Benefits Review Committee - May 21, 2026

Agenda

Vendor topics of discussion:

• Review 2025 Utilization with Carriers

1:30 – 1:35 General Business:

• Attendance
• Introductions

1:35 – 2:10 VSP Utilization

Presenters:

• Valerie Swyers, VSP
• Debborah Suchoski, VSP

2:00 – 2:10 pm Break / Kaiser Setup

2:10 – 3:30 pm Kaiser Utilization

• Tammy Rivas, Kaiser
• Dr. Reva Ricketts-Loriaux, Kaiser

Minutes

This document is intended to be a meeting summary.
Attendance and Minutes: 
Voting Members Present: Cheryl Bell, Cynthia Kodachi, Phillip Mason-Joyner, Paula McDonald, Ryan Miller, Jon Santana, Ron Wierenga, Nybelle Caruso, Alex Gonzalez, Cynthia Boettcher, Denim Schneider, Scott Vandecoevering, Brandon Paullin, Bob Skinner, Katie Alexander

Voting Members Not Present: Nancy Bush, Sandra Montoya, Greta Nickerson, Tina Marie Sears, Niki Edge, Ezra Flaherty

Minutes: Toni McGarvey

Facilitator: Cynthia Kodachi
Consultant: Joe Bober, Mercer

Welcome and Attendance and Announcements

Update: Providence Announcement - Discontinuation of services as insurance carrier

• The county will be sending out an RFP in late June or early July; 
• Mercer will be supporting and keeping an eye on continuation of care and claims processing through 12/31/2026; 
• Clarification of the role of the BRC in regard to choosing a new provider: BRC is responsible for plan design;
• RFP process will include reprocessing a year of claims, review of provider network and formulary drug changes or exclusions;
• Clarity around new plan and provider will be available before open enrollment and communications launched and will continue throughout the process;
• Ombudsman support is standard and will be applied;

Update: Dependent Eligibility Verification (DEV) audit

• As of 5/21, 91% have completed the DEV audit
• 54 people are in incomplete status with partial submissions
• Those that have started the process but remain in incomplete status and not completed will have more options for support or grace period;
• List of incomplete items supplied by Aptia lists general issues impacting completeness
• 7/1/2026 is the final “stop” or completion date for this project.

VSP Vision Services 2025 Utilization Review: VSP representative Valerie Swyers

Review highlights include:

• VSP has adjusted the allowance for frames and lenses to account for inflation;
• Eye exams are a “skylight” into the bodies’ vascular system and yearly exams are seen as critical for overall health;
• ID cards are going to be available digitally/virtually soon through implementation of an Apple and Google integration. 

Kaiser Medical Plan 2025 Utilization Review: Kaiser representatives Tammy Rivas and Dr. Reva Ricketts-Loriaux

Review highlights include:

• 82% of the time patients are able to see their preferred provider;
• Primary care demands have escalated;
• GLP-1 not yet covered for weight loss purposes, but can be obtained through self-pay. Healthy lifestyle tools are the starting point for a weigh loss journey with Kaiser;
• Wellness Program rewards are available;
• Blood pressure screenings are being conducted at most appointments, such as the blood pressure clinic at the county Wellness Fair;
• Report shows an opportunity to increase childhood immunizations;
• Kaiser working to identify mental health issues at a younger age, and has seen an increase in women identifying struggles with mental health issues (see Kaiser Wheel of Care in utilization report showing access to mental health services);
• Kaiser promoting measureable success with:
  1. Adding additional service and clinic locations;
  2. Care gap closures;
  3. Increased flexibility in scheduling;
  4. Institution of reward programs;
  5. Increase in mental health services and providers;
  6. 24 hour nurse consult line;
  7. New member welcome desk to assist with navigation of service questions.

Adjournment

There being no further business, the meeting was adjourned at 3:30 pm.

Next meeting scheduled for Thursday, June 16, 2026.