02/10/26 - Flagler School Board Agenda Workshop

001Call to order the Tuesday, February 10th, 3 M schoolboard workshop. Please rise for a moment of silence and the pledge of allegiance followed by our national anthem. I pledge algiance to the flag of the United States of America and to the republic for which it stands. One nation under God, indivisible, with liberty and justice for all. Heat. Heat. Start with roll call. >> Lauren Ramirez present. Jatie Ruddy present. >> Lil Furry present. >> Christy Chong. >> Lashaka Moore. >> Okay. Do we have any additions or changes to the agenda? We do. Um today is a jam-packed um agenda. Uh we want to be able to start with item 12.02 to be first and then um follow the order of the printed agenda with item 10.02 being last. And then one additional adjustment is that when

002we get to item 18 um01 that we do 8.01 and 1801 at the same time. So 12.02 first. We will follow the order of the printed agenda moving the insurance update to be last since we want that to be the majority of our time together here. And then um item 18.01 01 will be moved up to after 8.01. >> 18.01 will be after 8.01. >> Yes, please. We have asked our team to be very precise and point so that we can use the majority of this time to um have a a discussion around insurance. >> I get a motion to approve the agenda. >> Approval. >> Second. >> Motion by Mr. Second by ready. >> All in favor? >> I. >> All opposed. >> Motion carries. >> All right. 6.01. Anybody for public comment? >>

003No, we don't have any public comments. >> 12.02. >> Okay. So, we move on to 12.02. Mr. Freeman and Welcome. >> Good afternoon, chair, board, Superintendent Moore. Um, this afternoon we have a local mitigation strategy resolution to bring forward to you. This, uh, is a multi-year jurisdictional jurisdictional plan that allows local partners in the county to maintain eligibility for grant funding such as the uh, hazardous mitigation grant that we have used in the past. um to remain eligible uh for these grant programs, we have to submit this every five years, I believe, Jonathan, and this is our fifth year that we'll submit it. And this will be the last one from me that I'll submit. So, pending your questions or comments. Uh >> all right, let me just wrap my head around this. You're saying

004this is something that has been ongoing and uh we had if I'm remembering correctly updated some of our um agreement documentation through Levvenia. So is this on the has this been modified to that or is this because it's a legacy will be on the previous uh contract or am I out of the ballpark? It's not the same thing. I think she's m um mixing like proportion this year some of the adjustments that we've made with that. >> Okay. Yes. >> Yes. So when she's with the resolution made her >> Yeah. This is totally different than our hazardous uh mitigation plans that we have that follow our local mitigation or our um our ILA. >> Uhu. >> And this is dealing with grant funding through FEMA. >> Okay. >> Yeah. So these are these are funds

005that after a big disaster like such as a hurricane or even COVID, the federal government allocates back to to the county, >> okay, >> a percentage of the funds of that disaster to help make that community stronger again. So if you have a another similar disaster, hopefully it won't be as impactful. Um, in order to be eligible those funds, the local community has to have a local mitigation strategy. It's, as you all saw, it's quite a thick documents approaching 200 pages and then some of material, but every five years the county re updates that and then every other jurisdiction that wishes to be eligible to participate in that grant program has to also adopt the the plan that the county adopts. >> Okay, I see. Thank you. >> We've used these funds in the past

006for um generator repairs at Grimfire, uh Benell, some finations on some windows. Um we have partnered with as well. put some stuff in the windows. >> Uh, Wadssworth, so you know, we want to be able to keep doing this and getting grant fund. >> Absolutely. So basically from what I gathered from it, this allows us for if we need to use FEMA. So that's what this is basically. >> Yeah. If you want to take advantage of a specific grant program, so if there's a disaster, you incur costs from the disaster. You don't have to do this. But if you want to go after this grant program that helps make the infrastructure stronger and hopefully not as impacted in a future disaster, then you do we do have to have this particular document. >> It's helping

007us I guess prepare our buildings so that they are willing. >> Yes. >> To cover us and just being proactive. So with renewing the majority of the grants under this have a 7525 match, but certain larger events like COVID only had a 9010 match. Every now and then there's no match, but that's super rare in today's world that the federal government doesn't require a match. >> Thank you. >> Any other questions? >> Thank you so much. >> Thank you, gentlemen. >> Thank you for being here. >> Thank you. >> Finance >> 7.01 01 finance >> starting with imagine charter school financials. >> Good afternoon chair board members and superintendent Moore. Mrs. Bush and I are here to answer any questions you have on finance consent items. any of them or just >> starting with 7.01.

008>> Thank you. >> It's okay. We'll move on to 7.02 purchase orders over 10,000. Um yes, I see that we're paying um a good chunk of money to Stepping Stones. Obviously, I looked them up um in order to determine uh what services they might provide. And it looks like therefore some um additional ESC services. So what specifically does this organ organization do that we don't have in house? And do we have an idea of the total amount of funds we're using for that particular area? Um >> sure that would be a question for Dr. Halliday. Um Miss Dr. Thank you. Sure. >> Good. Good afternoon board. This is primarily to pay for uh school psychologists. Um and we do have some you'll notice some of the services are provided to our private schools as well.

009Well, okay. So, that is my question here. Um first, I believe the amount was over 200,000 for stepping stones. Is that the right amount? I'm sorry I didn't write that down. Um and previously we had discussed that we're not yet at the expense that it would make it feasible to pay somebody. So, how many um people units does that $200,000 buy us? For example, is that the work of 3.4 school psychologists? And so, uh you know, if we actually took that to hire a school psychologist, we'd only be able to get one and a half for that. Can you explain to me how that's still a cost benefit? >> So, we previously had um school psychologists, well, we still have the allocation if we were to be able to fill it. we were having a

010recruiting um issue when when we lost some school psychologists. Um I believe there were eight allocations. I don't have that in front of me. Not sure if um >> so when was the last time we've tried to recruit or fill those? >> It has been posted continuously and so we've had to fill it through contracted services. >> Okay. And when we post it, are is this something that we're actively trying to recruit um you know with our job fairs in addition to the teachers or going to specific events that's around these >> folks of these services? >> Yeah, we've actually um we've posted on several different platforms and we've gone to um NASUP and FASIP which is the Florida Association. We've we've even you know paid to advertise on those platforms as well. that particular

011position falls in our uh bargaining unit and as you can imagine has a lot of education and credentiing required for it and so oftentimes the pay just isn't quite as competitive. >> Can I So I remember learning about that and we talked um like last year. So what was the reason that they are in the bargaining unit because I know we took nursing out of the bargaining unit. So I feel like I've been told two different ways because that was one thing from the very beginning because they you know the salary matrix but you have to go through bargaining. So can you let me >> they're they're certified instructional staff. So they they would need to be um you know certified staff to be in in the bargaining unit. And what we've done is added

012um differentiated pay or or like a stipend uh within the the contract to try to uh make that a little bit more competitive in terms of of wages. But oftent times um you know psychologists can work at a higher hourly rate for a contracted company and also have a much more flexible uh schedule, work from home and so um it's a tough position to fill. We are we are not alone. We've reached out to our NEAC districts. Um, we're, you know, it's it's a it's a similar challenge that Florida >> and I know that could be a different like a different day and a different topic, but they're considered instructional staff, but is I just don't see but that could be >> they don't have to have a teaching cert certificate. >> They are in

013our bargaining unit and um what we can do is um we will have Mr. let write to you the steps that would need to be taken in order for us to consider bringing those individuals out of the bargaining unit. >> Yeah. Do we have an idea of um how many service hours we're getting for that $230,000? >> We could we could find that out. I don't have it. I don't >> I'm just trying to get an idea of like how many students are we serving with that money? If that's comparable, if we were to have full-time people, that's one thing, right? purchase order. So, >> I'm also looking for an aggregate because, you know, I'm seeing this we outsource with a lot of companies. Um, there's also counseling uh services that we've had ABA credential

014people. We just posted another one of those. The other element you said there is that we also service private school uh with this. And so, do the private schools in the area um also contribute to the cost of this? So they are re it's through the proportionate share funds that are um allocated to private schools and we're required um under child fine to evaluate >> to evaluate >> I'm sorry >> to provide evaluations for them. Yeah. >> Thank you. >> You're welcome. >> Any others on purchase orders? Um uh I just wanted to um clarify the nephew risk management insurance of over $2 million. This is for workman's comp and property insurance. So um we pull together with the NEC districts in order to have better competitive pricing for property insurance and workman's comp. >>

015That is correct. >> Okay. But we do not currently do that for health insurance. >> We are selfinsured, >> right? But you can still >> We do not currently do that >> for risk on selfinsured. Correct. Okay. >> Um see here. I also wanted to and I'm sorry I didn't write down which ones are on which the DOE um spending that of cap dollars that we sent back. >> Sure. That was uh 38,000 of the cap grant that um is overseen by teaching and learning. I'll have Mr. Reeves come up and speak to that. >> Thank you. >> Good afternoon board superintendent. M sent you a response earlier today with your request of information. Um I'll share with the board as well now. So the the CAP grant which is the workforce uh capitalization grant

016was a two-year grant from 2023 to 2025. And during that time we uh an initial request of approximately $273,000 and then that was extended and uh amended to include another uh approximately $300,000 over and above the initial request. And so um during that we spent approximately 73% of the initial request uh just over $216,000. and that purchased things like uh a a a truck, a Ford F250 for the agriculture, uh trailers, uh related materials and resources for agriculture and our carpentry classes as well as our veterinary class and uh very specific and targeted uh when the grant was written. So, it was only targeting those two industries that are also vital to our local economy. And so those funds could only be dispersed into those two areas included veterinarians because of a uh and we

017were granted that opportunity to do that. So there was an initial uh dispersement about 74,000 and then another one that followed about 188 uh about 6 months later and then lastly we received the last installment of the increased amount after that. And so uh we were dispersed our dollars as best we could. uh we could not spend all the dollars that we wanted to in that space partly because we had a transition uh in our department of our CTE specialist who left us to go to Siml County and change them all in finance uh that impacted us as well. And so we spent about $100,000 on our carpentry classes and the balance with our A including uh fencing to upgrade the farm and things like that. So just to clarify, you're saying that the industries

018that had to be focused on this grant because all grants you have to write what you're going to use that money for, how you're going to expend it has to be very restrictive. So you're saying agriculture and >> carpentry. >> Yes, ma'am. >> And so we spent uh you said 73% of the initial distribution. >> So about $216,000. >> So but alto together then we spent about 50% of it. about that. Correct. >> So, >> a little less than that because about 300,000 was returned. >> Okay. So, I'm I'm really at a and I I don't want to um I don't want you to think that this is directed towards you. >> Um it's just this is frustrating to me, right? Because um the number one thing we hear is that we need more um

019classroom to careers programs. We're out there asking for this money. We're working with um uh you know poor FTC. They're dying for money like this. We're asking for it with the rural renaissance and this doesn't bode well if we've asked for money in the past and couldn't spend it. So, um, how can we avoid this in the future? Because I can't, you know, there there could there's a thousand careers that we could think of under agriculture and that we didn't maybe uh incubate something or do an AB test on what might be interesting for our students. I'd like to know how to we can't do anything about it now, but what can we do to avoid this in the future? >> Certainly. And and just to be clear, FTC received funds as well and it's

020through this grant opportunity and they had their funds as well. This isn't this is separate from FTC. >> Yes. >> Um and so um when our CT specialist focused it was to try and focus on these two programs. One because agriculture needed to be upgraded and I worked with uh Mr. Freeman on just our facilities and space up there. So we purchased quite a bit of materials to upgrade the fencing and secure that as well as tractor supplies and equipment for them. I think lessons learned is uh a couple things uh better earlier vetting on our our vendors and the procedures for that. When uh we initially went to finance uh we thought we were in a a good space and then after that got some clarification with this whipworm meeting with our vendor to

021kind of walk through that decision-m process and we thought where we could have piggybacked on on a procedure which we normally do with contracts that wasn't allowable in this situation. And so we didn't find out till later in the game about February we started to pivot from that and then we're told about Amazon which is one of our primary providers and it took a couple weeks on that. So there were some timing issues that took place, but we purchased significantly through Amazon because a provider to help us in that space. But I think also when we're looking at our programs, uh what I'm working with our current CTE specialists now is what instead of just asking for dollars specifically, what's going to be the impact of that for us moving forward and making sure we're

022being targeted and intentional about as opposed to just asking for more money. That makes sense. And I think when by doing that and looking at how we're applying those CAP grants to workforce grants because that is still an ongoing grant option for us. We did not apply this year because we had this situation that just occurred to us with a new CT specialist. And I asked him, Mr. Evans to familiarize himself with our programs across our district and then him and I plan to meet to talk about next steps as far as how to target specifically as opposed to making large purchase of just supplies. >> Right. But you know in a grant you you outline those goals for what the funding is for. Um so I'm assuming with this grant you could not use

023it for salaries or things of that nature in order to um maybe bring in some subject matter experts in this area. It was not to my knowledge that based on that. It was about how to increase your programs or to create programs in specific fields. >> And did we um work with any con like consultants in this area? Maybe our workforce development program or >> Well, we targeted programs that were specifically aligned with our local economy, which is agriculture and construction. And then we went and hired a a uh grant manager to assist in the space only to learn after working with um Miss Whitmore and Miss Wormkick that uh the the process that they were following to piggyback in other districts wasn't applicable to our district and how our procedures are in place and

024therefore was not an option to us to to expend those dollars in that in that manner that we've outlined. >> Okay. So, sounds like we've got some action items to work towards when we apply for another grant. I'm disappointed to hear we did not apply this year and didn't have a solid plan with this. This is an area where our community is eager to have us grow in. Our students are eager to have us grow in. Um so, uh let me know if I can be of any service to help. >> Sure. Um if I can clarify, the grant was required to be submitted last May, right? And so, the our person just came on board in March. So for him to be able to have six weeks to fully vet and especially the RCT

025program, >> I guess my thought is we should be an octopus organization, right? Not top down, but flexibility where we have arms where people work together to get the job done and we have a robust uh staff in the teaching and learning department. I bet you if I pulled 10 teachers from our schools, they'd be able to write a grant that would probably be pretty amazing with that money. So, you know, that's I think sometimes we have to find some alternatives, right? >> Certainly. >> Thank you. I appreciate your your answers. >> Okay. Let's move on to 7.03 vendor payments. >> That was anything else on vendor payments. Let's try to stick to the agenda here. >> Uh the only thing um Thank you staff for all the answers to my emails. Um the only

026thing I just needed clarification. the memorial hospital visits uh or whatever it is that you can um I just normally don't see a lot of those on there. So, I wasn't quite sure if that was something specific to anything. >> Sure. Um the payments for um that's advent basically. Um that was for athletic training services. What had occurred is that they failed to bill us last year. So, we had to catch up on last year payments once they realized that they didn't bill us and then catch up on the first half of this year. So, that's why you see so many of those payments, >> okay, >> in this in that December pay run. So, that was an error that they brought to uh Superintendent Moore's attention and my attention as well and sent us

027the documents and we >> Yeah, cuz I never see that. So, I was like, "Oh, um >> it's normally paid quarterly." Okay. >> So, you won't see it again and maybe two more times this year. >> Okay. And then um Continental Airlines is that I didn't get a answer on that one. Um >> Continental American >> or >> not airlines, right? >> Was it airlines or Sorry, I'm looking at my notes. Um >> Continental. >> It's Continental American. >> That might be it. Yes. >> Similar to another question a board member asked. that is um a company that provides benefits to our employees. That's most likely life insurance. Um and so what happens is our employees elect who they want to get this supplemental benefit from and the payments are deducted from their paycheck twice

028a month and the wires are sent out twice a month to several different vendors. Okay. >> Thank you very much. Okay. 7.04 deletion of inventory 7.05 Finance Budget Amendments 7.06 06 district financial statements and 7.07 I will talk to this one briefly. This is the uh annual audit of the district's internal accounts which is the internal accounts of schools and departments. This is the audit ending June 30th uh 2025. I will note um as you look through this report, there are um some findings in there. To that note, if you look at how many items were sampled versus how many exceptions there were, it is an improvement from last year. That being said, there has been a lot of turnover in bookkeepers. So, a lot of these bookkeepers um are not currently in these schools

029and departments. Um, and this report once approved by the board will go back out to all of the principles and supervisors um for their review. They have already been notified during the audit process of these findings and signed off on applicable um data. Uh, with regard to that, last year we talked about um potentially looking at some positions where um through attrition we could do some sharing programs, bookkeeping possibly being one of them. Um and so um is there a particular reason we're finding that that role is not conducive to sharing between some schools for costsaving measures? So that's question number one. Question number two, we're saying that some of the turnover is what's maybe triggered some of these um items which you know anybody new in their job is going to have things especially

030something as very exacting as this accounting. What kind of onboarding and training is provided for our new bookkeepers? >> Sure. Let's go back to your first question. Can you >> What do you mean about um sharing, you know? >> Uh so it was last year we had at some school board meeting, I was requesting that we take a look at um some positions that perhaps could be shared between schools. for example, a bookkeep bookkeeper being one of them where they service part-time between two schools to save some funds, but it sounds like, you know, there were new hires and so that's not one of those rules that seemed like that's a potential candidate. >> I I will talk to this to the extent that I can and then I'll hand it over to the superintendent.

