Mukwonago board cites early savings from new self-funded health plan and approves annual employee health risk assessment

Megan Zimmerman of Marsh McLennan and Sarah Heus of MBS Advisers on March 18 told the Mukwonago School District board the district’s move to a self-funded health plan, a new HPS network and an on-site employee clinic has produced early savings and high member satisfaction.

The presentation said the district entered the 2023 renewal cycle with an approximately 124% loss ratio and a projected rate shock that could have raised costs by roughly 34%. Consultants said the district changed approaches — moving to self-funding, contracting with Prairie States as third-party administrator and launching an on-site clinic — to create more “zero-dollar” options and active care navigation for members.

“Heus said the clinic opened quickly and was popular from the start, and Zimmerman said Five-Star navigation has provided members a route to high-value care,” the consultants told the board. Zimmerman reported 238 instances through February when co-pays were waived and the member paid $0, and she said Five-Star had handled 956 phone calls to help members navigate care and that 128 medications had been provided free through program channels.

Consultants said those utilization patterns contributed to a year-to-date improvement: they estimated the district was tracking about a 16.6% reduction in total spending through February compared with the same point last year, while cautioning that claims lag and results could change as more claim data arrive.

During board questions, members asked about coverage of specific items such as hearing aids and whether collaborative-care exceptions could be made; consultants said collaborative care can recommend nonstandard coverage in narrowly defined, medically necessary cases but noted that as a self-funded plan the district must treat comparable cases equitably.

The board then considered a motion to implement an annual health risk assessment (HRA) for employees participating in district health insurance. Board materials and staff described the HRA as a biometric screening covering height, weight, blood pressure, cholesterol and A1C. Staff said employees who complete the HRA would retain a 12% premium contribution level; employees who do not complete the screening would move to an 18% contribution level, which staff said equates to roughly a $600 annual increase per employee.

The board voted to approve implementing the HRA, with a phased start that would begin with district employees using the district clinic and expand later as capacity permits. The record shows the motion was made, seconded and adopted by voice vote; individual board vote tallies were not recorded in the meeting transcript.

What happens next: consultants said staff will continue to monitor claims and adjust renewal projections monthly as more data arrive; the district will also finalize operational details for the clinic rollout and the HRA process, including timelines and any steps required to make clinic access broadly available to employees.