Gallagher presents 'Assured Excellence' bundles as part of Marion County schools' health-plan review; district weighs $8M 2027 gap vs. $2.5M savings potential

At a June 4 Marion County School Board work session, district staff and Gallagher consultants reviewed the district's self-funded health plan and options to contain costs for 2027.

Gallagher's Laura Lingal told trustees the district is now projecting a modest gain for calendar-year 2026—about $1.15 million—largely because renegotiated pharmacy-benefit terms and a more favorable stop-loss renewal than originally projected. "We anticipate that we'll be seeing about 1.5 million in additional rebates" from the pharmacy-benefit manager renegotiation, Lingal said.

But Lingal emphasized that, under a status-quo funding scenario with no design changes, Gallagher projects an $8 million loss in 2027. With a menu of cost-containment strategies the firm modeled, that projected loss narrows to roughly $5 million; the district would still end 2027 with several months of reserves if those steps are implemented. Lingal summarized the fund position: the district's claims fund is projected to finish 2026 with a balance just over $30 million and is required to hold an amount equal to 60 days of claims plus incurred-but-not-reported items.

A centerpiece of the presentation was Gallagher's Assured Excellence program, a direct-contracting model that bundles high-cost procedures into single case rates with participating providers. Gallagher's operator described how the bundle covers surgeon, anesthesia and facility fees under one transparent price and includes a 30-day outcome guarantee that holds the contracted provider accountable if a complication arises. The program also offers travel stipends when members must go out of county to a partnered tertiary center. "We negotiated a fixed price for these providers... it is one fixed payment, so the anesthesiologist and the surgeon are all built into one transparent pricing," the operator said.

Gallagher representatives said the program is voluntary for employees, carried at no per-member administrative charge to plan participants, and can be tailored to keep or carve out particular services or local providers. Board members pressed the firm about keeping local hospitals in-network; the consultant said Gallagher and its partners routinely negotiate locally and are already opening conversations with Marion-area hospitals.

Gallagher also outlined other targeted strategies to shave claims: international sourcing for certain specialty drugs, home-infusion or contracted infusion-suite options to stabilize costs (citing examples where the same drug can vary widely by site of care), second-opinion oncology confirmations, and retiree enrollment outreach. The firm said the district's retiree population on active plans (about 159 members) currently produces a high loss ratio and could be offered educational, concierge outreach to help retirees evaluate Medicare or marketplace alternatives.

Mark Avery, president of the Marion Education Association, used the public-comment period to criticize the sequence of events, saying the district convened the public presentation before reconvening the insurance committee that represents employee stakeholders. "We've never done it that way," Avery said, urging the district to restore prior practice of engaging committee representatives earlier in the process.

District staff underscored that no formal recommendation was being made at the June 4 work session. Mr. Rios Welsh, who introduced the presentation, said the information will be routed through the insurance committee and that the committee is expected to meet ahead of the tentative budget to produce recommendations for the board.

Next steps: Gallagher's backup documents will be shared with the insurance committee; staff will convene that committee and return formal recommendations to the board as appropriate before budget adoption.