DC Everest staff brief board on health-insurance costs, self-funding and direct primary care options
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Summary
District staff reported a 2024 total paid-claims figure of about $11.8 million, described a 27.66% recent renewal increase and outlined options under consideration including self-funding and direct primary care clinics.
District staff provided an informational update on health-insurance costs and potential strategies to control rising claims costs, including self-funded insurance and direct primary care (DPC) or near-site clinic partnerships.
The staff presenter said the district received a 27.66% renewal last year that would have meant about a $2.8 million increase shared between employees and the district, and that the district's 2024 paid claims were "just over $11,800,000." The presenter explained that self-funding would require stop-loss coverage and recommended maintaining 15% to 25% of prior-year paid claims in reserve (about $1.8 million to $3.0 million based on 2024 paid claims) if the board pursues self-funding.
On DPC, the staff presenter described on-site or near-site clinic models that provide unlimited access to primary care for covered employees for a flat per-person fee. The presenter said such clinics can reduce emergency-room visits and specialist referrals and can improve employee experience; as a cost-control strategy, DPC partnerships may generate immediate savings if the district is self-funded but are an investment with longer-term potential savings under full insurance.
Board members asked questions about previous district experience with self-funding, stop-loss "laser" risks that can carve out certain high-claim individuals, the role of third-party administrators and brokers, and whether existing local clinics could serve as DPC partners. One board member said, "I was really shocked ... out of a hundred million dollar budget we have-ish, we spent 12,000,000 on claims." A board member urged staff to review the district's prior experience exiting self-funding and to consider brokers and third-party administrators during analysis.
The presentation concluded with staff saying no recommendation was being made immediately; staff will continue analysis and return with additional information and possible requests for approval if the district decides to pursue self-funding or a DPC partnership.