031The bookkeeper position at schools does more than just bookkeeper. They're used to fill in with the front desk, car rider lines, things like lunch duty. um that's not something that finance would oversee. I can tell you that the biggest complaint we have had from bookkeepers is they don't have enough time during the day to do their job. So that's not something that finance would oversee. That is more of a school-based um admin that would control what their duties are. I I would tell you if if we asked a bookkeeper to share between schools, it probably would not go over very well. just knowing how much they are demanded of. Um in the elementary and middle schools there's one bookkeeper per school and they are required to do both the district budget and the internal accounts

032whereas the high schools have two bookkeepers for internal one internal and then one district so and rightfully so based on the volume but the work is is the same across the board. So that's the extent I can answer that. Do you have anything to share additional? Well, I would just um I what I would add is that uh we have identified um positions and areas that we can save costs on as an organization and um as appropriate we've implemented those cost sharing um >> measures and as we go into the next bud budget cycle we'll also do that same again to ensure that we're able to have a balanced budget as well as be able to save dollars um so that we can make sure that we're in the healthiest place fiscally and we do

033that every single year and and and we've been successful at doing that. So sometimes the cost sharing is not necessary or the cost savings isn't around um sharing a position but maybe through attrition positions that we're hold back on um and those those things in order to ensure that we can keep our our budget balanced and that we can save dollars um to ensure that we're in the best place fiscally. As to your second question, um, Mrs. RDY, the um, the comments, like I said, the audit comments are better, but just for clarification, >> these audit comments were under bookkeepers that are no longer there now. It's not the new bookkeepers. And whether understood, thank you. >> Yeah. And so I'm not sure if if you're aware, but um, going to the training piece, um,

034our finance department saw 100% turnover this year and we lost pretty much all of our staff and had to rebuild. Unfortunately, fortunately for me, but unfortunately for the schools, several of our new employees came from the school's bookkeeper positions. So, we had ongoing training for three or four of these positions of the people who used to do the job that were now in finance, single-handedly training them for two to three days a week for several weeks, a few months. We also have um a higher level staff person who used to be the bookkeeper at Wsworth who is now um she oversees the bookkeepers and the internal accounts. So anytime we have someone new, she singlehandly goes out there and trains. Anytime there's an issue, she handles it. If there's anything she can't figure out, she

035comes to Mrs. Bush and myself. So the training aspect of it actually has really improved based on the knowledge from the school level that we now have in finance. >> Great. Thank you. Any other questions on finance? >> We'll move on to I believe it's 18.01. Thank you, >> Mr. Owlette and Mr. So, we're at this time we're doing 8.01 and we will do 18.01 during this time as well. Um 8.01 Good afternoon, Chair Tom, Vice Chair Furry, members of the board, and Superintendent Moore. Um, firstly, I'd like to introduce myself. I'm Peter Drole, new coordinator of purchasing. Um, just because I'm a new face to the board. Um, I come before you today to ask the board to approve the evaluation committee's recommendation to award request for proposals number 26-01 for telecommunication service voice

036and internet and contract contract with United Data Technologies Incorporated. The evaluation committee was held on February 9th, 2026 at 1 p.m. The committee cited the following reasons for their recommendation. a robust and resilient network design, great point of presence demarcation architecture and geographical diversity, good approach and detailed support team, a clear routing plan and a highly comprehensive solution with a solid understanding of the project scope and needs. Uh these services will be funded in part through the federal program. The federal program provides heavily discounted telecommunication services to nonprofit private schools, public schools, and libraries. The -ate program is part of the telecommunications act of 1996. Uh the -ate program provides discounts of 20 to 90% depending on economic need and location. The level of discount calculated using is calculated using the percentage of students eligible

037uh for participation in the national school lunch program and geographical location. Uh Flaggler's 25 2025 202 26 calculated discount is 80%. Um the current telecommunication service provider is ENA Services LLC and the current agreement expires June 30th, 2026. The agreement was established by RFP22-10P. The district currently pays $670 per month for a 10 gigabyte access circuit with ENA Services LLC. Uh the total contract value for this is $120,600 minus the 80% e-ate discount leading to a charge for $24,150 for the district. Under the proposed contract from United Data Technologies, the district will pay $1,520 per month for two 5 gigabyte access internet access circuits with basic firewall service included. The total contract is $273,000. $273,600 minus the 80% -ate discount bringing the contract value to $54,720. We currently contract basic firewall services with ENA services

038LLC as well, but separately from Telecommunication Services. We pay $2,000 per month for the basic firewall services by itself as that agreement did not use -ate funds. Uh this item will come before you on the for approval on the February 24th agenda. Do you have any questions? >> So these were we did request for proposals on for these services. Yes, we do. And they were the lowest bidder. Is that how we selected them? >> They were not the lowest bidder. Um there we received four submissions. uh they were not the lowest bidder but they did choose to go with this because it fit the scope of work the best. We had altered the scope of work from our last contract which is why the pricing is different. Um we wanted a more resilient network design

039uh with two points. Uh so if one point had gone down there was another point of internet access that we could route through. Um and also we included the firewall uh services in this which brought the price up. This was not the lowest bidder. Um the lowest bidder was a Metro Fiberet LLC. Um but they had certain reservations. The evaluation committee had certain reservations um with the technical specs of their firewall and certain aspects of their proposal. >> Okay. And the previously what we were were we using for the firewall technology? >> Um that was contracted uh through ENA as well. >> Okay. But at that time it was not um set up uh and included in the -ate eligibility um platform. So um we have worked with our um consult -ate consultant that we

040utilized to kind of redefine what our scope of work was. So uh basic firewall service is an allowable service at this time. So in changing those scopes, those those costs now are eligible uh with this new scope for -ate discount. >> So now they're they're included and now you're you're going to see that the dollar uh the the value of the 80% uh of that roughly $2,000 now is is coming through federal dollars rather than local dollars. >> Got it. Okay. Thanks for the clarification. U so just from my understanding you're saying that the original internet provider also provided our uh firewall >> correct >> and so now we're separating our internet from that original uh provider but we're keeping them for our firewall >> that is not clear >> okay so who who's the

041firewall >> both both services because they're required to come from the same >> same businesses okay correct that was my I was like that doesn't seem that way >> for for eligibility really it's required to be from the same vendor and build mark >> I'm sure did you guys take a look at things like outages you know what's their up do they slow when you you hit a certain data point >> all all of those points are addressed in the RFP but I will tell you um you know from from hearing everyone else's comment and mine personally the the piece that you come back to is the resiliency piece um when you look at the opportunity that this proposal um allowed us to look at essentially what we're doing is placing a 5 gig internet

042pipe at Matanis that then goes to Atlanta and we have a 5 gig internet pipe that's at the government services building that goes to Miami. So there's seven. >> So and then we're able to use our back hall which is Pongo's Fibernet. Uh and then the collocation facilities that are there. So we could lose one site could go down the Kansas could go down and all of the sites then could be pushed out uh for access from the government service building and vice versa or >> and it's not unheard of. Right. the last two years we've had some major outages on the east coast and I would imagine that a lot of our safety measures um and hardening of our schools um rely on some of the internet >> absolutely and and more and more

043that's the direction everything's going I mean uh we don't have a bunch of servers sitting you know in our data centers any longer but we also then rely on a lot of cloud services so this is really kind of the the next step uh to put some additional resiliency in into those systems because on the same note um you know all of those systems um you know back hall and and some other pieces are included in this um but ultimately it gives us a a more resilient network to allow some of those outages. So uh there's um last year when we had some issues I think it was back in November there was a major outage uh in Orlando area. Well, our the current provider um ENA, our Demar location to the POP is actually

044Tampa. So that fiber goes all the way through Orlando to Tampa. >> Um so when there's major disruptions in those that that can happen on the same note, essentially the the north circuit will essentially go through Jacksonville up into Atlanta. So you know there's always those vulnerabilities when we're talking about fiber optic and and underground. you know, the the random somebody ran into a telephone pole and you know who we dealt with with the power or whatever in Benell the other day that that can affect uh fiber as well. So having one one point of uh uh something to kind of watch to um and we've continued to look at this I think with the inclusion of the basic firewall uh in this proposal a the the um the configuration that was offered by um

045UDT is is just uh very very robust >> right >> will give us some opportunities to ensure that we have access even if we do have an outage. Yeah. >> And we're leveraging the um the uh redundant capability that is built into the fiberet network as well. >> So when with the back haul when things are working well do those those resources share cross with that is that the reason for that to connect those two pipes where there's a higher demand on one side they could pull the bandwidth from the other. >> We can do some of that internally. Yes. Um but basically the the the default configuration for that portion of the network is our schools on the north side go to the north collocation facility and our schools on the south side go

046to the south uh collocation facility. And so we're essentially routing those on the shortest path. So the shortest path for let's say uh Belter and Indian Trails is Matanzis High School. Let's say Old Kings and Benell Elementary School would be to GSP. >> Okay. And it's five gigs each >> each side. Yes. So essentially we're still maintaining 10 gig total connectivity. Uh example would be if one of those happened to be cut um or offline uh we would reroute the traffic and then we would put QoS standards in place. So we would limit bandwidth on certain types of of um of network traffic for the time being. So example would be like streaming and those kinds of things to ensure that there's enough bandwidth for for phones communications. our LMS system, safety, security, uh, cameras,

047etc. >> Gotcha. >> And when transition occurs for the new vendor, is it pretty seamless when when it is like going forward and ready to go, like transitioning between one to the other? >> I mean, there's there's always a concern there's going to be some construction to work through with with this. I mean, there's there just is. Um but um UDT has been very successful with the implementation. Uh the other option or the other opportunity that we plan to take advantage of is there's um some contingencies within the -ate program to allow us to utilize the existing contractor for roughly 3 months possibly. So that is kind of a backup plan so that we would still have the opportunity to have internet access um if there happens to be some sort of issue andor delay.

048>> Thank you. >> All right. Okay. All right. Now I believe we're moving up to 18.01. >> Thank you. So before um uh Peter starts, I I want to add that this um item is a part of our normal timeline for um requesting an RFP, which is separate from any of the conversations that we're going to have today around insurance. And so we just wanted to make sure that everyone in the community understood why it's all separated. Okay. Okay. Um, I come before you today to seek board approval to advertise uh an upcoming request for proposals seeking healthcare consulting services. Uh, the last request for proposals for these services was coded RFP number 20-05. It was awarded to Brown and Brown Florida Incorporated. This agreement with Brown and Brown has no available renewal options left.

049This prompted the decision to seek a new RFP to find these services at the best value to the district and to ensure compliance with applicable procurement regulations. Um, this item will come before you for approval on the February 24th agenda. Do you have any questions? If uh what I'm concerned about is that the scope of work on the RFP may modify or change if uh we bring in this interim forward a vote and if that vote passes to um contract with fleet and so um talk to me about our ability to modify the scope of work after the fact if it needs to happen. And I and I guess my my only interjection with that is I don't know if it would be a modification of this existing RFP as much as it would be

050standing up a a separate RFP aligned with um the the initial agreement that would be signed with uh uh fleet to you know look into signing a contract at that point we would get with them because they would have the specs on that one. So in other words, um this this RFP and I'll let him speak to the details could at some point become null and void should you decide to move in another direction. We just would not um u stand up the committee to select the final >> or we could modify because in some of my consultation with fleet there could be some services that we want to still contract with uh another party but under maybe u the terms that are required under the trust uh uh that >> the only difference with

051that is is those folks for example if we move forward with this process and and we had vendors go with the existing scope. Um they may want to drop out. >> Yeah. And >> we we could just not award um resubmit our RFP. >> Where we are right now is Brown and Brown is is monthtomonth with us. They have agreed to go monthtomonth with us, but we also don't want to just um um continue to linger on that. So we do have fleet going forward. We do have an RFP going forward. we we are able to adjust our scope in the event that the board goes in the direction of Fleet. But remembering that with Fleet um the >> um you know we're we're going into an engagement with them. We have to be accepted

052into different portions of fleet as we go. So it starts off with the PBM and then it moves forward as they evaluate us as well. And so that would definitely affect this because maybe in year one we'd say we need this menu of services in year two it would drop to this menu of services year three. That kind of thing. >> Exactly. And the only concern is if if we don't start moving forward and no matter where we end up um there are serious ramifications for open enrollment and um you know uh uh how we start off the next year with whichever direction we go. >> Yeah. If I may, we are able to withdraw the RFP and modify the scope if the scope drastically changes or if it is minor tweaks, we are able

053to issue agenda uh on the current RFP which would affect the timeline slightly, but the RFP would still be out and we can modify certain details. >> Okay, thank you. >> No problem. >> Any other questions? >> Thank you, Mr. Owlette. >> Thank you very much for that. >> Thank you very much. >> Appreciate it. >> Thank you. Come on for 10.01 Mrs. Swagerty. >> Good afternoon madam chair board superintendent a bit more. um here today to introduce a memorandum of of understanding with career source career source breard flaggler and this would prevent it would permit um career source to provide workforce development career readiness job placement and related services to students enrolled at Flaggler Technical College and uh further the district's education mission and service um through the school district. And so they are

054closing their office location here in Palm Coast, which is located uh currently across from FPC High School. And this would allow them office space to continue to serve our students and um cooperative manner. And so we believe that the things that they have committed to provide to Flaggler County Schools and Flaggler Technical College ex um the provision of career assessment, workforce readiness, job placement, employer engagement, and supportive services constitutes adequate uh consideration for the district's in kind provision of this space. The specific location of the space would be at the Carver Center in one of the classroom spaces on the upper second story. >> So, we're letting them use this space without charging them. >> Correct. >> And what are the additional services they're going to provide for us specifically that are not that they're

055not currently doing? So with they are currently providing services to us but with the closing of the Palm Coast office location this would allow them to continue providing those services. >> I guess what I'm struggling with is this Career Source um uh organization. This is the same one that I believe last year updated spent $80,000 to update a Daytona office. And then this is the same organization under wi which we are one of three counties and so they're going to close the office in the county that has the highest unemployment rate of the three counties that they serve. >> They are closed in the office. Yes, ma'am. >> Okay. And but yet they're going to get free rent from us. >> Now, didn't we used to give them that space for when they were doing

056we were had a partnership for uh the uh roads of success the upstairs there. This is somewhat of a continuation of that with additional services. So within this commitment then they also agree to uh social media advertising to promote Flaggler Technical College, the Carver Center and district events. Um event invitations to students for career source events and internship program expansion for our students. uh special event participation, employer engagement through business leaison, uh career assessment and pathway planning, job placement services, work readiness workshops, labor market information sharing, and um then what would also be the same would be co-enrollment of eligible students into the NextGen program, which is um which is the same funding source as the road to success program was for out of school youth. >> And so what what additional services are they

057providing through this uhou um that they weren't providing before? Is it the same or are there additional >> the additional services would be to promote Flywood Technical College, the Carver Center, and the district events across digital networks including LinkedIn, Facebook, and Instagram. It would be the internship program expansion assistance specifically um and employer engagement through business layons the other services existing currently >> and sorry did they have like um with this marketing essentially that they're going to provide us is there a certain number or frequency an equivalent in kind dollar amount so that we can hold them accountable to that. >> There's uh not a dollar amount specifically listed in theou. Um Miss Murphy is here from career source for flaggler if you have specific questions that I can't answer specifically. >> Yeah, please come

058on. >> And I wanted to ask um so was FTC evaluated for space? I I know like probably there may not have been space, but I'm just wondering for these services. They're used for anyone. So, it doesn't have to be a Flaggler County student. It can it can be anyone in this county or any of the other counties. So, >> yeah. But if they're focusing on utilizing the Carver Center space or you know GE geographically space you know like FTC would be more beneficial to focus on our FTC students or FPC you know or our our students. So is that space evaluated just >> the space to be >> it would be nice to have them on our campus specifically but the space is not available not there. um what is available is at the

059Carver Center and it's at the heart of the population that needs these services the most. >> Okay. >> And so um we're confident based on the relationship that we have had already with this merger that we'll continue to get uh services for all of um for all of our Flaggler students. And then also in addition what's laid out here in the memorandum, >> would you be open to having a dollar amount listed in terms of that equitable amount of or um in kind marketing that you're offering within thisou and to um have some numbers relative to goals on um the internship expansions, some data that we could say, look this is what we agreed to in exchange for this space. >> Yes, we can we can definitely look at that. Um, our budget has been

060cut by about 30% over the last five years. So, we've had to look at our infrastructure and I just want to give you guys a background. Um, we're developing talent hubs where we go where the students are instead of them having to come to a career center. Um, in Bvard County, we have an a talent hub with our adult ed. And in Bard County, we just opened that. And Eastern Florida State College, they've given us free space there to help their students. So, it's it's really about the new strategy is going to where our customers are. And although we've offered a lot of these services, being there on site um makes it a lot easier. And one of the things that we we just opened the talent hub at Eastern Florida. And one of the

061things that is really helpful is to meet with the staff. The staff meet together and and talk about how they can, you know, utilize services and work together. And having those meetings, regular meetings, which is part of theou is really val valuable and important. We can put together some in kind um depending on the the services that we would market would be services around job and career placement. So any events that you have, we have a very robust social media um through LinkedIn and Facebook in all three counties. um and we can you know put together something like that for you if that's what >> that would be great and um I I agree with you that being on the ground is beneficial but um I see this as an extension of the guidance services

