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Thursday, April 24, 2014

Controls stabilize health expenses

Elkhart County government has implemented numerous changes to its health plan over the years to save money.

Posted on Feb. 23, 2012 at 12:00 a.m.


Keeping health-care costs from skyrocketing into the stratosphere doesn’t happen by itself.

For eight years, Elkhart County officials have been tweaking the county workers’ health-care plan, trying to keep a lid on costs. And while net claims have edged northward — par for the course in health care — county officials say the increase is a far cry from what it could have been.

“I think we’d be in a lot worse shape now if we hadn’t made the changes,” said Carol Caviness, assistant director of the Elkhart County Department of Personnel and Insurance.

Indeed, the efforts to keep health care costs in check have been “rigorous,” she said, and the county’s overall cost increases from year to year have been less than even conservative estimated inflationary hikes in the sector. The $7.28 million in net claims for 2011 — 7.5 percent higher than $6.77 million in 2004 — reflects a 25.1 percent dip from the peak in 2009 when the figure reached $9.72 million.

The county employed 847 full-time workers as of the most recent count, and the $7.28 million in health-care costs in 2011 represent nearly 10 percent of the county’s approved budget of $73.83 million for the year. Elected county officials, like commissioners, are included in the county’s health plan.


The various changes implemented in the county’s health plan, according to Caviness, parallel similar moves by employers everywhere. As such, they provide a window into the sorts of efforts required to keep tabs on health costs.

Here are highlights of some of the Elkhart County changes:

Health clinics: The county opened two health clinics for county workers in 2007, one in Elkhart and one in Goshen, offering generic medicine, lab work and routine care at no direct cost to employees.

Though the county foots the bill, it still ends up costing less than the likely charge if individual workers went to their private physicians. The first 12 months of the clinics’ operation, Caviness noted, the county’s pharmaceutical costs ended up staying at the level of the previous 12 months, bucking the national trend.

Clinic use has increased and the two outlets, operated by Novia CareClinic, have doubled their hours of operation since opening to keep up with demand.

Deductible hikes: The deductible has increased, from $200 in 2004 for single county employees to $1,500 this year. That means more cost to workers before insurance kicks in, though a reduction in insurance premium costs for employees this year, among other things, help temper the hit.

Co-pays: The amount employees have to use from their own pockets for visits to the doctor’s office has increased. From zero in 2004, co-pays for visits to specialists went to $50 in 2008, for example.

Such increases may not seem like a lot, said Floyd Hindbaugh, director of the county’s personnel and insurance department. But over the course of a year among 800-some employees, it adds up.

Stop-loss coverage: As of 2004, the county had contracted with a private provider to cover health costs of individual employees when their annual total exceeded $100,000. They upped the figure to $140,000 in 2009, reducing the charge for the coverage.

Miscellaneous: In 2008, the county stopped covering bariatric surgery, meant to aid in weight loss. In 2009, the county went to tiered coverage, with more insurance offerings for workers at varying premium levels depending on the number in their families. That means lower premiums for single employees and higher ones for those with larger families.

In 2010, the county contracted with a cheaper claims administrator and in 2011 a new rule kicked in requiring workers to get health assessments once a year, meant to detect and head off health problems.


Not surprisingly, the changes have caused at least a measure of unease among county workers at times.

Anecdotally, though, Hindbaugh can point to instances when the new health assessments helped county workers head off larger problems. And his office tries to communicate openly with employees to keep them up to speed on all the changes.

“They may not always like it, but they understand why and see the bigger picture,” said Hindbaugh. “That communication is critical.”

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