP I believe it was three years ago um the union groups were included um on that RFP um they were included in hearing all the proposals from those um uh insurance companies that bid um and we use United Healthcare to just administer our plan so we reimburse them for the actual claims paid United Healthcare is the one who goes and negotiates with the the doctors the hospitals and whatnot for the price of the service uh but we are a self-insured plan we we couldn't get out of that management contract either though we have to wait for that to expire we do have to wait for that to to expire and I believe it's a 5year term with the option to um extend for 5 years and you know just whose option just United Healthcare or Mutual uh it would the board's option I well and it would be mutual I mean if United Healthcare didn't want to continue it they wouldn't have to continue it I don't know that that would that would happen but um there was goodness now I lost what I was going to uh what I was going to say all right when I think about it I'll I'll I'll I'll bring that back up again okay I had I had another question so as people I going make sure I people one for some reason I want to say people saw people one might want to rename it um will this be an exclusive people want we serve the school district of Palm Beach County or will there be other organizations maybe Pratt and Whitney or somebody like that that would join in with you on this yeah for multiple reasons we have multiple employer share employers share this number one the more the employeers that share this in the community the more likely it is not only to remain but to grow our intent is to build many many more offices than four in the in your county so it becomes more and more convenient for more of your folks so we we usually partner with public sector Partners first counties school districts and whatnot what and we're going to give you all first right of refusal if you all take this partnership with us the first uh opportunity to raise your hand is for this the school district once all your members have kind of taken their seats then other employees will have the option but you all will get the first take at those um but yes we do partner with other Employers in the region to make it sustainable and grow in throughout your county we will also deliver a performance guarantee a contractual performance guarantee that for every dollar you pay us you will get that returned dollar for dollar too so we really put a floor to your risk that's how confident we are that we're no we're going to do right by your your folks and your plan what other public sector entities are you currently Contracting with or in what regions or States yeah uh Pennsylvania and Florida are two states so uh we have over 100 clients in Pennsylvania we started there uh we came here about two years ago so the school district of aola county in in um in aola County obviously is a client uh Orange County Public Schools is a client uh putham County government is a client um so those are all contracted already clients and there's numerous other school districts in Florida this this state is our is my number one Focus right now yes a pretty direct question would you share after this meeting some of those clients in Pennsylvania oh for sure happy too it sounds intriguing on its face I mean it sounds like one of those two good to be true type scenarios so it's not to be skeptical but at the same time to be a little bit but I do I appreciate everything I've heard and if it's as good as it sounds obviously it would be of benefit it would seem that's exactly what I said pretty much exactly what I said Ed the word promising okay thank you all so much appreciate the time and questions thank you yeah that's where we that's where we left off thank you Jordan we appreciate you okay right so um that really was uh that was it the general I don't have redlined articles although we would love for you to we know we would hope to resolve this quickly but you know we're just proposing updating dates and and that kind of thing um any other discussion uh based on the the premium increases that that are recommended here um again speak for the Coalition but certainly at this time in this point in the calendar year CTA is is happy to listen to all information that better informs any future decision I'm not sure what you mean by that that we appreciate the information but as far as discussing or or entering into actual back and forth negotiations right now where CTA is more interested in seeing additional data from some upcoming months what data is it that you're looking for just the additional monthly you know expenses expenses yeah okay we have been sharing that month by month we have we have the March ones that are coming out understood um and especially in light of the the dip and what hopefully would be some sustained dip like that um and the impact on the actuaries Investments or projections rather um so yeah we're openm minded but at this point CTA and I know that there have been a communication I believe from PBA stating that they they similarly they did not feel they were in a position to make decisions at this time I think that email went to everybody okay um well we are here at the bargaining table to to bargain I believe right and to reach agreement on our upcoming uh plan Year we will not sit back and we we just can't afford to do what we did last year we almost missed our deadline to implement any increases so we're we're not going to do that again this year um we we came here to bargain we've gone through our data we've been sharing data for that reason we're bringing these options here today uh these different options because in our opinion um avoiding an increase is is not possible at this point we we've seen our we know where our plan is we we hope that by pushing some some new programs and things like that that we could maybe uh limit future increases but but we are here to negotiate and and to seek an agreement so and I I do believe that's what we all have a right you know an expectation to do by by meeting here at the table understood and maybe we could we could CAU so we could speak as a group but um we certainly believe CTA that more information can't hurt we're not at that point where we're in October November and it's a critical time period that we're already past the red line that we would have liked to have been finished by um and obviously you know per the district