062uh that our counselors might provide and being at the Carver Center is you know a whole space removed from where the students actually >> are at FTC FPC Matanzis that kind thing. >> So, um is your office planning on making some site visits? >> Yes, we we also have business um services folks that work with our um work with our companies, but yes, we can do that. That's not a problem. >> I think I would like to see that inou as well. A certain number of site visits at each of our FTC, FPCM in Kansas. >> Thank you. >> Can I ask where like where does your budget come from in your funding? >> It's all the federal government. Go ahead. >> Oh. Um, so with the Carver Center, we host a lot of, and

063when I say we, it's, you know, Flaggler schools, but also our PALS, which you know, we're affiliated, and then the community, a lot of events like focused with children, um, things like that. So, I know workforce development like it is, it's not just Flaggler County, it's the entire county. So, I'm just thinking like with safety, is there like what like set hours? I didn't see anything on the contract like you know you guys will be there like Monday through Friday 8 to 5 or weekends evenings because we you know there's wrestling there there's um boxing volleyball like lots of things um special needs kids so I'm just trying to think what is safety just things like that >> so we plan to just be there with the staff which is the regular working hours >>

064okay >> and um and that's kind of the plan right now but we work with like we work with Eastern Florida they close on Fridays days. So, we've worked with that and then they then if you have long um holidays, you know, we work with that and and those staff can go work somewhere else during that time. We would never be there without the um Carver staff being there and present. >> Is anybody using that space now? Are we displacing a program or anything? >> Okay. And then um my other question is is when you made the decision, I'm assuming to close this office, I'm sure it was for for budgetary reasons. Um if if this was not if it wasn't at this location, what was your plan B and C? >> We were going

065going to um ask to talk to the county. >> Gotcha. >> That was our plan B. >> Gotcha. But nothing has there weren't any any other options on the table right now? >> No. uh specifically for you to relocate to, >> right? And and we would we could have also reached out to businesses, but um our number one choice was Flaggler Technical and being where the students are, that's that's really where what we want to do. >> And Mur to uh finish answering your question, everyone who comes through the Carver Center will also go through our Raptor system where safety is concerned your question. But for workforce development, I thought anyone because it's online like if they want resumes, job assistance, they can >> including online services. So anyone who comes to the physical facility,

066okay, >> would go through the raptor system. >> Okay. Like similar to engagement center when if someone just walked in, they have the >> and when we have hurricanes and things like that and open shelters. >> Thank you. >> Okay. >> Thank you very much. Appreciate it. Okay. Human resource services consent 10.01. Mr. I'll let Mr. Reeds auditorium director job description. Miss Bulmer is here. We'll invite Miss Bulmer to come and be a part of this question this um discussion. if there are any questions that you may have. >> Chair board members, superintendent, I'm here with two illustrious folks to uh share with you a redline copy of the uh uh director of auditorium as um one of our esteemed folks exits the stage left board. I shared this with you last week. The ongoing

067process and the timeline of events uh uh very collaborative working with uh Miss Fulmer uh Mlette, Dr. Brian as well as the board from the auditorium and uh having meetings ongoing as we go through this process together. Any any questions that I could maybe answer we can answer for you. >> I have a comment. I really like the addition of the K12 visual and performance arts because this past year I know you've been really trying to get more involvement with the elementary and middle and high school. So I really liked seeing that. And then my only question with that would be do you think that potentially in the future this would have to turn into two roles because that could be too much or do you think like has that been thought about because I

068do love that. I think that is perfect for >> part of it was trying to capture the work that as you know Miss Bourne was doing the last couple years. Uh her work came under teaching and learning and so as we started collaborating together this process we're looking at everything she was doing and there was a lot of things that were not listed and so we took the time to to list it and where under performance indicators we kind of separate out because some things were intermixed. um this is a lot and uh when working with their board concern of of finding someone with those qualifications, Miss Fulmer has provided us uh some links and information to do a a a stronger n uh national search to find someone that can help in this space

069for us as we expand that um job search for this. So, um, it could potentially, I suppose, one day, but, but right now, this is we fund this position through Flaggler schools. And so, this is where I kind of came up with. >> On the flip side, this role does have the board that, um, helps manage some of the financial aspects and accountability, right? So, uh, you know, it's not a oneman act, one woman act. Um, no. Uh but I do like the addition of the K12 support as part you know our organization is about the students and so I think that's important but uh Miss Ful former your um evolution of the program and um you know just stewardship uh and collaboration with us has been invaluable and uh we're going to miss you.

070You've really uh >> you've really um done some wonderful things. Um, and you know, many of these items you've been supporting, while it hasn't been in hard written in a contract or anything, you've been very open and so it's good that we're getting this documented. Um, and um, but I do have some, you know, uh, reservations to Miss Ramirez's point. You know, you're looking for somebody who supports performance, has an understanding of how to teach students in visual and performing arts. But then on the third spoke of this wheel, it's almost like we're asking for business management degree as well. And those three things are probably a difficult mix to have. And so I might um recommend that similar in what we did for the chief human resource officer. Uh we maybe one of these

071elements we say or working towards maybe some training or certification in that area. um you know for example uh K12 there may be some very uh or performing arts centered people may not have that business piece and vice versa. So we might want to consider that in order to keep our options open as well. >> Absolutely. I I mean I think A serves B in many ways because B is about relationships with our community members and engaging them in what happens with our students. And so by adding A, you're creating something that can work in partnership in that position. Um, I do agree about the business side of it, but the auditorium governing board does also some outsourcing for marketing, but you do have to have someone with a little bit of a business mind

072to understand how to oversee all of that or some session plan. Do that. >> The the board has, I believe, nearly three positions now that are there's a social media, there's um booking and >> we do print show bill. We have someone that takes care of that part. Um but and then there's also someone that does social media marketing. Uh we're working towards changing the way they do bookings to create using an agent that gets paid through the performers rather than so we're trying that for this year. They've contracted her for this year to to go out and find all the acts and that's been kind of nice to take that off of me. Um, so that will be hopefully that's something they can look at into the future as well. Um, that takes a

073great deal of time, but it they have to know our people and our audience and engage with the board to choose things that are appropriate for the community that will also make revenue that in turn serves our students, >> right? Um the question would be as we move forward uh at the at the pleasure of the board if we could uh perhaps post this a pending board approval and that's we've done that in other occasions with other positions as a redline document. Um so um I guess that would be something that we >> when is the anticipated vacancy date? July 31st is I believe >> but it is a unique position. So we would anticipate um an open till filled advertisement >> and right now we have it going forward for the February 24th and

074so I think that we can stick with that timeline of the February 24th um identify if the board approves any adjustments that are made and then we'll be ready to go for February 25th posting. It sounds good. >> Bulmer, we're very grateful for you. She does such a great job at staying in touch with all of us and we're going to really miss you. >> Absolutely. We uh missed and you know at the time serving on the board there, it was just uh wonderful to see how well you and the board members uh engage and um I will say that is a really a board that's invested in uh making the auditorium great and uh uh and Amy, you've been a great leader in in that charge. Thank you for that. >> I highly recommend

075a little book of boards. >> Very good. >> All right. Thank you for the update there. >> Okay. >> 10.03 point Mr. Owlette. >> So board at this time we do not have any additional information to present related to fleet. what you have on um the agenda it um represents the comparison of our current um services that we're receiving and then the analysis that that's prepared by fleet. This has this was a request from a board member to get this on. So this is coming before you on February 24th. um request for approval or or not um just a decision of the board. So you've now had the presentations, you had an opportunity to ask questions individually. We do not have any additional information at this time. >> So we're going to be bringing it

076forward to vote on whether or not we're going to go forward. Is that what you're saying? >> Yes. >> Okay, we will move on. I I think I just want to underscore and make sure that um for the benefit of people listening and stuff because we're going to be talking about some insurance items. Fleet is not an insurance company, right? We are self-insured. They are not brown and brown. They are a trust that works on behalf of school districts and they uh work through the super the board of superintendents. Is is that >> correct? Uh their the program is under fads which is um the superintendent association. >> So essentially they work for the superintendents. they do not work for um pharmacy or health insurance. They're not going to make money from discounts or other

077things that they negotiate for us. It's a fiduciary and where it it doesn't take away our ability to self-s serve. In fact, that is a requirement of their program. But just like earlier we heard that we pull for risk sharing when it comes to property insurance, we could pull for risk sharing when it comes to health care. And the organizations that work with them must comply with uh certain stipulations and regulations in order to be a part of and they want to. Why? Because right now they have nine counties and growing. they know they can get the business of nine counties with one agreement as opposed to sending salespeople to county after county after county. So there's a a lot of benefits and we see in the cost benefit here that um these are the

078kinds of things that it's uncomfortable, right? These are some alternative uh non-traditional decisions, but we're now at a moment where we need to make some non-traditional decisions or else we're going to uh you know be in a situation where our health insurance is going to be even more unaffordable or god forbid we have to provide a stipen so that our uh people can go find insurance which is not what a premier organization ation is all about. >> And I I wanted to or >> Well, I I I just there's one thing that is again a lot of the what what they've presented is is uh speculation of these things happen, these things happen. And that I I'm struggling with how much actual benefit we received uh that we receive out of fleet out of the

079gate. um because we already have self- insurance. Most of the the the districts that have come in have come out of a traditional um insurance plan moving into self- insurance and that's a lot of the large benefit that they are presenting to school districts. And you know right now they have you know we have 67 counties um they have nine in it right now. And the other component that just again is something that I'm still um trying to evaluate is the demands they put on the brokers that we choose. Uh because they have certain requirements that they have to come in. They have to say we agree to do the the thing the we agree to do it the way fleet wants it. And my only concern about that is is that have we evaluated

080does that limit our pool of of um brokers that we can work with that say hey maybe we don't we're our business model does not align with fleet. So in theory, I like the concept, right? Bargaining uh collectively to to get uh more purchasing power as a as a as in a as a state. But at the same time, um there are other mechanics in it that could end up taking away that benefit. So I'm just putting that out there that uh that these are some of the things that I'm trying to wrap my head around before I make a decision on this. Thank you for really digging in and giving this some deep thought and analysis and you know that's what it's all about asking all these questions because these are big decisions. Um

081and you know our our our HR folks here can answer this but this is something that I specifically addressed with Fleet when they came. I said look we're much more mature than many of the counties that you serve. Now, it the their model isn't that, hey, we're just going to help people go through the transition to self- insurance and then they're uh they're not needed anymore. They require that because they know that um the way their business model works um it makes more sense financially. But in terms of the broker piece, my understanding is that it's uh within the triumvirate of uh resources that works under fleet. There's three components, three arms under fleet. Those services may have and I don't have the current contract of what Brown and Brown or the comparison. It may

082then be optional and so that would potentially be another uh in uh savings. It depends on what we would see we need out of uh another agency if if we need that at all. >> Yeah. The one of the one of the things that was concerning and I and I I have not validated this in documentation, but it appears that most of the people that join fleet end up going with uh the their recommended broker because that broker already has agreed to the terms, right? And so I I don't know, maybe they're just offering something great or are they finding challenges with other brokers so they they you know go to their default. Right. So that I don't know if that's the case. I'm just I'm posing that question. Is that why is that >>

083because the scope of work is very different is is to that point. the scope of work that you would be going out for a broker would be very different if you were to go um go with fleet. >> Absolut absolutely. And to answer your question um uh Miss Ready about the initial savings and cost what they're saying right now it would be um $133 uh,000 is the savings. um now that that is with the board putting in additional monies for fleet versus your current broker. >> Right. Right. >> Essentially, we're transferring that money from one pot to another potentially and that if there's still services we feel that we need from Brown and Brown because again we're self-insured, right? remember and it doesn't it's not necessarily going to be brown and brown because we're going

084for our RFP for our broker. And so we were first would have to identify are there brokers that are willing to bid on what that RFP will look like. But to to be transparent, when we look at where we currently are, our current um consulting fee for Brown and Brown is $115,000 versus the $357,000 for them. I I to Mr. Furry's point, when we look at um other counties, I think we've already we don't have a lot of the fluff some other counties have. And so when you think about the commission that is assumed on a normal contract, the only commission that Brown and Brown for instance is getting is $18,000. Now when you look at what is just from the lens of fleet from theirs, theirs would be about $94,000. And so there are

085a lot of different diff you know I think it's we when we look at the two side by side um it is going to be a greater cost to um go to fleet with a savings that they're projecting right now is 133,000. However we can't necessarily compare that to our current broker our current services. is I'm not going to say broker our current services because our current services does not use the model of what the savings is. So it's kind of swapping from cost to savings back and forth and that's the part that you know you as a board just kind of have to sift through and I just want to bring that to the >> there's also the part where fleet they will negotiate let's say pharmacy prices and things and that >> that

086rebate goes to us and not necessarily >> you know within their organization which my understanding and I don't know we can ask Brown and Brown if that's something we split it with We currently do get our prescription rebates. We do get prescription rebates. Absolutely. Yeah. Uh typically it is o over a million dollars that we get in that um excellent >> in that prescription rebate. >> And something that I' I'm still evaluating as I'm sure all of you have been like this has been top of mind for a while because there's there's a lot. It's not it definitely is not you know an apple and an apple. I mean it's like a unicorn and a dinosaur. But you know here's and again potentially you guys have been thinking and evaluating this further still but so

087the risk sharing with um medical. So as of right now and I know you you all probably had meetings obviously but um you know there it hasn't started yet the risk sharing but there is intent to start shortly. Our district we would be they're in different tiers. So our tier, we would be in that first tier. And so this is what I'm still looking into because that tier, it's based off of population. So we're in the smaller district. So we are in the first tier. Then there's another risk share that will be the second tier and then another risk share in the third tier. We're in the top right now. As of when I had the meeting, I think it there's six that are in that that would potentially be in that first tier. So,

088you know, just trying to figure out, okay, risk sharing the amount that we would be putting up front is, you know, just the pros and cons financially of being in that smaller bucket with a low amount initially, right? So, these are just things I'm evaluating. And then also, >> but we're also contributing a smaller amount than let's say if a Miami were. Well, yes, but when you if you look at what we're contributing, it's it's actually it's a lot from what you know, it it's this is going to be a big chunk, but it's you know, >> it's it's almost like the lottery, right? You want to win. There's a big chance it could work, it could not. So, that's that's kind of like what this is. However, so that's one thing that I'm evaluating,

089which I'm pretty sure you all are as well. >> Like to be clear, what you're talking about is the timeline for you to join the risk sharing. You know, you want you want to ensure like the risk sharing at those >> because that was one of the priorities why we wanted it, right? >> The last meeting risk sharing was not yet um involvable. Y >> now like what is our timeline for joining risk sharing if we go into this agreement >> and then though say say we're all like yes this is it we're going to do it we put the money in now the time comes for risk sharing for everyone which I think is coming up in the next quarter for everybody because they're still working on the things they have to do to

090even do risk sharing. So when we get into our risk sharing we're in a small bucket it's like we're in this little pool right with other little ones. So, you have to evaluate the risk like is it really, you know, and that's what we're looking at. And then just the last thing that I'll say um the cost sharing or the cost savings that they they told us about the 277,000 um if you asked or you know or talked to them more about it. For me, the cost sharing that they said, the stories, the two stories they said, they were with much much larger districts that that they shared. And then the reasonings of those cost sharing, it was, you know, one, you know, we have our wellness center. So, our wellness center, those providers, if

091you go in with a heart condition, they're going to say, "Oh, you know, we we can do an EKG here." But what they were finding at other districts those wellness centers were there but then the concier services were saying oh no go to the ER and you know go to this cardiologist and then it's out of network out of network this much this much those costs. So someone was not doing something I guess properly and not utilizing their wellness center. So that's kind of on that district. >> So that's some of the consulting that they provide >> but that's what the savings that they're marketing. So that's I'm just still evaluating and you know I have lots more questions that I have >> and we are inviting them to be at the table so that

092you guys can have this conversation. We just did not have anything additional to bring forward. They you know >> and I just want because now we're talking about it you know because we can't talk about it any other time. So from my perspective, I'm still evaluating because again it sounds really great for risk sharing but then we would be in that first tier and right now at least from when I spoke six >> but I think it's fair to wait it right you know like um often when even health insurance itself right it's almost like a weighted uh just like an actuary and say well this is your chance this is your probability this needs to be your equitable contribution to the pile but in talking with other school districts The only one that I've

093uh spoken to that has said that they made a decision not to join this so far was Pasco. And the reason is because they have such a tight relationship with their um community health partners that they receive many times um either free or lowcost health care um through them not just at their own clinic. Right? So they have a much more robust I guess share program with their uh w with their area health providers. That's you know Pasco is much larger. um they I don't know exactly what that contractual relationship looks like but um they have several let's say okay our clinic they had uh numerous and I think they had something actually I I want to say like through a CVS or something like that where if they went to the CVS or pharmacy

094they got an additional you know savings with their pharmacy benefits. So, I could understand somebody like that where, hey, they've got things under control. Their insurance premiums are ridiculously low compared to ours. They're not in the same position. So, you know, we're in a whole different position. So, when we speak to other counties, be sure to say, "Well, what's the health of your current program? What uh who are you partnering with? What kind of partnership do they provide?" Right? I'm sure it's going to be a combination of things that we need to figure out to go forward, but this is, you know, uh I I'm I see this is something that more and more people, even businesses are going to have to turn to under what's happening with the current cost of healthcare. >> Well,

