LaGrange to switch employee medical insurance provider

Published 8:00 am Friday, August 26, 2022

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On Tuesday, the LaGrange City Council was presented a plan from insurance broker Strongside Solutions about proposed changes that could change the entire scope of how the city offers medical insurance.

City Manager Meg Kelsey advised that her office would normally handle the city’s medical insurance plan but because of the scope of the changes she wanted to keep the council informed.

The plan will not change dramatically, but Kelsey said they would include changing the city’s medical insurance broker, third-party administrator and professional benefits administrator.

Medical benefits costs have skyrocketed for the city in recent years, now hitting upwards of $8 million per year, which Kelsey said the city cannot afford. In order to continue providing medical insurance benefits, the city began looking for an answer to the rising costs and they may have found an answer with Strongside Solutions.

Wendell Strickland, owner of insurance broker Strongside Solutions, presented the council with a medical insurance plan that is expected to save the city at least $2.5 million per year using alternate methods to pay for high cost claimants and certain high-cost maintenance drugs.

“Out of your 400 or so employees and retirees, you will always have a handful of employees that are driving those claims,” said Strongside associate Mike Bodker, former Mayor of Johns Creek, Georgia. “What [Strongside] does is literally find someone else to pay those claims.”

The company takes advantage of grants to pay for particularly expensive medical procedures, along with maintenance and specialty medications through their Angel Rx prescription drug plan. Normally, LaGrange would have to foot the bill for high-end medical costs that greatly exceed an employee’s deductible, but Strickland advised that they find grants that help pay those costs in their entirety.

“We wrote over 4,000 grants last year,” said Strickland. “If we can get those medicines for free, they’re free to your employees and they’re also free to the city.”

Strickland advised that Angel Rx finds the least expensive pharmacies in the country and ships 90-day supplies of medications to people’s mailboxes. All Angel Rx prescription plans have a $0 copay. About 40 percent of City of LaGrange employees are estimated to have no copays for their medicine.

“With the grants, it’s usually zero cost to the city or up to about 70 percent less,” Strickland said. “It’s always zero cost to your employees.”

The broker also uses similar solutions for the handful of high-cost medical conditions that drive up insurance costs through their Angel Access plan. The company has identified a handful of claims that drive up costs such as, cancers, dialysis, high-cost pregnancies, heart attacks and other conditions that municipalities have to pay for, and seeks grants to help pay for them.

Strickland advised that they have found a way to write grants so that it covers the cost of care at 100 percent with no deductibles and no copays, and it’s free to the city.

“There’s 300 people in America that have to give away $6.6 billon to maintain their not-for-profit status,” Strickland said. “I’ve got them all in my phone.”

Using the city’s last two-year year history, the company estimates that the can save LaGrange at least $2.5 million per year using the plan. They actually estimated it closer to $4 million, but they said they wanted to under promise and over deliver.

The plan is already showing benefits locally. Hogansville switched from United Healthcare to Strongside Solutions in 2018 and saw a savings of more than $150,000 their first year, with only 40 employees. Now they save almost $400,000 per year, according to Bodker.

The broker also recommended moving from the First Health Network as the city’s preferred provider organization (PPO) to Aetna.

“It’s our opinion that you’re going to save about $1 million just by moving networks from First Health to Aetna,” Strickland said.

Only one doctor that the city currently uses isn’t in the Aetna network, according to Strickland. Wellstar is also in the Aetna network, so the hospital is covered.

Everything that employees currently do to interact with their doctors should remain the same. Copays will remain the same for doctor visits and prescription medications. If an employee’s medication is identified as eligible through Angel Rx, they can choose to have a 90-day supply delivered to their door with zero copay, otherwise current copays apply.

Employees should have more choices for their doctors as Aetna’s network is larger, but at least one physician that the employees currently use is not part of the system.