Benefits Review Committee - April 16, 2026

Agenda

Vendor topics of discussion:

• Carrier Updates
• Review 2025 Utilization with Carriers

1:30 – 1:40 General Business:

• Attendance
• Introductions
• Minutes from 2/26/2026 Meeting

1:40 – 3:00 pm Providence Utilization

Presenters:

• Cash Spencer, Providence
• Katie Gallacher, Providence

3:00 – 3:05 pm Break / Delta Dental Setup

3:05 – 3:30 pm Delta Dental Utilization
Tami Long, Delta Dental

Draft minutes

Attendance and Minutes: 

Voting Members Present: Nancy Bush, Cynthia Kodachi, Phillip Mason-Joyner, Paula McDonald, Greta Nickerson, Jon Santana, Alex Gonzalez, Cynthia Boettcher, Denim Schneider, Scott Vandecoevering, Gretchen Pacheco, Ezra Flaherty, Niki Edge, Bob Skinner, Kayla Brenner

Voting Members Not Present: Sandra Montoya, Ryan Miller, Ron Wierenga, Nybelle Caruso, Cheryl Bell,

Minutes: Toni McGarvey

Facilitator: Cynthia Kodachi

Consultant: Joe Bober, Mercer

Welcome and Attendance

Medical Carrier 2025 Utilization Review: Providence representatives Katie Gallacher and Cash Spencer 

Review highlights include:

• Overall spend is in alignment with benchmarks (benchmark group consists of total number of self-funded clients); 
• Pharmacy rebate not factored into total spend, showing medical spend below benchmark and pharmacy spending higher than benchmark; 
• Lower than benchmark on PCP visits; 
• Higher than benchmarks on utilization of cost lowering services such as telehealth and express services; 
• Decrease (below benchmark) on emergency room costs;
• 72% of membership covers at least one dependent; 
• County top 5 chronic conditions the same as the top 5 across benchmark. 

Cash Spencer provided recap on Providence transition to partner with Collective Health:

• Transition has been rough;
• Challenges across the board with alternative care service processing;
• Providers not submitting claims correctly are being identified, with some claims being uploaded to old system instead of new processing system with Collective Health;
• No changes occurred to coverage or contracted services for 2026, but there were mistakes in loading incorrect base level data into Collective Health systems;
• Providence continues to work with providers directly to educate and support claims submission or resubmission;
• Providence has been conducting end-to-end auditing of claims from January through May.

Questions as answered by Providence staff:

• How are providers informed of difference between self-funded clients and fully insured?
  Adding “powered by Collective Health to subscriber cards was an attempt to do this. FAQs have been given to providers, but because of the messiness of the transition trust with Providence and providers was lost. Unforeseen issues and unintended consequences have occurred during transition.
• With the new spike in claims will there be a post review or audit to summarize issues and resolutions?
  Providence team receives daily reports wherein duplicate claims or issues are isolated. Claims will be up but money spent should be to single claim and not listed twice. There are many audit levers in place to screen for and avoid duplicates or erroneous claims.
• Should any send issues with claims coming to members from the teams still be sent to Benefits via email?
  (Cynthia) Yes, send to Benefits email box. Rachecl Forslund is the point person for Providence/Collective Health matters
• What is the status of the Providence sale and how will it effect Clackamas County?
  Local leaders are still searching for clarification from larger national leadership. Providence reps pushing for guidance ahead of open enrollment and more information should be available in May.
• What is the county doing to find a replacement for Providence?
  (Joe and Cynthia) The county is working with our broker, Mercer, and we are keeping an eye on the progress. We are researching our options, remained prepared to make changes and will continue to monitor.

Dental Carrier 2025 Utilization Review: Delta Dental representative Tami Long

Review highlights include:

• Enrollments remain consistent which supports accurate utilization reporting; 
• Utilization peer groups (benchmarks) uses other county member groups; 
• Utilization of services was 5.2% above peer group;
• Preventive services were 6.6% above peer group with 3.5% above peer group among children;
• Per member cost is up bit relates to higher utilization;
• 98% of members using in-network services and providers with only 2% using out-of-network;
• Membership demographics remain very similar across peer groups.

Committee Discussion:

Questions as answered by county staff regarding member questions about Providence 

• (Greta) What can we expect as we move forward with shopping for a Providence replacement?
  (Cynthia) The county is working with Mercer and it is still too early to talk about process. We want to and will be prepared, but it is simply too early to know and we are waiting on more details. We will keep the BRC informed as we move forward.
   
• (Greta) Can the BRC still be expected to influence plan design?
  (Cynthia) Yes, the BRC will influence plan design but the county will select the new provider to take the place of Providence. 
• (Alex) Can we be sure to include BRC members early on with communications that will be distributed to staff? The DEV audit and breaches create concern among members, and BRC reps can help mitigate if we know ahead of time what will be shared.
  (Cynthia) Good point. We will have to continue to work with outside vendors, and will work to mitigate concerns that communications are secure and not spam. I will keep the BRC in the loop on all communications.

Adjournment

There being no further business, the meeting was adjourned at 3:27 pm.