095I have a um some thoughts. You know, you have to look at the riskreward. And you know, when when I look at the what what they're offering and they say that, hey, we we would save about $100,000 in saving $100,000 in millions of dollars of budget can be wiped out in 3 seconds, right? So, it it's not a substant if we're basing it on money saving, I don't even think it's even a consideration because right now, out of the gate, it's not it's really not saving us a lot. now. And if we go in now, we are essentially being an early adopter. Uh hoping that they that that the promises and their actuaries and the things that they think can happen are going to happen. And my concern is that we might uh and let's

096give them the benefit of the doubt that they can get there. We might feel short-term pain be by getting in too early. And another thing that is concerning to me is if this was so great, you know, we're we're we're we're wrestling with this here to try and come to a decision as a board. How come more counties are not jumping into this? And I I really think that part of their pitch is baked in with taking districts into a self-insured model. And the there's immediate benefits to them. They will likely see not just 100,000, they'll see a lot more. So even though because this person is the person that brought it to their attention, walked them through the process to get them to self- insurance, they see, okay, well, this is just one more

097piece of that puzzle where they could have done that same thing without fleet. They could have gone to self-insured, probably received the the benefit that fleet presented to them even without them, but they're adding that in as a future value. and and I I I really see that that that's probably why uh only a handful of district have entered in at this stage. So these are again just some evaluations and concerns that that >> no those are very insightful but to keep in mind they've gone from three districts to nine in a year. So you know this is an early organization to your point. The other piece is uh Miss Moore, I guess I'd like some clarity on the amount of the cost savings. Um there were larger numbers that were discussed, but my understanding

098is they can't necessarily put that down because it's not a right there immediate thing because they'd have to essentially open our books in some way. Am I misinterpreting that? because you know >> uh so they that what is there is what is was provided from them of savings that they can provide to to us. It all of that is there anything additional savings would be maybe this is like a conservative measure for them but this is provided to them directly to us. we did not alter um any of >> so when they come next I think I want them to uh address that specifically and then I think um to Mr. refer's point is that you know um is it that they're saving people by supporting them to go self- insurance to me that makes

099their uh program obsolete after the first 20 years >> I will tell you because they have said >> so they've got to have a next >> yes they have said that for the districts that they are supporting to go self- insurance the district that they're supporting to bring on um a wellness center those uh districts are are seeing significant and immediate savings versus we've already done the work. And so I'm not by any means going to say that I'm well versed in flea. But what I will say based on this and what the um conversations they presented to us where we would see savings would be in our uh pharmacy our PBM and then eventually and I don't mean eventually in a derogatory way but initially it will be through PBM is what they're projecting

100and then it would be through um risk sharing when we're at that point. And so my understanding is there are phases to what that will will >> and that's my understanding as well. These people that go in they're not getting these cost savings immediately because actually to be to receive the pharmacy benefit and then the risk share. They have to be self-insured. So we're coming in at a larger stage where a lot of these um counties and maybe some counties well they're not jumping in because you have to have a good number of reserves to be able to say yeah we're going to be self-insured now. you know, you've got to have the money to pay up those claims. Um, who that could be a a limiting factor. >> Yeah, I think it's all of

101those different pieces that we we we have to consider when we're considering something of this magnitude. it would be and and the reason why I pointed out the savings piece is just because we cannot look at it from we got to look at cost to cost and then this provides here's what the projected savings is but a traditional broker that that's not it's not going to be presented in that way and so I think just to be fair to any brokers that will be looking at it we're not just look we we're we're making sure we're making that distinction >> and that's what I think I'm looking for is what is the timeline on the pharmacy benefit and that projection because that number that I had seen was substantial. >> Just to also share my

102thoughts with the board, you know, I know that they're new, but for me, I'm like I need objective data and they don't have it yet. So, it's a lot of buy in. I I like to see the numbers. I don't like to just have promises um to jump into this. So, >> and I think that they will be willing to bring the data that they have and we h we will we will invite them to come and be a part of the board's uh business meeting um be it in person or make them available virtual because I know that they are traveling across >> there was a meeting last year where they brought some data um >> but then they said that they were going to pull some exact numbers from ours. So, I think

103that's what we would like to see that exact presentation but with our more specific data. So what you see and what they've been able to come through, why they are able to look at a projected PBM savings is taking the information that we gave them from our contacts on what we currently have. So that's how they were able to go through and do the 277,000 based on their own metrics. Okay. um things they've shared with us as far as Rick sharing and being able to figure out just exactly what we would save. They would have to negotiate a stop-loss contract with us and probably be in agreement with us to participate before they are able to do that next that next hurdle. >> I mean to be fair, you're asking a consultant group to provide

104their consulting services before we contract. All right. And then one other thing I I just want to point out is when we start talking about uh say you go with fleet, what would it look like for essentially the leftovers for a broker to take over? It would be what we would call a contract effectuator. Um so we would need those services. And when we talked with fleet trying to get a ballpark on what that would look like, they they told us it would probably be pretty much in line with what we're currently paying Brown and Brown out 115 just based on addition. >> Yes. in addition to the membership fee and the capitalization fee. >> Yeah. >> So, if we bring them back, I like I just don't want to spiel for an hour like

105I'm serious. We need >> Yeah. >> They really every time they've come, I'll be honest. It's been lack substance and and it's very hard. I need actionable information and it we cannot uh you know take this this uh aircraft carrier in another direction without knowing that you know we're on the right course because it's so hard to turn it back. And you know the other element of this here is we're we're doing the RFP and again we we have apples and oranges right now in dollar comparison because that 100,000 it again we don't know what brokers are going to uh offer us uh just in the normal um RFP >> and and we don't know it may or may not affect the fleets demands may or may not affect that that that quote I don't

106know yet but then that's just another layer of uncertainty and when I spoke with them on the one-on ones. It was it was basically like you have to agree to come with us in in in a sense. Well, not not fully before we can tell you what else we can do for you. And I just that that's that's problematic um for for me in that scenario. Um you know, I think they're going about it wrong. Uh if I was fleet, I would be first going out and pres presenting my offering, go out to a majority of districts, get letters of in um of intent, right? And then have a come to come to a district like I say, listen, we we know you all got uh are afraid to be the first in, but we've

107got, you know, out of the 67 counties, we got 30 letters of intent. So that means that if we can get all these together here, then we can do cost sharing on on a realistic date coming, right? Doing it one district at a time that everyone in the early stages is taking on greater risk. um hoping that others are going to buy in later cuz if they don't then the plan doesn't work because in theory they're just saying well of course people are going to sign it because it it's always cheaper when you buy together but not not always because you you're always giving some freedom up uh or control up when when you join a group because you you have a you're going to have a board that oversees the the entire program and

108that they may that that may or may not reflect the interest of each individual district. So now I know that we can choose our own insurance plans and everything else they that we have that autonomy >> but the program itself fleet it's going to be have to be a one-sizefits-all on their size for for the most part. So uh again those are just some additional things to consider. I guess where I see it is that since this agency essentially I is um accountable to the fads which are the superintendent um that's less a business board and acting more of a fiduciary in our interest and to your point yeah u it would be great if they said hey we have all these letter of intents I think the problem is is that the companies that

109are working with them they want to have money for the services they're going to provide. Right? So, um what really impressed me was that the three companies that are working with them um agreed to comply with their stipulations and their pricing limitations um and these are multi-million dollar companies, right? So, if the companies can see the writing on the wall who, you know, they they're doing their market analysis, right? How are we going to make sure that we can still make money at a reasonable rate where the pool doesn't turn into a sick pole and then it's an ever expanding problem, right? Um that's was also very impressive to me, right? That they they they agreed to some very clear stipulations that are not in their best interest. Well, you know, the other concern I

110have is that it it sort of creates a a monopoly for the the risk sharing insurance world because right now there are many people competing within the state of Florida with different districts, right? So again on uh when you do these things sometimes in the beginning they seem good. They offer some short-term benefits that you can measure. What you can't measure now is that really there's going to be one risk share in their vision for the entire state of Florida, which eliminates all competition in in the market. And once that happens, there there are liberties that can be taken when um when you just have one and and and that uh so at any given time there's probably going to be maybe two people every you know it's going to come up for bid every

111year or whatever it is, but you're going to see a market shrink uh in competition for the for the the stop-loss type of insurance. I'm curious if that has ever hap like is that's coming to realization in the property insurance world where there is risk sharing. Well, you don't in property insurance there is >> hazard insurance I believe like hurricane and >> yeah but it's all they're individual there's no there's no pooling >> I think the the reality is that they will work to get all 67 districts to join and not all 67 will join because as we've said there are varying reasons why it works for one district versus doesn't work for for another district um based on where they are the relationships that they have locally um with their healthc care uh providers.

112All of those things are are factors. Do we know that they are working for the benefit solely of school districts? Yes. Um again, that doesn't mean that it, you know, this will work for us versus it will not work for another another county. And I think it'll be helpful to be able to have them at the table so they can answer some of our questions and our speculations um so that we we're clear, you know, as you guys go into the vote and we'll we'll we'll we'll have them here for you. I think what might help if I mean if they are coming back uh I at least for me so maybe the board if you um if we provide the exactly you know if you have five questions like I know you know I've

113been building up mine um that we have it provided to them prior to them coming so we know that's what they're going to answer because you know our first meeting we had was over an hour then we had them again and it was pretty long but it was a completely different meeting in my opinion and so and then we met with them one-on-one but I think if we do have them back because we have a lot you know there's a lot that we need to to do in this district in general like we have a lot of topics so provide it to them if if that's what we want >> well I would hope that I would imagine they're they're listening to this conversation right now they're I've laid out all my questions and concerns

114here I'm happy to put them in writing if need be but uh um I I do hope that they come with some actionable actionable information that we can say okay we can move forward with this or those those numbers are not they don't provide enough benefit for us at this time I in theory again I like the idea I just don't know if the timing is right >> so you want a three-year projection >> where at least a three-year projection would be helpful um but I've asked for that and they've clearly told me that that that's not available >> they want to get specific >> until we They want us to to go to fully engage them first before they can do that. And there may be some data sharing issues there. I don't know.

115But again, I can't I can't buy something and then find out what I bought afterwards. All right. Or the benefits of buying it afterwards. I >> What about the data of what um for example, what if they shared data of the counties that they're working with who uh what they're saving after they move from self insurance to the next not doing the the risk sharing yet, right? They're >> Well, that's because our first our first piece is the pharmacy and then the risk. >> No one's doing that already. It's not I mean, we're we we are getting >> Well, I'm asking would that data suffice for you, right? >> It's not No, it's not enough cuz cuz that that those are the again we don't know what the next contract's going to look like with

116our next broker too where all these things are going to uh come from. They're saying they can negotiate contract prescriptions better for sake. >> Well, yeah. >> Well, I'm trying to extract specifically the data that you want to have to be able to make clearly make this decision. >> I want them I I'm the I'm the customer, right? I'm I didn't I didn't I never I didn't seek fleet out. They sought me out sought us out, right? They came to >> I sought them out. I went and spoke to them. >> Yeah. But we we've heard from them before. So the the but but fleet is they they came um I'm they have to convince me I they got the product I'm the customer come forward with the the benefits of of coming to your

117program and you have to convince me. I'm not trying to convince myself to take this to do anything. I want them to bring their best forward and convince me that they have the they're the best direction to go to. If they can't sell themselves, I'm not going to do it for them. And right now, they they haven't. >> But that's the question is what do you want to see? Because >> this cost savings that we would see over time >> over the at least the three >> a minimum of three different things. >> But even still, it's all speculation. That that's my big problem, too. There's two layers here. You you can I can make numbers up. I can do forecasts and everything and sometimes they could be right, sometimes they could be wrong. But

118we're talking about going a whole different direction without uh showing that these things will actually come. >> Well, that's why I was wondering what if they took the data of what uh the current um their longest running uh districts what their percentage is cuz right now every data that I'm asking you is this what you want to see? Is this what you want to see? You say, "Oh, even that or I believe the sampling is a no-win situation. The sampling is too." >> Let's relay our questions to Mr. Walker to follow up on that. >> Yeah, >> cuz I think we're just going back and forth now. >> Yep. >> Okay. 10.04 approval of personal items. >> I like that the ASD um you know helping out the students that we see the need and

119then we're filling that gap with that partial amount. So, uh thank you for keeping up with our ESS students and those support roles. So thank you. >> Okay, we'll move on to 12.01 is Deina legacy points. Thank you for walking. >> Thank you very much. >> Good afternoon board. I bring to you the uh proportionate chair mitigation agreement with legacy point cottages. This is a project that has 22 single family um units in its um plan and um it is set to uh generate about six students, four of which is in middle school and high school and there's no available capacity at at those school levels. So they are coming to us to mitigate for those um four student stations, two in middle school and two in high school. Um the total mitigation amount is

120$119,900 um dollars. This will come to you at the February 24th >> regular session. >> Is this north on US1? Is that >> um >> just trying to figure out where >> is it? No, this is over by Flagler Beach, isn't it? >> Yes beach. It's the the nearest intersection is um Jan Anderson Highway and >> yeah this is behind where that churches that coastal I think it is or >> where the Babcock furniture used to be remember that Babcock furniture building >> there's a Shell gas station it's right behind it >> and they are within the old kings body Taylor Flagler pump school zones bless you >> and um if you have any questions. >> Uh so previously we had a discussion about the ability to track not only but the projected number but

121how uh did that come to fruition? Did we make any progress on that? um the track the actual yes like you know how when we say oh we think there's going to be 15 kids from this development um and then afterwards right how do we identify is that accurate are are numbers um accurately reflecting how we're being impacted >> the student generation rates are um based on the study that we had in 2020 so 2024 for um we have we are ready to do that this year and we're going to see if what we had in 2022 would be the same 2024 would be the same this year but we do have um uh listing of how many students and I'm going I'm doing that right now how many students are actually being generated by

122this development so I am not uh done with it yet but I will have it um probably in a couple of Okay. So, you mentioned that um these schools that these students were hit are already at capacity. >> Yes. >> And so, um >> you know, uh with this open enrollment that's happening, are we hoping that there's going to be some leveling out? Is there room at other schools? Well, right now what I'm uh what we're doing is as the certificates of occupancy come in, we're removing them from from the >> discre the discrepancy, right? Yeah. >> So then we're uh right now we're since we've removed some we're at the level that um it's probably doable. We don't we won't need classroom additions or anything like u what we did in Matanzas. But a

123lot of the reserve capacity that we have right now are from the DRI and based on our interlocal agreement. They are the the reserve capacity that we have for those DRIs are still in our books. So we cannot remove them because it's part of the internal agreement. But if you uh if you are looking at what we have with regards to mitigation, they would have the capacity because our actual utilization right now um would absorb those school choice. And you have to look at um how when you would see a a student come out of a of a development. Normally it's about 3 to 5 years and sometimes it would mature at the sixth year. So you would see those students at the sixth year >> but we make adjustments to the capacity the availability

124as these come on and as they rolled in out each each year >> and correct me if I'm wrong. So these are um developments of regional impact. Is that the acronym? Yes. >> Yeah. Okay. So, and and the issue is is that these could these seats could have been reserved 10, 15, 20 years ago. These developments, they never got off the ground, but they're still entitled if somebody else wants to do it in the future. So, uh, like one like this project, they may be wanting to start turning dirt right away, >> but we still have these reservations from a long time ago that, uh, but we have to be ready and it for if they do start the project, uh, even though it it's been dormant for many years. >> Well, not only that,

125but the ones that were built, we have to state, did those students actually come into the schools and can she remove them off the list? So I think that's what you were alluding to earlier that that she's working through that audit now. >> We are removing them. Um the problem with the DRI as well with the DRI they have entitlements and like for example for um right now town center and Palm Coast Park do not have any reserve capacity anymore. We've cleaned that out. Um, with Hunter Ridge and Plantation Bay, there are some because with Hunter Ridge, um, there are still some developments that have not come in. So, uh, we're still holding on to them. Like, for example, they have, um, Hunter Ridge is entitled with school concurrency for like 3,000 units right now.

