By Bill Rusteberg
Much has been written about the Raymondville Independent School District’s health plan over the past several years. Located in deep South Texas, this small rural school district has solved health care.
The district was the first TRS ActiveCare member district to challenge the state government health plan by taking back control in a Coup d’état in September 2019 lead by Stetson “There’s no such thing as an unsolved problem” Roane, the district’s superintendent. Stetson and his team created a health plan model that has since caught the interest of districts statewide, a proven example of how to solve health care.
Within a year over 120 other districts followed Raymondville’s lead, catching the attention of the Texas legislature. State legislators came to realize many individual districts could better manage their health plan on a local level rather than through centralized bureaucratic control in a far away place. As a result the legislature passed Senate Bill 1444 which for the first time in 20 years allows Texas school districts the option to exit the TRS ActiveCare health plan. Prior to this legislation TRS ActiveCare member districts were held hostage by Austin bureaucrats, prohibited from seeking competitive alternatives in the commercial market.
What did Raymondville ISD do to solve health care? What is their “Secret Sauce? Here are the key highlights:
The Raymondville model incorporates:
(1) Medical homes in partnership with primary care physicians with plan managed referrals
(3) Cash Pay Centric point of service claim adjudication,
(5) Direct Medicare based provider contracts
(6) Compassionate Care Plan™ option,
(7) Specialty Drug Risk Transfer Strategy,
(8) Expanded stop loss features,
(9) Strong centralized leadership empowering administration with decision making,
(10) Dominate, independent fee-based risk management.
The plan doesn’t incorporate:
(2) Managed care contracts (PPO),
(3) Wellness program/s which never work,
(4) Political interference by Board members,
(5) Insurance committee composed of clueless plan consumers,
6) Deductible, co-insurance features which are silly,
(7) Commissioned insurance broker
RESULTS:
(1) No rate increase going on 4 years, all-in employee rate of $350
(2) Better benefits – removal of all financial barriers to health care for members who play by the rules
(3) 100% of employees insured for the first time in 20 years
(4) High employee morale,
(5) Higher employee retention, capturing high quality teachers from surrounding districts
(6). Increased student enrollment from other districts,
(7) Increased revenue to the district.
The reader may be thinking “If this plan is so good, why aren’t more districts doing the same?” Because it’s easier to sell a logo than an idea. It’s easier to sell a plan that increases cost and reduces benefits year after year than a plan that doesn’t. No one ever gets fired for recommending Blue Cross, Aetna, United Healthcare or Cigna. And not too many school districts have a Stetson Roane.
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