as it relates to finances and the and the state budget when that picture becomes more clear that further informs decisions about money whether that's Healthcare or raises as well um so that's a variable consideration for us as well well if I could speak to that I that was presented at the budget advisory committee as well as the last budget Workshop in April this the legislative session you know started in January closed in March so we do have the available funding so the available funds for salary and benefits um is $38 million um because it is one bucket of funds that we have available um so after taking into consideration those costs that we have to reabsorb back into the general fund um increases in categoricals uh we have $38 million for both salary and uh benefits two questions one is that number inclusive or exclusive of the the teacher salary increas allocation from the state it's inclusive okay and so if we could it doesn't have to be right now but if you could provide us the broken down numbers because I know we would be interested and I'm sure the other bargaining units would be interested in segregating the money that can only be used for teachers so that that 38 million doll figure is is more clear to us what's available to who um and then second So based on what you just said if any bargaining Unit were interested in beginning salary negotiations in the near future the district is open to that if we are ready I I'm I'm yeah we can we can begin discussions on that okay all right for ours it's a little different obviously our our contracts you know begins on July 1st where some of the others wouldn't because there's doesn't uh it would go in until January 1st of 2025 um but it it's we would have to set some dates and see what we can do okay but that being said those those negotiations are separate um last year year there was a there were they were combined a little bit too much and and we won't go that long this time we will not overlap negotiations like we did last year um because it it presented quite a a challenge for us where we're we're actually seeing the impact of it now where the increase that we're seeing that we're going to you know we're suggesting we have to impose here this year is greater because we did not pass anywhere near what we needed to last year we we all know that we came to that decision you know when was it October or late October or something like that and and things needed to go out beginning of November for for open enrollment so we we just will not wait and we're really not interested as you brought up during last negotiations co-mingling the the negotiations um that did not go well and and so from our position we're not going to enter that if if that's what you're asking no I think it it might be more of a Nuance to it we agree obviously that they can't be tied to each other but obviously both parties have it's money and it's a pot of money so there are implications to each decision that each each side weighs so that's all I meant by that um yeah if we could caucus with our group just to to touch base and just for your information so this is what was presented at the budget advisory committee as well as was the uh budget Workshop back in April so the increase in the teacher compensation is 12.45 million of the $38 million and not everybody at the table probably understands but that's a dedicated that's actually uh has to be used for teacher salary nothing else it does have to be used for teacher salary so when we talk about other groups they would not be inclusive in that 12.4 million uh no but when we look at what we're setting aside for a district we always combine the two um so it's a it's a total amount available for salary and Ben benefits of 38 million and 12.5 million of that is is is dedicated for Teacher raises you know in the past we've always tried to do better than what was uh provided by the state legislature um it is difficult you know this is a difficult year uh because it is the year that the Esser funds are sunsetting um but so the the total amount we have available is a 38 million inclusive of the of the set aside for the teacher salary categorical well it's no longer categorical it's actually now in the base student allocation but it is still set aside within the base student allocation so they didn't okay so it's not specific as as it had been the last two three sessions yeah right they rolled it in into the base student allocation but they still give it to us as a separate page saying you need to make sure to set aside this amount understood any other questions all right we'll step out you guys could have the room thank you um so first we appreciate the additional information and the updates um that are corresponding with uh the monthly data and what's what's been presented today um we receive your offer today uh the Coalition wants to um meet and speak with our respective boards and some of our members to evaluate our position and then get back together and develop a a response um so that that's what our position is at this time okay I we have our next session is May 30th um my recommendation would be then that we find time to meet again in May before that so we have some some more sessions um does anybody have their availability for the month of May I just know that the 30th is not is not good for the PBA that's the last day of school there's no way we'd be able to break to come here okay um did Katie accept it that that's the next one on the schedule we can schedule some virtual sessions if needed but we do need more sessions um we're just we're we're we know what the data looks like we're not just going to table this throughout the summer um like we did last year we understand all we're asking for is appropriate time to develop our positions okay uh we will float some days out there for May um if we need to get a couple sessions in we're we're open to it um but once school gets out it's it's hard to bring everybody together um so we we we we do expect to to have some sort of some make some progress on this while during this school year here so that that is our position on that so we will send some uh any data that you need please send that those requests to to either myself or or Caitlyn and we'll get that to you um and then we'll send float some dates out there for everybody to to consider whether it's in person or virtual either is fine with us okay okay all right thanks everybody have a great day thank you e