126um if there's any addition to the to the DRRi um that no longer comes into our reserve capacity, it's just with what they are entitled from the first. >> So with Palm Coast Park, for example, which is off I think US1 the sidewalk to the nowhere uh some people call it uh the So you're saying if if that development uh was to to to start again or or one of the they have to do new reservations. Yes, they will have to be subject to school concurrency review. >> Okay, got it. >> Thank you. >> And mitigation, >> right? >> If there's no more um capacity at the middle school. >> Got it. >> Any other questions? >> We're going to take a five minute recess. >> Okay. Thank you. >> Thank you, Mr. Dina. ask

127questions throughout. However, there will be a chance for the insurance committee to go back, make suggestions, recommendations, and changes. And there will be an opportunity for you guys to do the same thing in a close session related to negotiations. And so um this is not necessarily about us changing um future plan development but really around us presenting here are some options going forward so that each group hears the same presentation at the same time and we know that everybody's on the same page where we are. Okay. And I I do want to just say thank you to um our union members who are here and a part of our insurance committee for being here. We do apologize. We thought that we didn't think we were going to be here at 5:00, but >> well, we

128knew we would be here until 5:00 for sure. Thank you so much for being here. >> Welcome, Miss Boil. Walker, Mr. >> Thank you. There's a lot to cover today, but it's nice to see you all. >> I will try to get through it and be respectful of your time if you have some questions that we have to answer them along the way. So I will have you progress driving for me. >> So as you know in the past couple of years you all have taken a deliberate approach uh as well as the insurance committee to try to enhance the benefits offered to the employees here at Flagler Schools. You've opened your employee wellness center. You were able to enhance the board contribution to a couple of the plans to try to get more dependent

129be able to afford that coverage. um and added a new plan design last year that I think was also a step towards doing that. Um but despite those efforts, we are seeing escalating claims costs still and you're not alone in that. St. John schools is facing a 19%. Blackberry County had to increase funding by 15% in 2024 and again by 8% in 25. Palm Coast, a client of ours, has two tough renewals, 21% in 2024, 12% in 2025, and we're pending their projection for this coming renewal in October. Valicia Schools was fully insured or is fully insured and left Florida Healthcare after over 30 years to try a new carrier, uh, Curative, which is a disruptor carrier in the market trying to do things a little differently. And so far, things have gone well. um

130they are going to have their first renewal coming up in October, but they have a rate guarantee for that renewal where I think it's an 8% that they know that they're going to have for that one renewal. So today I would like to focus on several options to mitigate your increases. I'm going to talk to you conceptually about what what levers we can pull initially. So to set your stage here, components of your self-funded plan, you have the pie chart is a good visual. So 67% of your costs in 2425 were medical claims with 24%. Your fixed costs represent 9% of your all spend that you are doing. Um, so far this year we're at 71% for medical. So, we've had some shift there between medical and pharmacy so far this year. Here is a

131look at your medical claims back to 2020. Now, you'll see a step down in 2021 and then a rebound back up in 2022. We all know what that was. That was the COVID uh pandemic. So, aside from that, see, we've had pretty steady increases. Uh 8% is a trend medical increase. If you make no changes, you expect an 8%. And we've had 8%, 11%, 16.5%. That's not what your funding um premiums increase. That was truly your medical claims on a per member per month basis. Your pharmacy claims, similar stories. We've had some es and flows there. But in 2024, we saw a huge spike at 30% and then again in 2025, 12.4%. and that is directly related to GLP1 utilization. So we'll talk about that in a moment. At the bottom you just have it

132together medical and pharmacy with claims through December. Our actuary has projected the plan to end 12.3% over budget which is about 1.6 million. So that is 1.6 million coming uh that we don't have coming in. and that is going out the door. Two out of the four months have run over budget, there are three members with claims over 100,000. So before we talk about anything for renewal, there's one thing you can do now to address that and try to stop the the lead of money. And so >> and if I could just add for this 1.6 million above, this 1.6 6 million would be dollars that will have to come out of the insurance fund and anything that is over um that is not available in the one in the insurance fund will be supplemented

133by the general fund. Okay. So, if we continue to project this out this way, the general fund will have to kick in in order to assist with our um insurance fund because of the rise in claim cost. >> So, just keeping that in mind. I I guess I'm wondering what's changing now because several months ago both myself and Miss Chung brought up about covering GLP once for weight loss where um I stated that it's even unusual in the private sector for health insurance uh to cover it and Miss Chung brought up the now affordable version which is sometimes less than what you're paying through >> the insurance but at that time it was stated it would be too disruptive. So now we're saying that well this is one of our big factors in mitigating our

134cost and this is less than I don't know Miss Chong do you remember when that was about six months ago. >> I don't think it was that far. >> Yeah. >> I don't know that's so what we um are what when we get there um the re the recommendation >> it's on the next page. >> Okay perfect. I will not respond that answer. That question will be answered next page. Um, Miss >> So there's a definition up there in case anyone doesn't know. Um, but your current coverage covers for weight loss but not general weight loss. It has to be someone who is classed or is diagnosed with morbid obesity or an elevated BMI, overweight with coorbidities like high blood pressure, sleep apnnea falls into that category, high cholesterol and cardiovascular disease. So you cover

135it but with some guard rails. However, to your point, it's overpriced within the PBM space and you can get direct to consumer at a fraction of the cost. And what has happened since I I'm not sure if I was at the meeting whenever that discussion happened, but in the past few months, you now have access to direct to consumer and we can pull out from your CVS plan or whatever pharmacy benefit manager you're with and get the direct to consumer rate for your plan and you could choose to subsidize part of it. And so what we're looking at here is just kind of setting the stage. But on the next page, if we can go there, >> we did over 500 scripts of >> WGO. You did 710 total scripts. Not not individual people. So

136if you think of one person being on 12 Yeah. But still a lot. So there were 710 prescriptions that represented $958,000 in spend. And that's because you're paying over $1,000 a piece for prescriptions that now you can get direct to consumer at 3.49 for WGO that bound for $2.99 to $4.49. The oral version of those are now coming out at $149 up to $299 for a stronger dose. So what we are proposing uh which has not been presented to the insurance committee at this point but um what we agree would make a lot of sense is if you pull it off of the pharmacy plan carve it out say it's no longer covered through CVS pharmacy or on our insurance card instead the we educate the employees on how you do the direct consumer and

137there is a mechanism for you to subsidize it so it would maintain the same cost today. So for the rest of the plan year, you're not taking away the coverage mid year. It would still be $35, but instead the prescription is sent whenever the person goes to get it. It is sent to the manufacturer. That's that's the filling pharmacy and there is an electronic debit card that is funded by the district to make up the difference. So if you were to do that and assume the same utilization, it would cost $223,000 versus a million. Now, this is just talking about the weight loss portion of it. For folks that use, you know, GLP1s for diabetes and things like that, that would still be a part of the pharmacy benefit and the medical benefit. We are

138looking at just targeting uh the areas as it relates to just having a BMI, which Flagler schools when you kind of look at other organizations is an outlier in allowing that coverage for um GOP ones for weight loss uh just based off of BMI with no co-orbidities. And to go back to Miss Readyy's original um question, we did not want to take a benefit away from staff and we're not recommending right now that you take a benefit away from staff. We can absolutely go back and u we'll have to look at this for the uh 26 27 um year, but really the available options that are now available to us to be able to do that. >> I think that that's what Miss Chong had actually presented. You had that paper, right? That's I think

139it was when it was released through the government like you could get >> the consumers now. Yeah. >> So, we weren't we were encouraging the exchange >> early. >> I think the missing piece was the mechanism for you all to subsidize it to make it the $35. >> And how does it so to to the insured it it's the same process for them to get it? No, because they don't show their card >> and go to Walgreens or CVS to get their medication anymore. Instead, when they they have to get a new prescription from their doctor, >> and this is also in the appendix whenever you if you want to bruise later, they get a new prescription from their doctor and that is sent electronically to the manufacturer >> that ships from them >> and

140the employee pays for that medication with two forms. So they will get an electronic payment that is loaded with money from you all and then the rest would be their own credit card to pay the $35 and then it's shipped directly to them. >> So that card though that that's the only thing that is kind of is it is it restricted? >> Yes. It's truly only loaded for that. >> And so no no they can't process that card anywhere else except >> and it's not even a real card. It is like an email that here's your money for your um whatever the direct to consumer name is and that's all they can. >> I had a similar thing. I have um eczema. So there was an injectable eczema medication but I couldn't go through my

141health insurance. I had to get it looked like a gift card and but it was basically money that the manufacturer provided and so then the insurance would pro provide it only because I had that and that's similar >> otherwise it cost $1,400 a month similar to that mechanism right so we've >> we have a vendor that does this for our clients that's what's new and it's um RX save card and there is information in your appendix about how the whole flow works but it's working really well for clients that you can pull that off of the farm pharmacy spend. And I just had a claims review with um a large county that's a client and they were sitting there with their insurance carrier at the table saying, "Why is it costing $1,200 a month when

142I can get it on my own for $350?" And >> why can't I do that here? And they said, "Well, that's just not the pricing we have access to under the plan." And they said, "What about the oral one? How much does that cost?" And they said, "The same price as the injectable." >> So there's no relief even through the PBMs. >> Yeah. as of now on those significantly lower cost medications. >> Can you tell me about though this loss of rebates if we change that? What what's the overall impact of that? >> So you get a million dollars in rebates give or take in a year. And by removing medications that are rebatable because they're a brand new medication. By pulling that out, you don't get paid the $3,000 or whatever the the amount

143is on the rebate, which these aren't specialty meds, so I think it's probably like $600 that you get in a rebate. It doesn't eliminate it all together. It's just for >> It's a net savings, but that is part of >> We still have the net savings even with the administrative piece of having to produce these carbs and everything. >> Exactly. >> Go ahead. Sorry. >> For type two diabetes, are we having the same issue? >> So, type 2 diabetes, I think, still has to be filled under the health plan. But I'm That is a great question. I haven't had anyone that's carved it out for that diabetes medication. It's always it's been for the weight loss piece. >> So is there is is that a is there an opportunity there? Is that uh >> I

144I will research that for you and we will bring that back. I have not seen direct to consumer ompic the way that I've seen wobbi and zbound. >> Gotcha. >> Okay. So ju just I want to understand uh just so it's so clear. So they go to the doctor they get this they get the script >> the the doctor send doesn't send it to CVS they send it to the manufacturer. Okay. Then the then what's the next step for the patient? I mean for the yeah the patient >> the patient I believe gets an email or something right there that has the code with their payment information for that medication. Okay. >> And it only works for that pharmacy. >> Okay. So they'll pay $35 out of their own funds. >> Correct. >> And then

145the rest they'll use that virtual debit card. >> Okay. >> So Oz Bank also does have a similar Oh >> then I'll I'll bring that back to you. >> Some additional save. Are we marketing like you know patient care assistant programs too and I know that's more on the on the person themselves but maybe that as a district because that a lot of medications that are very very expensive like personally that's something that is000 a month or something they have that but it's on them but that's something we should probably >> look at too to provide >> your current plan with CVS Caremark um which we're out to market right now on PBM. But with CVS Caremark, you have an automatic where they take the manufacturer's assistance for specialty meds. >> What traditional PBMs like

146CVS Care Mark do not do is do it for just brand name medications. So, you could right now be promoting the brand name medication copay cards. The other PBMs that we're looking at, and the one that's actually leading right now from a pricing standpoint, takes in consideration the brand name ones too and applies that as a savings to the plan. and the member has a reduced cost as well. So there are some disruptive strategies out there that can just try to get more and more of that savings for both the member and the plan. >> But doesn't that affect the member's deductible? Like if they're on the high deductible plan, there's even that little amount of pharmacy um can add up and and whittle away. That would not count towards that deductible. Correct. >> That

147is correct. So they're not paying anything out of pocket. So it does not track. >> So we'd want to really target that towards the ones on the PO. >> Correct. >> Okay. Um just a curiosity, was there any other was there a full rec uh reconciliation of our PBM to find any other trends that are increasing above normal your >> in terms of pharmacy? >> Yes. Your anti-inflammatories are the other cost driver. So things like steroids like stellar >> stellar um specialty medications that treat things like Crohn's disease and rheumatoid and seroriatic arthritis and those are where we're we're really seeing it. >> Are there similar programs out there for for those >> not for the ones that we don't have it in place so or I'm sorry there's two different things that we're talking

148about here. I was talking about bioimilars. So I'll take that. >> I meant like similar alternative ways to >> carving it out. Yes. No, >> those are $20,000 a month for a lot of those medications and direct to consumer is not an option for something like that. But you do have manufacturers assistance that we're tapping into that automatically funnels that behind the scenes to the plan. So it reduces the cost by 15 to $20,000 a year, but that's maybe like one month of the cost of the medication is what it averages out to. Has anybody done anything uh where they've said, "Hey, we know that if you go through like a good RX, it doesn't come off of your high deductible, but is there something like creative where we could say, well, you can get

14910% of it or something like that where they would be incentivized to use that alternative kind of coverage, >> like a better a lower cost pharmacy, a place to get it for a better price." >> Correct. >> Yes. So, we're going to get there. >> Okay. I'm sorry. >> All right. So, just so just to kind of recap, that first section was really about these are the things that we're going to do. This is what we're going to do in order to um save dollars for this current plan. So, just to be clear to everyone listening, the board is not removing any benefits from any of your employees. they're going through a different process. Their coverage will remain the same. Their costs will remain the same. It just will allow for uh us to go

150for an option that will be more affordable to the plan itself and and the um insurance fund. >> And one uh benefit is that right now Zbounds, which is the one that is more effective out of the GLP1s, is excluded under CVS care. They partnered with WGO with that drug manufacturer and excluded Zepbound. um which is why you have more WGO spend than debt bound on your plan right now. Both of them have direct to consumer so the employee could use >> and we've gotten feedback from our employees that um have requested for the zip bound to be included in the CBS portion. Okay, now we're shifting to 2627. Some options that we have as we look at projections for 26 27. All right. So, just to set the stage, we are because of what

151we just talked about with the current year running over budget, we are looking at a 22% increase, but if you remove the GLP once for weight loss, that goes to a 17 million or 17% 2.2 million is still not a viable option. So, what are some of the strategies we can do to get that down to something that's more manageable? Um the PBM changes focus on the lowest net cost for the medication. Some steerage opportunity there. We have 8% pricing improvements right now pending additional options. We will be be we will be bringing that to the insurance committee and then the board at a future meeting. That is 8% is about 290,000 in savings from where you're at right now. But when we say savings in pharmacy, and this is really important, it never means

152your costs are going down. It means if your claims were the same under your current contract like CVS Caremark versus this other one, this other one would cost 8% less. Pharmacy trend exists. So your costs are still going to be going like this under any PBM that you're with. But the pricing improvement is contract to contract is what anyone that is selling pharmacy benefits needs to understand is going to be a pricing improvement, not a savings. like we don't take $280,000 off of your projection. We do include that there is a a premium or a savings or if there's an improvement in rebates and we know that money is coming in, we can factor it in, but I just want to be clear on that's how it works. Um, so we'll go into that in

153a little more depth in a second. The second one is a solution for certain high-cost claimments that is funded by charitable donations and it is a program that was established because a the CEO of the program had a wife that had a terrible medical condition and saw what it did to their family. They couldn't afford their premiums, their deductibles, their everything. was able to start a charity, get charitable donations, and those fund people that are approved for the program. And so I have several clients that are taking advantage of it. The member gets free care for the whole year, no premiums, no deductibles, but we'll talk through the mechanics in just a moment. Plan design changes. So, in the past, we've been able to impact your renewal increases by increasing deductibles, out of pockets, um,

154moving some things around within the plan design itself. That is shifting more costs onto employees. And I know that's not really where anyone wants to go when we are battling a renewal. So, I have that up there because I have to show you that that that is a lever that you can pull. That is not where I would recommend. >> Did we um, so we introduced the standard plan, right? One of my concerns was we now have four plans as opposed to three um and that uh you know really trying to guide people towards those um alternatives to the PO. What did we see in our overall um uh did we collect any more people to purchase health insurance because we introduced that plan? >> You did. >> Okay. The next question is we have

155an employee employee plus flat spouse employ and family or or employee plus one child. Uh you have employee plus employee only, employee plus spouse, employee plus child or children and then employee plus family which includes a spouse >> in uh have you had uh organizations say well the employee plus plus spouse that maybe because that employee um you know maybe our plan is cheaper which I don't know or maybe they're self-employed um or maybe they can't get coverage somewhere else. Um, if our if we're trying to create a a healthier pool, should we look at saying let's do employee and then employee plus child employee family and skip the employee spouse? Have you seen savings >> carving out that altogether like not offering employee spouse coverage? >> I haven't seen it in public sector. Um,

156you are permitted to do it legally. We have some clients that do it in a different way, meaning you could make them sign a affidavit saying that they don't have coverage elsewhere in order to be on your plan. I have a law firm that does that, for example. Um, others like my own organization just did this this year does a spousal search charge where if the a spouse has coverage available through another through their own employer and they come on your plan, they have to pay a penalty basically a search charge on top of the regular premium for someone that doesn't have a working spouse. So there's those are >> Does that move the needle on any of those options that you've seen? >> Um, it does. So you'll have fewer people that will have

157their spouse covered. I'm kind of laughing right now because I have clients who their spouses are complaining because they have people coming on and off of their plans due to what my company did to our own benefits. So, you do see movement. Um, >> but in the right way, does it make the the collective whole healthier? >> Spouses are the worst risk on a plan like generally. So, yes, it can work, but I think that you all that's not going to be what saves the plan in general, but that is a strategy that you could look at. I'll I'll say a lot of companies do that, but it was actually cost-saving for my spouse to pay the fee for me to be on his >> with ours. So, like it depends, right? You know, >>

158you're not going to get everyone off of the plan, they're still going to make that decision, but >> it's instead of saying you're excluded all together, it's a way that you could still offer the choice but charge more for it, >> right? Because inherently we're going to have more risk in taking that person. >> Yeah. Exactly. All right, the next thing that we will talk about are network changes. We looked to uh we went out and looked at different TPA. So in addition to Florida Blue, we went out to market and asked for different TPAs to propose not only their fees but their networks and what's available. And so we had uh Blue Cross gave us their own blue options PO network, what you have today, broad national network. and they also proposed their blue

159care network which is a Florida based HMO network. It has almost all of the same doctors in our area but not all of them. Uh hospitals in the area we don't see a disruption but once you get up to Mayo Clinic that is out of network with with blue hair. You also don't have coverage outside of the state of Florida except for emergencies urgent care and pharmacy. >> What about like Shans and stuff the medical the children's medical? Um, so I just went through all of this for another client. I believe that Shans is in network, Neores is out of network, but I could have those reversed. I have the full analysis. >> Can we double check on that? >> Yeah. >> Okay. >> So, with that, you could keep your same four plans and

160instead of having a 17% renewal, you would have a 7.9% renewal. Now, I wouldn't recommend that you only offer a a blueare HMO network because some people might need that outofstate benefit or want to buy up to that or they have a child that's away at school that they want to have full insurance for, not just for emergencies. So, there are there are some options that you can combine them. So, Stson does that. They have a blue care and they have a blue options plan and it just costs more to have a bigger network. So, we can look at that overall restructuring of the plan. So this is something that I think speaks to what you were asking about pharmacy. Can we steer them to lower cost better providers and uh this that is the

161concept that we're looking at here. So steering employees to lower cost higher quality facilities pay on a fair transparent price for services rather than a percentage of build charges. So, if you can do this, and we're going to show you the mechanics in a moment, then you can offer richer benefits to employees that make the choice to go to those lower cost, higher quality providers, and they still have the choice to go to others, but there is going to be a higher cost for doing so. And that is not something that I've brought to the board before. It's something I've been talking to um the staff about for about a year and a half or two years and vetting through different options there. And so we want to just show you what that would look

162like and um take any questions that you have. So this is a table because as I was going through this uh over the past couple of weeks, I thought it was helpful to just at least see it all line by line and then we can come back. Um the ASIS renewal, as you can see, the 22% if we remove the GLP ones for weight loss, it goes to 17. The alts one, two, and three are for um plans that I will show you, but they are not what I would recommend. They involved either moving everyone onto your current base plan or moving everyone on to your current base plan, but at a higher deductible and out-of- pocket cost or the final option is your current base plan paired with a slightly less generous HSA plan.

