Reno County approves payer matrix and pharmacist outreach program for employee health plan

Reno County commissioners on May 10 voted to adopt two new strategies aimed at slowing growth in the county's employee health-care spending: a payer matrix and a pharmacy outreach program run by TriaHealth.

Helen Foster, the county's HR director, introduced the presentation and said the proposals were developed with the county's consultant, USI. USI's consultant summarized a per-employee-per-month analysis showing administrative costs fell after the county moved from Blue Cross to BML and worked with USI. The consultant said the two new strategies target high-cost infused drugs and chronic-condition patients taking multiple medications.

The consultant said the pharmacy approach uses a PharmD to conduct voluntary discovery conversations with flagged members and then return recommendations to prescribing physicians; when manufacturer assistance applies, members would have "0 out of pocket responsibility" for covered drugs, he said. The county's analysis identified 810 plan members and 194 who meet the program's outreach criteria; TriaHealth's fixed fee would be $5 per employee per month, about $21,000 annually, with incentives estimated separately.

Commissioners pressed staff on whether the program would steer members away from local pharmacies. The consultant responded that the outreach is clinical and not intended to redirect fills; local pharmacists remain part of the care continuum. Commissioner Hurst urged recordkeeping and clear demonstrations of results if the county proceeds.

The board debated how projected savings should affect next year's budget. USI cautioned that exhibits compared current experience to a hypothetical Blue Cross renewal and emphasized the difference between "maximum exposure" and actual net claims. County staff said renewal numbers from BML were not yet final and recommended monitoring implementation and engagement before altering the levy.

A motion to implement the payer matrix and TriaHealth as options, effective at the October renewal, passed on roll call (Commissioner Sellers: yes; Commissioner Hurst: yes; Ben Friesen: yes). Staff were directed to proceed with implementation logistics and return data on uptake and realized savings.

Next steps: staff will move forward with vendor logistics and report engagement and financial outcomes; commissioners asked for clear, periodic metrics that show participation and realized claim savings.