Duval DOGE Special Committee

117 W. Duval Street

Jacksonville, FL 32202

Council Chamber,

1st Floor, City Hall

Legislative Assistant: Rebecca Bolton

Council Research: Steven Libby

Auditors: Phillip Peterson and Brian Parks

OGC: Mary Staffopoulos

Council Member Ron Salem, Chair

Council Member Chris Miller, Vice Chair

Council Member Raul Arias

Council Member Mike Gay

Council Member Rory Diamond

City of Jacksonville

Tuesday, June 16, 2026

11:00 AM

Duval DOGE Special

Committee

Agenda - Marked

I. Call to Order and Introductions

II. Public Comment

III. Telehealth Update – Phillip Peterson

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

V. The Bailey Group – rate recommendations

VI. Comments from Committee

VII. Adjourn

Page 1 of 1

Morning. >> Welcome to the. The final doe's meeting. Council members I just wanted to mention. I think said this before. But council. >> Elect. PRESIDENT Howling is has plans to go in a different direction in terms of this type of effort. So I indicated to him that we would wrap-up the the last item, which is this insurance issue today give him the maximum flexibility to move in any direction he wants to do. So with that, let's begin with introductions to my far left. Steven Levy Council research. >> Marais Plus Office of General Counsel Bryant Park's counselor's office Peterson Council under good morning, Rory Diamond District 13, the beaches. Ron Salem group to a large morning row areas, district 11. My gay district, 2. Will and in district 3 dozen. That car live chat, large group or just visiting and are you going to be taking up the telehealth update? Yes, I am okay. Thank you. That's I am. Councilmember Miller, he's hoping to make it might make it might not is what I've heard. Is there any public comment? I know you've a couple of telehealth updates place through the chair of the committee. So our office was asked to look into kind of comparing the 2 programs telescope through the health Link Jackson initiative and then the right site or a right site to provider. >> And so through conversations with both Jfrd but with telescope and then with members of the mayor's office, weve ultimately come to the conclusion that in their current form, these are 2 separate programs. 2 to do a true cost benefit analysis. We would need to to have programs that kind of lined up together and provide the same service. Easy way to see that is is a dedicated phone line is set aside for health Jax. There's a specific phone number 9, 0, for 9 to 5 care. You can call that or resident can call that receive services from helping Jax, whereas the right site model in its current form, someone contacts 9-1-1. You're obviously aware of this. But in order to get to right you have to go through 9-1-1. And so that is a strain on 9-1-1, resources that can be a strain on jfrd personnel depending on how the call is deployed. So it that manner. There are 2 different programs. You obviously are where the clientele that they serve, even though right site will take uninsured patients right now, their model is for ensure patients, whereas telehealth is specifically for uninsured. And then obviously the cost. We know that telehealth currently has a 1.5 million dollar cost to the city and the current year right site is a 0 cost contract if right site were to expand into a different area or expand their services to where we have a dedicated to line their taking in more calls. I don't know that that would remain the same. Maybe it would bode until we until we got to that place. We would know. And then lastly, the usage very aware that you're reading the car, the report that this committee adopted and it right. I just hasn't taken off given a number of of instances, maybe its lack of training. Maybe it's lack of involvement. Maybe it's lack of marketing. There's there's just not a a dedicated push for right site or right, like concept. So in their current format, 2 totally different programs. Maybe having the overall same goal. They don't serve the same purpose. And so it's difficult to do a cost-benefit analysis. We are also asked to look into things that cannot stop you right there, sir. And Councilmember Diamond wanted to jump in. >> I know I think you threw the chair. I know you're doing the council orders but just, you know, just for folks listening the issue here is that you have to Dial 9-1-1, and you get to write site where as the city is paying for that this phone line and for telehealth. But it would also be true that if instead of getting that paid telehealth, folks, you could be redirected up right side or another group agreed to it to be routed to them and get that for free. The folks at rights sites say that that's how it works in other places. It doesn't have to be 9-1-1, and their other providers to Troy has another provider where you don't have to Dial 9-1-1, to get. What is a free to the city of Detroit service. So we could set up that kind of thing of all the parties agree, correct? Through the chair to counsel or a dime. And so we have not had specific conversations with right site directly. >> What you're saying makes sense in its current format. You're right. And individual calls 9-1-1, Barry, they speak with the jfrd dispatcher who then the based on the information that they take in determine whether or not they can go to write site. And so the jfrd dispatcher will transfer the colder right site that call stays, quote, open, if you will, Jfrd site until the right site physician identifies whether or not that person needs to go to the er or not. And if they don't need to go, they are they communicate back jeopardy and they close that call. But you're right a if there was a separate phone line. Separate from 9-1-1, I think it would give a better picture of what the availability or the use of rights. I could be. Yes. And you had the second issue on the health care expenses. Well, just want to address one of the things we're also