163>> I have a question about um our high deductible. It also has a co- insurance. Yes. And that's what I found to be actually shocking. I think that's part of the problem. Uh because typically when you have a high deductible, you once you pay the deductible, that's it. But our high deductible, you keep paying that co insurance. What if we remodeled it so that um it's more a more traditional high deductible and then see if we can move people up the PO because previously the PO is the one that's always in red. Is that still the case? >> It is. And let me let me get there. But I'm going to tell you just one thing about the HSA plans. They can be there's one rule about them. They have to have the IRS minimum

164deduct two rules. IRS minimum deductible which right now is $1,700 for single and $3,400 for family. And they can't have have an out-of- pocket max that exceeds the maximum for that year. So in between that it can have co insurance. It can you can put a the deductible and make it 100% covered, which I'm going to show you an option on that in a second. Or you can have co insurance, which most of my clients do a 20% co insurance once you've met the deductible. So you're paying the first 3,000 and then 20% up to 6,000. If you make it a $6,000 deductible and then no co insurance, they just get there faster, right? So they're they pay the full high deductible and nothing else at I think the people in a high deductible, they

165need kind of like what is that amount that I have to save for to put in that HSA? And when you say that you have a deductible plus co- insurance, they're like, why would I do that? Nobody lay people do not understand that, oh, according to law, there's this maximum. Why not just bake it in so we can make them feel more secure in making that choice? >> If we made the deductible, right now you have a deductible of $2,000. If we made that also the out of pocket >> single person >> if we made that also the out-of- pocket max you would it would just cost more. So the plan itself the >> what would be what would be the deductible with the le let's say what's the average 20% co insurance what if

166it's 4,000 right and then we make that the but it's a concrete number and not some hey 20% you hear uh horror stories like a million dollar medical bill. Oh, because the out-ofpocket max still caps you. So on your plan, you have an out-ofpocket max. So you have a a $2,000 deductible 20% to a >> 3500 out of pocket. >> Okay. >> So instead of making the deductible 3500, which is truly that like limit, >> we've layered it so they're only responsible for the first. >> I'm less concerned about the individual and more concerned about the family because those are the ones. But uh I don't I think it's more than that, isn't it? No, the deductible on your plan has an embedded $3,400. If you have a family plan, one person has a $3,400

167deductible. Then the family and aggregate won't pay more than 4,000 between the combination. And then is it 20% Joshua? >> Yeah, 20% 3,300 is the embedded deduction. >> And what's the max out of pocket? >> 7,000. >> But each person has their own 4,000, >> right? Which that's I think that's also a little unusual. I think if we tweak our high deductible to be more um appealing, more predictable, we would get more families. >> All right, let me show you some other stuff too on alternate three and four. We already talked about the different networks. So, let me go ahead and show you the model. >> Oh, I should speak to that. So, two things. one the notes at the top you can see but the PBM savings are not factored into these meaning once

168we have a decision this will change you're going to see an improvement no matter what because right now we already have one the other thing is alt five and six are the ones with the tiered network or the tiered benefits sorry not a tiered network and if we assume a savings on the facility claims of 35% which alternate 5 is what I'm comfortable with alternate six is something that is realistic and you'll see why in a moment But on alternate five, if we have a 35% savings in facility, then you would have a decrease from your current funding rates. You would have a a 4.9% decrease and we would also be able to enhance the benefits as I'll show you. >> And real quick, so in your packet for all one, all two, all three,

169and also included in this uh PowerPoint, you have the breakdown for what that plan would look like, out of pocket maxes, deductibles, things like that. We'll be diving into actually what five and six look like for those just as reference. So we'll get there here in just a little bit after. >> Yeah, I'm not understanding how we get savings on facility claims. >> Yeah, that's what I >> just side note real quick. The um I'm sorry the health center that we can't we don't call it a health wellness center. Sorry. Um, what type of participation are we getting there? Are we getting up to what we need? Is it that they're going there maybe for their blood work but not their chronic conditions? >> We have additional we've got additional information on that coming. >>

170Okay. Sorry. >> Yeah. No, no problem. >> Just in a nutshell, you are outperforming every expectation with your engagement at the health center. >> Awesome. >> Wellness center. This quick hit is just what we are doing for you. So you are part of a group p group purchasing organization for pharmacy which is RX benefits. Right now you're with CVS Caremark but they have access to CVS optimum and express scripts. It's 3 million employers with three mill 3,000 employers with 3 million members and those contracts are renegotiated every year. So we don't have 2027 pricing yet because it's so early in the year. You're on 2026. um they do release those over the summer and so if you were to stay with RX benefits you would go on to the 2027 enhanced pricing. The additional group

171purchasing organization opportunity is through our managed pharmacy alliance. So Brown and Brown has a team of 200 pharmacy consultants that we tap into for this. RX benefits just joined the managed pharmacy alliance also so that they can we can offer their service model for certain clients if they go with them. But we have access to things like Rightway who partners with Mark Cuban's cost plus pharmacy. I'm not sure if you've seen anything about that where it's why are we paying markup? I just want the drug for the price and then pay a slight admin fee. >> Yeah, >> that's the model. And >> he's actually done that for all of his health plan. So the businesses that he owns, he does not he does everything direct contract cost less. Um the Met Impact is who

172is leading the charge right now. They are the largest independent pharmacy benefit manager and they only do transparent pass through pricing meaning it is an admin fee. It is not a spread pricing. Welldine is another one. Right now we are looking at MET impact and pending the rightway proposal. So when we come back to you again we'll have all the details on that but I wanted to let you know that's where we're at. Um some of the disruptor PVMs that are out there like rightway and med impact include additional savings tools like the uh manufacturers assistance for brand name medications not just for specialty. Um there's some patient assistance programs that they help the member work their way through if they want to. Nothing is forced and then cost of care navigation. And if you

173can go to the next slide. The only other point I would say here is that it is a transparent pass through with there are no games. And I think I've told the board before because I'm pretty candid. It's it's murky on purpose. There is so much ambiguity within pharmacy pricing that none of us really know what the pharmacy is getting paid versus what you all are paying for that medication. Like that's difficult to to ascertain. And so we have a a transparent model that you can tap into. The right way typical savings is 15 to 25%. That impact is 10 to 20%. That's if you take advantage of their international sourcing and additional programs that we'll talk about the next time I see you. When we show an 8% we are that is the guarantee

174within the contract. It can outperform that based on these programs. >> And this is access to the same prescriptions. It's not like okay why is it then that we would get different pricing on international I thought we had like a most favored nation kind of agreement >> that's something that uh the president is working on but that is not rolled out to the greater world >> and real quick to touch on the drug list whenever we if we did entertain the possibility of going to a cheaper PBM what we do is we have them pull a disruption analysis so that way we could see based on our current formulary and what it would go to that way we have an understanding meaning of hey if we're going to go with saving 5% 8% 9% but

175it's going to have this impact on our current employee population that's something we take into account and would have in front of our insurance committee and also have that available for you all. Yeah. All right. This is a program that helps those with complex conditions. And if you all think that this is a good idea, which every client I've spoken to did, um, we do need to launch this a month before open enrollment. So that would be April if you do May for your normal open enrollment. Uh the reason for that is if the member the employee is accepted into the Samaritan Fund program and they get the free medical care for the year, they need to decline Flaggler schools health insurance during open enrollment. And so that's the timing issue. >> Should you walk

176this through again? Okay. So you're saying that somebody who's already ill, you're has something massively, you want them to decline health insurance. What I'm saying is that the member instead of being on your plan if they apply for this program gets placed on an individual plan with the same doctors and prescriptions covered and that is funded the premium and the out-of- pocket costs are funded by the charitable donations. >> And where do they where do these donations it's a it's a nonprofit agency that's running this. >> Yeah. Can you where are they pulling the money from? And how do we know like um how solvent do we know it is? How successful like our we don't want to move to something like this and then boom this thing you know goes out it's like just

177a fancy gofundme or something. >> Yeah. And everyone's like what what is the catch? So I've I've vetted that too. I have university clients that their charitable donation team have vetted it and so I don't know how you do that frankly but they're a 501c3 nonprofit created to enable eligibility for grants and charitable funding >> and this is the name of the company the Samaritan Fund >> so the Samaritan Fund Foundation is the 501c3 the Samaritan Fund program is a for-profit entity that administers the funds to the members so there are two different entities foundation. >> That's how they get the grants without paying the taxes and then they give it to their own business to administer. >> They only use the funds that are in the foundation to purchase individual health plans and pay

178for the out-of- pocket costs of members. >> Do you know if so this specific because I know that there and I don't know if it's this one or others but there's similar um organizations. So if I'm um you know someone looking for that I have the insurance um I apply is this one that says okay what is your diagnosis because they only have certain amount and I'm asking because I know some do like if I have a certain diagnosis and I click on that or that's what my child has and I know the medication is going to be $9,000 a month so I do all of the things upload it they only have a limited number of diagnosis so I'm wondering is that like >> that's not the model because there are models so I

179just want to make Sure. Cuz I would >> I think the biggest thing with this as we start looking at like some of the samples of it is this individual would apply for it and then if they are accepted, we still we would pay >> $55,000 for those individuals to be a part of of this program. And we >> 55,000 is your payment for that concierge to place them on an individual plan and to not go away afterwards. >> Is that we are still total or >> 55,000 per person that is accepted onto the plan. And so for example, I have a 2000 life group that they had two people that were accepted onto the plan. Um I have Stson had three. Yeah. >> Okay. >> And there's certain thresholds it has to hit. So

180say I'll use me as an example, right? getting to the end of this plan year, right? Say I'm on the health insurance and I get diagnosed with a condition that I know is going to be longterm. It's going to be very costly. I'm on the insurance plan. Come April, I go, "All right, I need to get some assistance. I apply to it. I sign over information so that they have access to all my medical data and medical records." It then gets reviewed by a nurse that goes, "Yep, based on this condition and what we see looking ahead to the next plan year, it is going to cost let's say $150,000, right? It would cost in medical cost and pharmacy 155 $150,000." Goes back to Brian Brown. Brian Brown's able to go, "Yes, eligible. We would

181pay $55,000 for what would have cost the plan $150,000." If I am an employee and my max out of pocket cost is $7,000, why would I do this? >> Because you have no out-of- pocket costs on that plan. Zero. Not any co-pays, deductibles. >> So, this is a chronic condition that they'd have because >> like let's say that I get cancer in the middle of the year. I wouldn't know that. >> Correct. So, the the one thing about it is that it is based on your plan year. So, you all are a little unique. Um, I was telling uh Bob and Joshua about this. Since you do open enrollment so early, we would need to advertise it in April and employees would reach out if they are accepted into the program, they can decline your

182plan in May. Well, what if something pops up and they have a new diagnosis in June or July or August? because your plan doesn't start until September, we will recommunicate that and we can move them from your plan onto that >> from the um let's say the last couple of years the conditions where it drove us into our using our risk pool >> were those conditions that folks would have known earlier on sorry look at that >> I think it's like two pages >> are you chat ping what are the questions that J ready is going to ask one page ahead >> yeah I always tell the team that I train, I anticipate every question. So hopefully we're >> nicely done. Very good. >> So the common conditions that qualify are cancer, ongoing cardiovascular conditions,

183organ failure, childhood diseases, uh inflammatory autoimmune conditions requiring ongoing specialty medications. So you can see it's a variety. Um some of these conditions are lifelong. Uh there's one, but if you go to the Samaritan Funds website, you can watch some videos. They also have um a weekly webinar that's hosted by the CEO to kind of talk about the mission, but one of the videos is about a child who is wheelchair bound and has a birth condition and they they are on Samaritan Fun year after year and they like love it and think that it's the best thing ever. They don't have to pay anything for the insurance. The ones that are more short-term are what if I have breast cancer and I go through my treatment and then at the end of that year, you

184go back through the approval process again. So each year during April, >> your team that uh sends out the information for open enrollment would say Samaritan's fund, they would go through the underwriting again and if they are better, thank God, they just go back on to Flaggler schools plan during open enrollment. Um the other guard rail that we need to put on this is especially given your participation is that you in order to qualify you need to currently be enrolled on Flaggler's plan for 2025. Um because we don't want somebody just coming out of the woodworks and saying I want free healthcare and you weren't like that's not fair to the the premiums for everyone else in the plan. >> So do do they continue to make their premium payment? No. So we send out

18555,000 >> correct >> for that year. >> There's no more premium for the patient. >> That's all funded out of the 501c3. So the premiums debit card. >> Do we receive the premium from the the 501c3? >> No, they're not on your plan anymore. >> That's that. So we're we're b and then what about the in the next year? And the next year they would go through the same underwriting process and approval denial process. If they are accepted to stay in the program they just get it again. >> But we have to then pay another 55,000 every year. >> Absolutely. So >> if if they meet the qualifications. So remember the minimum amount of projected claims in order to qualify for this program is 100,000. >> Okay. >> So that's not an employer. >> So

186we're at least going to save 40% cost >> avoidance. How much would in in in an average because we have different plans. >> What would we have collected in premium or in um >> Oh, the most that you collect in premium is maybe 10,000 a year and then you're paying out $100,000 in premium. >> Clearly the math goes it works. The math works. >> Yeah. Right here it's saying that we would have saved $2.1 million. >> And that's if all of those if they opted in, qualified, and wanted to go in that direction. Now, the ones that I've shaded in blue are some of the conditions that would have likely been accepted based on the history of those conditions, how long they were going on for, and what it was. >> Um, so you could

187maybe three would be great. And we don't account for this in your renewal projections. So, I'm not going to gamble and say we think your top three claimants are going to take this um free care. >> This would be just gravy because we don't. >> Correct. Okay. >> And then I think furthermore, it's somebody that is going through a really tough diagnosis and treatment to not have to pay for their premiums and their deductibles is is huge. >> That's the what's in it for me, >> right? Because otherwise you're just doing it to help out the the district. >> Their benefit is that no no um >> and I welcome anyone to look up the Samaritan Fund program and watch the videos and and you can participate in the webinars. They are. It's been life-changing

188for several of my members at >> I really appreciate you bringing something unique like this forward. >> Thank you. >> No, they're not related to Samaritan Ministry. >> They're not. >> Yeah, but can you go to the principle of the good Samaritan is where the name came from. >> Okay, here we go. >> So, inspired by the parable, sorry, of the good Samaritan. They exist to bring peace of mind, financial relief to employees facing serious medical conditions. So that's truly the mission statement. >> And just to just to uh what Miss Ready asked earlier for the sustainability of it? Um are are they doing like some direct negotiation with with the healthcare provider? Are they just paying the full rate like we were? >> They're paying individual premiums. >> So an individual policy and >>

189Okay. But so essentially they're they're creating their own you know network of policies. Are they are they self-insured or is it >> No, it it is not a group plan individual to transfer the risk fully. >> Okay. All right. >> So all they have to do is is calculate that they can that they have raised enough money to pay the premium >> not so much the procedure. Okay. Got it. >> Yeah. And that has been I'm trying to find the how does this work? How does this work? I think it is funded by people that really want to help address a problem which is higher deductibles and out-of- pocket taxes have become common and people can't afford their medical care. And so there are charitable organizations that will say I will I'll buy your a

190health insurance. Now you all the entire role of the district HR team is to say that this program exists. This is not one of your employee benefits. This doesn't go in your guide. >> This is a program that exists and if you apply and want to decline the health plan, you you have that ability. >> So how does that information go get to the employee? Because you know with HIPPA and everything our HR >> we don't target the employees. it is sent out to everyone but for open enrollment >> and if there were employees that have let's say come to anyone and said I I'm have FMLA and I can't afford my bills and have expressed that you're welcome to say do you know about this resource right >> but there isn't going to be

191we're pulling claims from blue cross and sending out targeted mailers like >> and I just want to be realistic that many of these diagnosises you're not always going to know about like an acute polycyitis you know >> I looked at the history of how long some of this stuff was going on for is the only reason why I highlighted those. >> Sometimes the primary diagnosis is swirly too, but they had claims that were happening for multiple like seven to 15 months of the ones that I highlighted that were questionable. >> Now, is that 55,000 a lump sum >> or is it paid out? Because here here's you know just you know worst case scenario. We we have somebody come on. >> I know you're >> we we throw 55,000 next month they go insolvent. >>

192What is our liability now? Because we've we we've paid out 55,000 uh >> as far as the foundation going insolvent. >> Right. >> So they they prepay the premiums. So the premiums are paid for that employee. >> Okay. >> Now the other issue that I have had come up with clients is what if somebody were to leave? >> Just leave. Yeah. and you paid >> and you've paid 55,000. That's is their own individual policy. Like >> there's you can't claw that back because it's truly you you don't own that policy. >> So if they're no longer an employee here, >> then will they still get they still get the that coverage for the remainder of the year >> for the rest of the year? Now the the counterargument to that is if they would have

193stayed on your plan as a COBRA member, you'd still be on the hook for all of those >> or maybe they're too sick to work. So then >> correct. You don't want to hit them with >> but then we're the only obligation we have is for that plan year. >> Yes. >> Right. So after that if they leave >> they couldn't reapply if they were no longer an employee. >> There's no like like a cobra for this. Right. Okay. Gotcha. >> All right. Very good. I mean it sounds >> too good to be true really. I mean uh if somebody can get approved for it >> they can get approved for it. you know, >> it's I think it's one of the most exciting things that I've been able to bring to clear. >> Okay.

