Durham County's Budget Work Session on May 20, 2025, spotlighted significant changes to the county's health plan, which is self-funded and primarily driven by claims funding. The meeting revealed that the county is projecting a total claims fund of approximately $35.6 million for the upcoming year, with a notable increase in costs attributed to rising healthcare utilization and expensive medications.

A key highlight was the recent Request for Proposals (RFP) process for administrative services, which resulted in the decision to continue partnering with Cigna. This choice is expected to yield around $2 million in cost reductions, largely due to improved pharmacy cost guarantees. Cigna's proposal also included enhanced wellness funding, increasing from $100,000 to $150,000, aimed at promoting employee health and reducing long-term costs.

The discussion emphasized the importance of the health plan in attracting and retaining quality employees, with nearly all full-time staff enrolled. The county's health plan is designed to manage costs effectively while ensuring comprehensive coverage. Notably, the plan's stop-loss insurance threshold is set at $225,000, meaning the county retains responsibility for claims below this amount.

Concerns were raised about the rising costs of GLP-1 medications, which have surged in price, prompting the county to implement utilization management strategies. Employees will need to meet specific criteria to access these high-cost medications, reflecting a proactive approach to managing healthcare expenses.

The meeting also touched on the county's wellness initiatives, which have shown promising results. Over 1,200 employees participated in biometric screenings, with more than half showing improvements in health metrics. This focus on wellness is seen as a critical factor in controlling insurance costs and enhancing employee satisfaction.

In conclusion, Durham County's strategic decisions regarding its health plan are poised to not only manage rising costs but also to foster a healthier workforce, ultimately benefiting both employees and the county's budget. The anticipated outcomes from these changes will be closely monitored as the county moves forward into the next fiscal year.