Minutes - Duval DOGE Special Committee

Chair Salem convened the meeting and called for introductions.

II. Public Comment

No public comment cards were submitted.

III. Update on P Card

Call to Order and Introductions

Chair Salem asked whether there were any questions from the Committee regarding the P-Card

presentation from the previous meeting. There were no questions from the Committee.

IV.

Adoption of Telehealth Report – Mary Staffopoulos

Mary Staffopoulos, OGC, provided an overview of the changes made to the report from the

previous meeting. Ms. Staffopoulos stated that most of the changes were non-substantive.

However, she directed the members to review page 17 of the updated report to confirm that all

requested changes to the Recommendations section had been fully captured. Ms. Staffopoulos

stated that the most substantive change was the deletion of the second recommendation, which

had directed OGC and the Ethics Office to review the dual employment of Dr. Bradley Elias. She

stated that the recommendation was no longer needed because an analysis had previously been

completed and, following discussion with CM Diamond, the recommendation had been

determined to be unnecessary.

Chair Salem stated that he had asked Mr. Phillip Peterson, Council Auditor, to conduct a cost

savings analysis regarding telehealth and asked Mr. Peterson whether he was still working on the

analysis. Mr. Peterson confirmed that they were still working on the analysis and that they had

reached out to the Administration and Telescope Health to ask about numbers the entities had

provided to them. He stated that he hoped to have the analysis ready for the next meeting. Chair

Salem asked whether Mr. Peterson needed anything from the Committee to facilitate the process.

Mr. Peterson stated that he did not and that the entities had been cooperative.

CM Diamond moved to approve the updated telehealth report as a final report, which was

seconded. Ms. Staffopoulos asked Chair Salem whether the Committee would like her to change

the subject line of the memorandum to replace "Telescope Health" with "Telehealth." Chair

Salem affirmed the change. The Special Committee approved CM Diamond's motion without

objection.

Update on the 2% Lapse – Council Auditor’s Office

Mr. Peterson informed the Committee that the Council Auditor's Office had not received any

requests from departments to restore funding. Mr. Peterson reminded the Committee that, when

Ms. Taylor had presented the Quarterly Summary at the last Finance Committee meeting, she

had reported that some departments were projected to go over budget because of the 2% Lapse,

but that none had submitted requests to date.

Chair Salem stated that he hoped the Administration would use its transfer authority to cover the

projected budget overruns in those departments. He stated that he believed this mechanism could

be used for future budgets, especially in light of potential changes to homestead exemptions.

Chair Salem confirmed with Mr. Peterson that they were projected to save $4 million. Mr.

Peterson stated that he believed the figure was accurate.

VI.

The Bailey Group will review medical plan performance through three lenses:

(a) Population Demographics: Key workforce characteristics and cost drivers

(b) Benchmarking: Comparison of plan costs, contributions, and design against

other public sector clients

recommendations

Mark Bailey, CEO of the Bailey Group, introduced Sherry Bugnet, Bailey Group. Ms. Bugnet

began the presentation by providing a demographic breakdown of the employee population.

Chair Salem asked Ms. Bugnet how much retirees paid in premiums. Ms. Bugnet stated that she

believed retirees paid the fully insured equivalent rate and that those rates had not been updated

for many years.

Ms. Bugnet gave an overview of the plans used by City employees, highlighting that the majority

of employees are on the HMO plan. Ms. Bugnet highlighted that the population enrolled in the

high-deductible BlueCare 128/129 HMO plan is small. She recommended that the City

differentiate premiums to encourage greater enrollment in that plan because those plans lead to

its enrollees making better health care decisions.

Chair Salem asked whether the BlueCare 128/129 HMO plan was one that had recently been

added. Mr. Brian Parks, Council Auditor's Office, stated that the City had offered various

high-deductible plans but that he was not sure when the BlueCare 128/129 HMO plan had first

been offered. Mr. Bailey agreed with Ms. Bugnet that the best way to contain costs in the long

term was to encourage as many people as possible to join the high-deductible plan.

Ms. Bugnet then gave an overview of the plans used by City employees broken down by

generation. Next, Ms. Bugnet gave an overview of the Plan Design and Costs of the HMO, HDHP,

and PPO plans. In the HMO plan category, Ms. Bugnet highlighted that nearly 2,000 employees

are enrolled in the BlueCare 48 plan while 143 employees are enrolled in the BlueCare 65 plan.