194>> So, there's some more information in there just about like how it works really kind of getting down things that we've already kind of shared here at the table. So, that Yeah. So that's there for you just to review just as we kind of continue and move forward to our next >> and we wanted to include that in there so that when the committees and the community looks at it, they'll have all of that information and not rely just solely on what we're saying, they can see it in writing. >> And the only other thing I want to clarify when it says that our office approves if it's over 100,000, we need to verify that they work here. >> Sure. >> So we say yes, that is a person that is currently on the plan.

195>> Yeah. Yeah. So, we're not doing the medical underwriting. >> Okay. All right. So, creating a sustainable health plan is kind of the next section. Um, >> I think that's an oxymoron, >> right? Uh, sure has been my mission. I've been podcasting it up for the last several years. >> Oh, really? Oh, I'll have to look that up. Um, I can share some good ones for you that you will get hooked on. So, really what I want to talk to you about for the next few minutes is regardless of the discount. So, we looked at blue care versus blue options and we talk about discounts versus build charges and we want to get the carrier that has the best discount off of the build charges. And with the passage of the Consolidated Appropriations Act in

1962021, the CAA, there were some compliance things that employers and health plans and hospitals and everyone have to do. And even as a benefits consultant, I just looked at it was why do we have to post that we have machine readable files on our website? And without really understanding the purpose and the intent behind that law, I didn't realize how powerful it would be. And what we've found is that there are tools, free tools that you can tap into transparency data and that carriers are no longer allowed to prevent employers from seeing your own pricing specific to a hospital, a facility. Now they do. So we still do not have access right now to your specific claims with Dr. Bob or what what was paid to Dr. Bob versus what the build amount was. We

197have it in aggregate, but we don't have that. There is a letter that I've just gotten from an attorney that you could actually send to Florida Blue saying, "We have rights to this. Please send it over." >> Um, there's also anti- steerage clauses within every TPA contract. And I have to say, I I have 17 years of strong relationships with carriers, but I work for clients and especially public sector. I'm passionate about it. ask anyone that I've been on calls with not being able to steer members to a lower cost, higher quality of care because there's a contract prohibiting that does it doesn't make any sense to me. If we know that something is the same exact test, the same exact quality provider reading that scan and it costs $1,000 at hospital A and 10,000

198at hospital B. Why can't we have that information in order to better inform? So, you can't even provide the information or is it that you can't just say, "Well, that one's the better one." >> Um, the the carriers in the world, even the one that you're with now, who I we have a lot of clients with, you cannot set up benefits to steer members one way or the other. We cannot say hospital A costs less. We want the copay to be $50 there. It is not allowed. So what the CA did is they do not allow the gag clause at the station that we all have to do prevents us from not having the data we need to make those requests. And now that we have the data and can see the costs specific to

199each hospital and facility versus what their costs are because that's also a law that they have to file what their costs are every year. Well, now we have the information needed to do our fiduciary liability or our fiduciary obligation as stewards of a self-funded health plan and steer members to the lowerc cost, higher quality care. >> Mhm. >> And so that was the missing piece. So if we can go to the next section, this is what I was just kind of hinting to. It's not only but I I do want to look at that for a second because as as a self-funded plan most plans that are not governmental are um overseen governed by Orisa and Orisa was enhanced with the CAA but it also applies to public sector clients. Any self-funded client has a

200fiduciary obligation to be a responsible steward of employee and public funds. And now you have the data to guide informed decisions. And if you do not use the data, then there is an argument that we don't you're not doing anything. Right. >> Right. >> And so I have university clients that are calling me because there there are beginning to be lawsuits out there of people saying, well, why didn't you find me a lower cost facility or why is my insurance going up so much? And literally within the last two years is when this data became available. And now there are tools that make it easier to gather. And so if we can go to um this one is really just looking at your spend from hospital uh based on location. And so you can see

201you've got a lot of spend within um Advent Homeost which of course were right here uh in the community. Uh third is Advent Daytona. Then Flaggler Hospital which is up in St. Augustine. You have some in Mayo Clinic Baptist Halifax, Orlando Health and so on. Um, hospital spend is making up, let's see, what was the total hospital? I believe it was nine $9 million in hospital spend. >> All right. >> So, that's interesting because I know the our hospitals in town don't provide um you can't deliver babies there. >> Correct. >> So, I was I'm surprised that >> they're probably going down to um Advent and uh Halifax. >> Yeah. Advent Daytona has an excellent that's where a lot of my friends have their babies. >> I'm trying to find that one on the list.

202>> It's the third one down. >> Oh, okay. So, because I was like, oh LPGA. >> It used to be the um Halifax and then the one in um St. Augustine. I was like, that's too low. >> Yeah. >> You know, so okay, that makes more sense. Thank you. And when we look at number of members versus number of claims, same things as we were talking about with pharmacy, like one person could be going for multiple services because one episode of care could have 15 claims on it. So that's what the claims are. >> So Miami is that like so this is not emergency care >> or is this like >> everything? >> Okay. So if somebody was on vacation Miami, they got hurt, that's probably why. Okay, I see. >> All right. So this

203is what has been like really empowering and so cool and uh there is a link to it within my like live presentation. We will send it out to you so that you can uh access it. It's free. It's public. It's called Sage Transparency 2.0. was launched in 20 May of 2022 and updated again in May of 2024 and it aids employers, policy makers, researchers and the general public in making informed evidence-based decisions. It highlights the wide variation of pricing quality across providers. It shows the break even cost data for individual hospitals, hospital systems and states and quality metrics specific to individual hospitals. So when we're looking at this today, I'm looking at facilities. I'm not looking at individual providers. Um I think that if you have to start anywhere, it is your facility claims because

204they're driving the bulk of your spend. >> So one thing that I want you to just keep in mind and I'll call it out again is that when we're comparing the ratios, we need to look at the total inpatient outpatient. So I'll show you that column, but as you're going through your own tool, you might be like, well, why is it so much? They're charging so much for outpatient provider and really there's one column that you can make an informed comparison with. Okay, this is not specific to Flaggler schools. This is to paint a picture that is incredibly frustrating. Florida is the most expensive state in the US for medical care under commercial insurance plans and there are several others below the all states median that we removed for spacing on this exhibit. So the

205median is 29 269% of what Medicare pays is what the median prices for a Blue Cross Etna Sigma a normal insurance commercial payer to pay. And in Florida they pay an average of 380,000 or 380%. The break even amount is 137% in aggregate. And so the delta of 380 to 137 is the profit. This is this is an aggregate number, right? So we'll dig into more granular. So how do we use that data to design a better health plan? Direct contracting, we can directly contract with high value hospitals and facilities for bundles. We can do um a maternity bundle where that whole episode of care is in one bundle. uh you can look at imaging and msk muscularkeeletal services the same way uh there are predictable prices and quality guarantees and you remove the middleman

206but you pay them like you pay your I don't know any of your bills that the district pays you don't rely on a tpa for some of that you truly just pay them I had eight babies here is eight times $100 >> hospitals and facilities win because they eliminate that l that lengthy payment time of getting paid by the insurance carrier. >> What do you do? Uh charge like a um if if a if an employee doesn't go to the preferred hospital or whatever for them, >> they pay more. >> Okay. >> So, in the first section or the direct contracting that I'm talking about, um this is some wins for the hospital are that they get paid faster. And did you know how much money insurance carriers make on float? the money that they

207take or that they have invested between when they collect premium and when they have to pay a claim. >> I bet >> I'm telling you it's been eye opening and I think that there's just a lot that you can do for public sector on this specifically that is needed. So we've been >> okay but in an area like for Palm Coast where we don't have a lot of options for facilities. So, you know, unless Advent is also feeling generous, what are our options? >> I think that we need to continue having conversations with Advent. Um, I think that having access to your own transparency data and saying, "We don't want to get paid. We don't want to pay what Medicare pays. That's not what we're asking. We want you to have a profit." But if

208your data comes back and shows that you're paying an excess profit, I think that there's a conversation that can be had to work out something more >> manageable and fair. It's it's using transparency data. And I think that there's there are four major payers of healthcare claims and it's difficult to try to do one-offs along the way, but I think that you all are a small enough we're a small enough community that we can have those conversations. It's not like we don't know anyone. Um, so I think that that is something I would highly recommend is to to have that conversation. Um, the other piece is that you'll see on the next couple pages what a tiered Oh, no. Go back, Joshua. What a tiered benefit looks like. So, in that model, which I'm going

209to show you today, you make low co-pays, no cost for services at providers that are willing to provide the price. >> That's what we're doing with our wellness center. But you're saying for the services we can't deliver in the wellness center, correct? Let's create agreements that >> talking about cardiovascular surgery, the big gamut. >> Yeah. Okay. >> Um, so let's go to the next page. This is your data. uh with the exception of the blue and green columns are not your data but after the scary letter we will be able to tap into your specific data per tax ID. >> Okay. >> Uh what we do have is for in general let's look at Mayo Clinic. Mayo Clinic had or has a 297% is their average that they charge commercial payers. Their break even point

210is 137%. So you can see how it it swings all over the place. And there are notes and a full section about how you read this data and what it means. And it takes into consideration the financial losses from Medicaid, Medicare, charity care, and bad debts as I've highlighted there because that's always been the argument. Commercial payers pay more because Medicare doesn't pay enough. That is included in here when we say break even point. And part of it is that there you can earn you can earn um funds by endowments and fundraising and things that mean that you don't necessarily need to charge 350% of Medicare in order to be profitable. And so this every single column on here is from that transparency tool. I did not do anything to it. So net profit margin

211has to be published. Operating profit margin from commercial payers versus Medicare. the operating profit, the CMS quality, overall star rating, which that is broken out into different types of procedures. I just did the general one. So, there are some hospitals that are really great at delivering NICU babies and taking care of them, but awful at knee surgeries. And so, this is just the aggregate that you can pull up. Um, but if you go to the tool, you can see which ones make the most sense for the knee surgery versus the the other examples. And then the patient experience star rating is something else that I thought I would put up there because maybe it's a great hospital, but people don't like to go there um for whatever reason. And then the one on the right

212is just a vendor that we have access to and they are not the only one that is out there. But I called them and I said, "What do you what's your experience with all of these with this model?" and they're paying 158% of Medicare at Advent Daytona. Um they're paying 180% at Baptist and 140% at Halifax and there's a contract stipulating that they pay that with Halifax. So this is not something that is all over the place at this point, but I think it should be for public sector specifically. It's it it's one of the most no-brainer things I've seen. If you have the data and it says that something should cost $20, but you're paying 2,000, then we have to do something about that. Um, so what does a a tiered network look like?

213And can we do this? And what does it mean? These are the plans that I created. So we they are subject to change. We haven't even shown this to the insurance committee yet. Uh, I called them the new A+ plan and the A+ HSA plan. Uh we did put vendors at the top. That is not set in stone. We will go out and find the vendor if that's the direction that everyone wants to go in. Tier one and tier two will be based on cost and quality data and that facility's acceptance of the fair and transparent payment model or a direct contract. So, the tier one providers and facilities, if you are on the co-pay based plan, there is not a deductible. There is a $2,000 out-of- pocket maximum. So, that's the most that they'll

214pay including medical and pharmacy for the year. Office visits $20, specialist 30, inpatient hospital stay is 700, ER in and all of these are all inclusive, meaning they include the provider services. The plan is paying everything above that. So 700 for inpatient, 250 for ER, 50 for urgent care, outpatient and ambulatory is also 250. Free labs, $50 X-ray, and 250 for advanced imaging. If they go to a provider that is not willing to accept that model and they are the more expensive, then they still have access. It's a $3,000 deductible, 30% co insurance plan with an 8,000 out-of- pocket max. So, there is choice still, but there is the data to support that this is the way to go and we're going to steer. >> So, uh when you're paying a deductible though, you may

215have several medical events. So, is there like let's say that you go to four things in the year that get you to hit your deductible. If one of those events you are not you don't choose the preferred facility or um not available does that kick you out so that it you know essentially oh now you're it resets and eliminates all the other credit you have. >> So you'll see that the overall out of pocket so the out of pocket for tier one is 2,000 and the out of pocket for tier 2 is 8,000. So combined, you could worst case scenario if you made some choices to go to bad or not bad but more expensive hospitals >> and hit your out of pocket of 8,000. You could technically pay 10,000 on this plan. >> Right

216>> now, if it's an emergency, it's going to be treated as a tier one. >> There is not a steer. You can't steer someone when they're having an emergency close. >> So that's something that I do need to change there as far as the emergency row. >> Okay. Um outside of that, yeah, they they would be paying three if they choose to go to one of the expensive not wanting to work with us hospitals, $3,000 and then 30% co insurance all the way up to $8,000. >> So, we're assuming it's one medical advantage >> and they could go back and forth. No, they could have, let's say they want to have an MRI and that's $1,000 and they want to have or they sorry, no one wants to have an MRI. They have to have

217an MRI. They go to that provider. we do have a mechanism to steer them in real time. So, hey, you are going to this provider, you should go to this one and you'll only have to pay $250 versus 3,000. Um, but it could be a series of events that add up to a 3,000 30% co insurance 8,000. And then what if you're using providers that are in the green and also in the gray? Then you'll be >> okay. So, I'm gonna ask a really dumb naive question here. I thought that's what PPOs were, preferred providers, right? So >> that was the original intent. >> So are we saying we're just creating our own bespoke PO on what we're now saying, okay, >> thanks but no thanks. You guys didn't really help us. We're going to

218like >> Yeah. >> And what kind of administrative uh load is that for us? >> It is. You have an administrator. So, Health Scope is the one that I put up there, but there are boutique TPA that do this. >> They are not owned by Blue Cross and Sigma and United and Etna. And so, they don't have rules prohibiting them from doing that. >> Um, they you pay them an admin fee and from my experience, they're what you're paying right now for an admin fee. >> Okay. Comparable. >> Okay. So just so I understand in in this model we have to every plan year have to identify different places that we can that will agree to this price. >> I wouldn't say every plan year. So the intent would be to develop a long-term relationship.

219Now, as your consultant, we want to maintain like looking at the transparency data and say, "All right, look, we have a contract with you at 180% of Medicare. Really, you're still very much overpriced there, and maybe we want to renegotiate that, but I I would suggest that it's a multi-year contract and that >> every three years a check." Okay. >> So then if if we say okay we we look at the hospital costs and we say okay it looks like the one in St. Augustine is is less expensive right so we say okay if you go there you're in tier one coverage but you know if you want the convenience and everything uh to go to Advent here >> then you're in the tier 2 bucket >> assuming that Advent doesn't come and do a

220direct contract with you. So what we're showing on that page is the average commercial rate. So what they're charging Sigma, Blue Cross, Etna >> plans by removing yourself from their contracts with those providers. Advent has the flexibility to offer you different payment >> without opening that up to the broader market that is specific to that is an agreement between you and that hospital. >> So this does this kind of open up a competition uh in itself. for example, because if you know, Advent has a you know, again, love our relationship there, but I'm just using this as a real world example because it's our local hospital, but if if they if if there's a significant difference, we could choose to say, "Hey, this this is the one that is covered under the tier one." >>

221Yes. And I would highly recommend that as part of the next several months if we go in this direction that those conversations are are had with not only Advent and and Palm Coast but all of the hospitals that your members are going to and say look we want unless they are just an awful quality hospital for some reason you don't care but we don't want to disrupt employees want them to be able to go to their hospital but this is this is tier one and this is tier two and tier one is contingent on a fair price. We're not doing this anymore. We're not paying five times what we should be. >> It seems like what I'm what I'm interpreting from your data is that commercial insurance is subsidizing the loss that the hospitals are

222taking from covering Medicare. >> That is what a hospital would tell you. >> What transparency data says is that they're making more than that loss. Correct. >> Okay. >> Yeah. And and you know this in a way because this is something I've been trying to to to to put into a a format is in a way like uh healthc care sharing programs, right? So >> what how they operate is you go get the service, >> you get the cash price >> and then you get reimbursed, right? They they they reimburse you. So I I don't know how that works in in in the world of commercial insurance, but in a way this we've pretty much pre-negotiated the cash price >> in the tier one. So it it essentially accomplishes >> a similar outcome for us.