Ms. Bugnet further highlighted that, while the City's plan designs were comparable to the

comparison set, contribution strategies were lower across all tiers except the family rate, and

recommended adjusting those rates to align them more closely with the comparison set.

Chair Salem asked Ms. Bugnet whether the data used for the comparison set came from Florida.

Ms. Bugnet stated that the data was nationwide, that the HMO comparison set consisted of public

administration groups, and that the data was drawn from NFP clients.

In the HDHP category, Ms. Bugnet highlighted that, to encourage employees to join the HDHP,

there needs to be sufficient differential between the premium and contributions into an HSA.

Chair Salem stated that, in his experience in the private sector, a high-deductible plan had been

the only plan offered. Chair Salem asked CM Lahnen for his personal experience in the private

sector. CM Lahnen stated that he had worked for two large companies, one of which had used an

HDHP, and that a benefit of HDHPs is that they possess triple tax advantages.

CM Lahnen asked Ms. Bugnet whether the $2,000 employer HSA contribution for HDHP

enrollees was representative of what they saw in similar-sized plans. Ms. Bugnet stated that it

depends on the deductible and that the City's plan for single coverage has a $2,000 deductible.

Ms. Bugnet further noted that, in her experience, premium is one of the biggest drivers, and if

there is not a sufficient difference between the plans offered, employees will not move. She added

that the amount going into HSA accounts is also important.

Chair Salem asked, if premiums were the biggest drivers, why the UF healthcare plan population

was not growing despite the plan being free to employees. Ms. Bugnet stated that the reason could

be the limited network of the UF Health plan. CM Lahnen emphasized the need for the City to

market the benefits of the HDHP and HSA. Chair Salem confirmed that the enrollment period is

in September. Ms. Bugnet highlighted that the employee-only cost was $30 for the HDHP, which

is the same cost as the HMO. She stated that an employee does not have an incentive to move to

the HDHP, besides the annual HSA contribution. Ms. Bugnet then presented the PPO Plan

Design and Costs and stated that she would like to see more differentiation between BlueOptions

5782 and BlueOptions 3768.

Mr. Bailey gave an overview of the current premium equivalent rates and the renewal claims

development. Chair Salem confirmed with Mr. Bailey that the City is paying 87% of the cost of

premiums while employees pay 13%, compared to a benchmark average of approximately 80-20.

Mr. Bailey stated that he would get back to Chair Salem on the specific numbers. Mr. Parks

clarified that the City had not changed the rate since transitioning to a self-insured plan on

approximately January 1, 2015, because the City had accumulated a large reserve from saving

money, but that reserve had slowly dwindled. Chair Salem stated that the City had also used

COVID funds to support employee health insurance costs. Mr. Parks confirmed and clarified that

the City had moved claims expenses to COVID funds for claims related to workers'

compensation.

Ms. Bugnet gave an overview of the upcoming project timeline and stated that the Bailey Group

would return on June 16 to present contribution strategies, recommendations, and stop loss

estimates. CM Lahnen asked Ms. Bugnet whether it was normal for only 6% of employees to be

enrolled in the Employee + Family tier and for 70% of employees to have been employed with the

City for less than two years. Ms. Bugnet stated that it was unusual for 70% of employees to have

been employed with the City for less than two years, especially for a government entity. She also

stated that the enrollment numbers in the Employee + Family tier were due to the City's

contribution strategy and that other entities with premiums similar to the City's offered more

Employee + Family coverage options. Mr. Bailey added that another reason for the low

enrollment rate in the Employee + Family tier was that more households are now two-income

households due to inflationary pressures.

CM Lahnen asked Chair Salem what the next steps would be after the Bailey Group gave its

recommendations. Chair Salem stated that it would be up to the Administration to implement the

recommendations but that the budget process would allow the Committee to have discussions

with the Administration regarding the recommendations. CM Lahnen stated that he hoped the

Committee would convince the Administration to embrace the recommendations, especially since

the City would likely experience pressures on the General Fund in the future.

VII. Comments from Committee

Chair Salem asked Ms. Staffopoulos for an update regarding the OGC's research into three

entities that were under the City's benefits program but were not City employees. Ms.

Staffopoulos stated that she had spoken with Mr. Sean Granat, OGC, and that he had referred