223>> Mhm. But then you still have stop-loss coverage for high cost claimments. You still have the protections of a health plan, >> right? Because those are not insurance. Those are reimbursement. There's no guarantee that you're going to get covered, but it's a promise, right? And it also can be uh difficult whenever you have very expensive care that you need like ongoing chemotherapy and radiation treatment and you don't have insurance cards. They can't say we know we're going to get paid. This is real insurance. >> And when we look at tier 2, right? So say whatever happens, we draw the line. There are facilities that are in tier 2 that an employee still wants to go to, right? We understand people have that relationship and they still want to go. I'm going here, right? Hospital X.

224When you look at the breakdown between the plan deductible, out-of- pocket maxes, and everything else between deductible and co- insurance, it mirrors very closely to what our base plan is right now with a few differences. The base plan has a 50% co insurance while this is being modeled at 30%. And then you see slight adjustments in out-of- pocket maximums and uh things such as getting your office visit co-pay. So what I can appreciate looking at this is it wouldn't be something like you better better do this or else you can't afford to go to the doctor. It is slight differences but in line with what we are currently offering with our base plan. >> I think one concern for me is if you go to a doctor and they say okay we need you need

225to have this surgery they're going to say well I do the surgery at this outage or at the right so what we don't want to have happen is that somebody needs a surgery but the doctor doesn't have privileges there. What happens in those cases? >> They happen. So member may be rrooted to a specialist that has admitting privileges elsewhere is is a realistic thing. I >> do you see doctors in the plans? Uh you know we're a large employer in the district. Are the doctors going to naturally kind of gravitate to or how difficult is that process? >> I'm in Orman and my providers that I've seen typically have admitting privileges to Halifax and Advent. Now, I don't know if that's the case for every provider. I I truly don't. >> Well, I guess the

226the back the backup from what way I understand it is if if they don't want to change to a different um surgeon or physician, they can always just go to use their tier 2 benefit to to to do it the way they want to do it. >> Correct. They just >> They can also ask for the cash price and see if that's a better deal. >> Well, no, no, that's interesting. So, um I I assume the cash price would only help them in the fact that they would their their out of pocket would be less potentially. >> Um >> well, for a visit, you're not going to get a cash price on a knee surgery, I wouldn't think. Like, >> well, you you act well, it depends if you if you go in for >>

227if you can pay it. Yeah, but I mean in the health sharing case you do there you no matter what procedure you get even if you go in for a heart transplant there is um a there is a cash price that you you you get reimbursement. >> Do they work out like a payment plan under that model? >> Well, exactly. Because most people are not going to be able to to to pay you know $500,000, right? Uh but so you you work out a payment plan and then while you sub I just realized while you submit that then then the healthshare pays reimbures you and then you pay off your bill essentially that that's >> the reason that they can still tap into a cash price is because that provider is not dealing with the

228insurance. >> They have no insurance >> that that costs 30%. >> Yes. Right. >> So ju just I'm just saying that that that's how that model works. But I I know that, you know, I I'm looking at this saying, hey, maybe this is some happy medium in between these two uh offerings, right? The key is just to to not pay these inflated prices. uh we should be paying what things should cost and we should >> with enough for them to keep the lights on and and invest in the tools and people, but it just when I see something like it should be $5 and it's costing 5,000, it makes my head >> and I I and I've seen it firsthand because because our family uses that that kind of sharing program and it's worked out

229really well for us. But when I see the bills and then what we get them down to it, it it's it's substantially less. And then you see the individual line items for like that, you know, pill for $5 and getting charge 150. Uh so if if we could try and bridge this gap here through something like this, I think this is >> I want to just kind of add here that what Danielle has done is here are some options for us to think about as we go into the next um next cycle for the insurance committee. They'll come, they'll look at it, make some recommendations. You will do the same thing as a as a board as a board. The bottom line for us, and this is really for um just the bottom line, is

230that we have to be able to provide quality health insurance for our educators. It's it's problematic to me and maybe just because I'm biased because I, you know, we're here in education, but it's problematic when our educators can't afford >> to have insurance and can't afford that. And so we're we're not looking by any means to we're looking to have options and looking to um um look at all the options that are available to us to help us be able to provide a benefit to our our employees. When we think about $10,000, even though this is some options that gives us some flexibility, when we think about $10,000 for some of our employees, that could be a third of their salary right there easily, you know, and so just like looking at the affordability of

231this >> um for all of our educators. So when we're talking about this, we're not talking about just our teachers, but we're talking about our teachers. We're talking about our pair professionals, our bus drivers, our administrators, all our front desks, um all of those individuals being able to give them affordable options for healthcare. That's what we're looking for. We ask that you as a board take this information, pick it apart, bring some more suggestions. We ask that the insurance committee do the same. We ask that people out in the community, they look at it and and give us feedback on options that maybe we haven't seen. and and and I want to say, you know, um we have a great relationship with our local health provider and we're we're hopeful that they too will come

232up with some ideas because they do want to um they want individuals to be able to get quality health care in their in in um their community, in our community. And so we're we're hopeful for that as well. We just we have to have options because what we currently have is not affordable for our educators. and and another thing. So, just one one other clarification. So, when you're paying a premium, the premium is the same, right? Whether you uh from tier one or tier two, you're just paying a single premium, but you're using uh different deductible models and pricing model. >> So, uh what I just think in in general when I've always looked at insurance and I look at the premium and I go and you want me to pay $10,000 more, >> right?

233I would think hopefully we would get more participation if they saw the premium and because it's the tier one has no plan deductible, right? So I mean that in itself that's the unknown like you were saying earlier something more predictable that co insurance. This this is something predictable. They know they're paying one price. And if they do, they follow the the rules that we've put into place and go to the to the places that we've pre-negotiated, they know they their their health care costs for the most part are budgeted within their premium. >> Because I think that's what everybody tries to do is budget it within their premium. >> And otherwise, they say it's not even worth it. Especially if you feel really healthy and optimistic, >> uh, you know, you're like, I'm not I'm

234not spending that money. But with that, it's like, gosh, if something did happen, >> I know that I'm not going to pay any more than what's came up came out of my check this month. >> Well, and that's why we included the HSA as the other option there because under that, it still meets IRS rules. It's still a high deductible health plan, but then the 0% co insurance happens. Yeah. >> And if you go to tier one, you don't have any more liability. >> Awesome. And I think, you know, to uh the success of our wellness clinic, the messaging that we've done and we've learned how to message through the marketing program that Marathon provided, we could also double down and say, you know, every dollar you spend in your health insurance really affects everybody,

235right? So the, you know, we all need to be responsible. We can't just say, hey, we prepaid for something and now I'm going to use it to whatever. I'm not saying people are taking advantage, but you know, choose this option when possible when when you're not going to sacrifice your quality of care because really we all need to be responsible users of the insurance. >> And I I always look for what's in it for me because there are people that will do things for the greater good and there's some that are not going to do that. But there is a what's in it for me with no deductible and I that's the motivator. Why are you going to go why will you drive an extra three miles to this place? uh if if you could

236still go to this one. Well, it's because I have no deductible, right? You know, and uh and I agree. We should be good, you know, as an organization, everybody should be a good steward of of everything. But, um you know, human nature is >> I just want to take a second to thank Danielle. Um we she hit us with the 22% >> um on that first slide is what we got hit with at the last insurance committee meeting and you know we asked we we we got to start looking at alternatives and and she took a deep dive really >> and so um I I appreciate that and uh the pit in my stomach got a little smaller. >> Yeah, we don't we don't have all the answers yet. Just didn't have all the answers.

237We still have a lot of work to do between now and then but I appreciate >> optimistic. So I have been this concept has been in my brain for over two years for you all. The issue is I didn't have the data >> once I I'm going to send you the podcast. Once I listened to this um it is the relentless health value and it is a fantastic one. They they told us about this uh study that had been done by a large employer union who worked closely with a consulting house and they tapped into all of the machine readable files and took in the other transparency data and now we have this tool >> and that that changes things because then you're not just saying please give us a better deal. It's that this

238is truly what the cost is and we we don't want to pay cost times 10. >> Yeah. >> Well, this is great. >> Well, this is encouraging and also we can look in just one last thing is that uh you had mentioned about the type two >> type two diabetes >> diabetes rebates. Let's look at that too to add that. Maybe that could provide >> we have that right now. And then there are some additional slides that we did not go over. It is for um just information. uh when you look at uh some of the options that we've done before and some of the options that we've discussed. So um if you look at like slide 34, it's talking about if you as a board wanted to say we want to drive down the

239in um increase by changing networks, here are some here's what this will look like. Um and then it's the same thing if you wanted to drive down it uh by changing your plan. here are here are some things not necessarily options that we are looking to go to again because a lot of this shifts the cost to our employees and that's not what we're looking to do. Um some the marathon reporting is in there. We've already said that we're hitting our metrics for marathon um at this time and then there is just some additional information that's for the benefit of the board as well as the benefit of our insurance committee and the public that is there for the continued work that we have to do on this. >> Okay. >> Yeah. and Danielle um

240what they said when I got this and I went through it right when you see the 22% I'm like oh no but you had a plan so I I know this is a lot that you put together but I liked how you strategically you you said it and you're like okay but here is option A B C and I think that's helpful for us and obviously the public when they open up so this was >> yeah I will say this is this is the most digestible u uh presentation we've had on insurance where you could actually see like oh gosh does it actually there's something meaningful that is change could could change here you know >> it gives us a little hope >> there there's definitely hope and I don't want to be the bearer

241of bad news right but with the understanding that we are still running over cost 12.3% and so that shortfall we're going to have to to make up but here are some options to keep us from being in that that u repeated cycle le of this >> and I think for the public too to realize because you know we keep talking about you know insurance insurance and it's expensive but if for them to realize okay the school district is literally writing the checks because we're self-insured so the money that's coming out of their paycheck is going to this a bank account and then the school district writes that check so when it gets higher and higher and higher so that's for anyone that's listening like that's kind of what we're trying to help and then coming

242out of general >> in the simplest form our expenses and our revenue are not balanced right now. Our expenses are way over what the our our revenue is in its simplest form and we can't sustain that. And we've already experienced increase. We've made changes. You as a board have made um work towards this, but we're we we have to think of some other options and look at a different direction. I think our insurance committee, they're ready to do that work. Um I know that you guys are committed to doing that work. You've already demonstrated that and what you've done. um for this plan year. Um but we have to be able to control the claim. >> Can you just can you imagine where >> I can imagine if you guys did I mean because you've

243you committed to um Miss Warmeick was it 2.9 additional how much? 2 million $2.2 million additional that they that the board put in last year for the adjustment. >> It was well over a million. >> Yes. So a million dollars additional to her and we still have to adjust that. So, if you as a board had not done anything differently, then that would be a different conversation. And I want to just end I'll end this and I promise and I'm so sorry you didn't get to go to Bulldog tonight. >> Oh, no. Um, but what I I I will end it with this. As um things change with how our funding is provided to us as an organization, we have um stuck to our budget. We've stuck to our forecasting. And so you don't hear

244us talking about these major cuts that some districts are having to make because we've stuck to that. So we are being fiscally responsible with our dollars. And so this is really about expenses that we cannot control. And so when we look at that, we we don't want to have to bring dollars out of our general fund in order to cover this because then that directly impacts our employees because that goes into their raises, their bonuses, their steps, and all of those things. So, we're doing our part on this. You guys have done some great work on the insurance. Um, and we just have to continue to do that so that we can always be in the best financial position to do the best for our employees. >> Thank you. so much. Great work. >> Thank

245you. >> Now we're on to public comment. >> It's nice to actually feel like you can fix something. >> Okay. Public comments. Anybody? >> Board member request. >> I had on there um so the B internet awesome. But it looks like I just got an email that we are looking into that or utilizing it. So um >> can you clarify what that is? So yeah, be internet awesome. It's um free technology resource designed to help students become safe, confident explorers of the online world. So I saw that uh was marketed, you know, it's through Google um and the highlight and then I was checking in to see if we could look into that. So I think >> was like a student certification or something. >> I the school district >> kit for families and organizations.

246So it's targeted at like elementary schools, private uh as well as public uh public libraries, um after school programs is really what the target is. So it's a set of tools to be facilitated with students. So it's it's not a just a student thing, but it's a facilitated like uh program to bring like digital literacy for for that uh K5. >> Okay. So >> I have that on my list just something like to see if that could be utilized more with our younger youth elementary and middle school. So just for future use so more more information on it and more consistency or implementing it more. So that's all for me. Great. Um yeah so I know that our uh tech team has been doing great work uh especially partnering with the um AI task force

247run out of UF. Um I'm curious in order to just uh ensure that we're crafting our policies in the best foot forward and the recommendations um provided by that task force. There are a couple of items that I was hoping we could surface and just take a look at and one of one of them are the implementation or u the uh norms around you AI utilization in the classroom um like how we're integrating it and with that um what is our uh best practices or vetting uh process checklist look like um you know the education software is evolving continuously and they're incorporating AI faster and faster. Just wanted to take a look at what that review looks like, what our checklist uh look like, and really just um piggybacking off uh Miss Ramirez specifically, I

248was looking at how uh our um redefining our digital literacy to include AI literacy and and what that might look like uh within uh the students progression and what age is appropriate to even begin that. I know Senator Leak has a bill out there which um is to help protect uh students from companion AI where it very much speaks to the student like um a person which can be very concerning. Um so just I'd like to kind of gather some of that information to determine where are we in in this landscape at this time. >> Yes. Thank you. Mr. K, >> not for me. >> Um, board, I just wanted to look at a date. Um, may or may not feel the same way, but I just realized that the day after Memorial Day, we

249have meetings. I was just thinking like as we plan things in the summer, there's kind of a rush to to get back here. Um, maybe we want to move that up a week ahead. >> Uh, Memorial Day is the 25th. >> 25th. Oh, and I see that we have a workshop and a board meeting there. Are you proposing moving the workshop up to the 19th? >> Yes. >> Uh both the workshop and the >> right the 1 p.m. and the 6 p.m. >> Can we Can you tell me the date again? Sorry. The May 25th to the May 19th. >> Oh, you get a good memory. >> So you want to you want to move it up to the 19th is what you're saying. >> Yeah. just to give some flexibility there if that's okay.

250>> Just don't bring me a birthday cake with 51 candles on it. >> That's exactly what we'll do here. Set off the fire alarms and all the things. >> Okay. I'm I'm okay with that. >> I'm fine with that. So, you said uh changing the potentially the workshop and the meeting just >> so moving everything to the 19th. >> Thank you. Got it. >> Okay. >> So, I believe that is everything. >> Comments. >> Oh, I'm sorry. Comments. >> Uh, I just had a quick thing with um the legislative session, how it's, you know, coming through um the academic side. The House unanimously passed bills that would require cursive writing proficiently um the allow marching band participate to satisfy the PE credits and then families with um students with ESD. Lawmakers are advancing measures that

251would strengthen safety plans for students and grant parents greater access to IEP services. And then moving forward, they uh the legislation is um moving forward to require the district to post, you know, full line budget online uh total transparencies. I personally feel like with our district, any questions we have with like budgeting and things like that, we are we're open to get anything that we need with meetings and calls. So for for us, it doesn't really matter to us, but uh just want to give an update that things are moving along. So otherwise, have a good >> It matters. It just doesn't really change. >> Yeah. for us. I feel very good about a lot of things that changed. Um >> but just wanted everyone else to know. So we're we're doing great here. >>

252Thanks. >> Uh yeah, I just want to thank the board and um for a robust conversation today. I think you know we all got to really dig into some questions and understand um uh the problems uh that we're facing around healthcare and uh be solution forward. So, I thought it was a really great conversation, great presentations. I appreciated that. I'm looking forward to the um teacher and employee of the year banquet on Thursday and uh I just wish everybody a good night and for all those who have suffered through this four and a half hours. >> Yes. Uh very encouraged with the um presentation today. I appreciate all the the effort staff put together along with Brown and Brown and um you know insurance is always one of our biggest challenges and uh but uh

253we want to make it as as best we can for our employees uh and we will we will continue working that forward and again thanks everybody and the rest of my time. >> Just echoing those comments. Happy 111th day of school. >> Have a good night. Lots of great things happening. Stay connected and we'll see you guys next time. Great. >> Eating is a joke.