asked to look into things that things to consider with the right site like service. If the city were to truly, you know, go down that route full And I think the biggest thing is marketing that service. So the residents of Jackson not aware that right side is is an option or a service that the city uses because they called 9-1-1, expecting an emergency transport our emergency assistance right on the spot unlike health Jax were there is that dedicated phone line. So if there was if the city was going to go to a right, I like service, I think there needs to be some marketing. Community awareness that would occur with that. The other aspect report hit on it a little bit. But is the time spent by Jfrd staff while transitioning someone right site physician, if it's on it site, which they do on site, Jeopardy personnel will assess the medical needs of the resident. And then if they are willing to talk to to a physician, they will help connect them. Will they stay there on site until that call is closed out? So depending on if that's a five-minute call or a 30 minute call, there is a jfrd personnel are. On site. Don't leave until that is all. Resolved. Because jfrd resources are somewhat limited. That could cause firehouse, if you will, to have to go to a call in that area that normally would be covered by that that you did if you up. That's nothing nor out of the ordinary that already happens on normal er cause. But this just adds one more layer to it. So just something to consider. And then lastly, if we're going to move to a right site like program we would want to expand the hours here. Obviously aware right site operates Monday through Friday. 07:00am to 11:00pm, but calls are consistent on nights early mornings and weekends. So just another thing to consider. And then as the chair indicated, we're asked to look into the amounts quoted by telescope for the savings that the city incurs through their contract. And first off, want to address the terminology of savings. There's no savings to the city. The city does not realize any savings by entering into this 1.5 million dollar contract with telescope. There are avoided are possibly avoided charges. But those avoided charges are by the resident. By. Yeah, they're look. They're avoiding charges by the resident or the hospital. There is no savings to the sea. There's no avoided charges to the city. This is a true expense for the city. And as to the amount cited by telescope, they applied estimated er diversion rate of 55% to all of their ceo Jay encounters to calculate a number of estimated diversions. That percent of emergency room visits that result in hospital admissions, which was a 12% figure and transfers to a different hospital or an extended hospital. Stay of 2%. We're numbers that they apply to those er diversions and those percentages come from the cdc. So nothing out out of the ordinary there, but they then multiply those percentages by the published data from state of $4,844 for hospital charges. The national average for extended for hospital stays of $10,000 and the national average of a high variance hospital stay of $18,000. All of this resulted in a calculation of 11.1 million for first year through September of 2025. Where their math. Fails. And our opinion, is that they apply those same percentages to the total number of Co j encounters rather than just the amount that would have been diverted from the er. So when you apply those that 12% for a hospital stay in the 2% for an extended hospital. Stay to their figures. It reduces their savings number by 2 billion dollars down to I take that I buy 1.8 million dollars down to 9.3 million. So there is. Fallacy in their logic. How they calculated the savings. We've communicated that to the administration. We've communicated that to telescope but wanted to report back as the chair specifically request us to look into that. Through the chair, MR. Park System for me. The Ministration agrees our number and not telescope sober. Okay. Just make it. I don't want to relitigate this hole issue today by any means. We have a report we've we've submitted it just a couple comments that would make I have been frustrated. Then at the right side program and other cities such as Atlanta. >> In San Antonio grew like crazy. The right side applied the same trainee cetera, to the local group as they did out in those other cities in for whatever reason, that's still not clear to me, just did not take off. And we are where we are. But I would I would like to to move on. But let me go to Councilmember Dimon and then Councilmember College. >> I'll be really quick. I look, I think any telehealth money is going to come out of the budget. I think the Finance Committee where move it this year. So I think the message really is to jfrd. Taking a look at one of these other programs that are free because you're not going to have this other one that's going to be on. Councilmember College. MR. CHAIRMAN. >> I think would be good too. Get a calculation on how much they delivered. The emergency room like this after maybe 3 years. And see what that number actually is. And then and then the administration telehealth, whoever the parties would be to talk with our hospitals. The main when I guess being you Chan's the see it there. If those diversions could equal some savings towards the city budget. That's just what I think. If we're spending money to save money and you know, we want to save money. I think the encouraging thing here, the wind, when you're looking at quality of life and you're looking at people that just don't have health insurance. And we're so lucky to have it. I mean, my GOD, I've gone through a pinched nerve deal for last 2 months and then say is thank the good Lord. I have health insurance because it's been brutal. You know, by doctors finally got. Their arms around it. So. So people can get decent and better health care. To me. Cost one and a half million dollars all forward. I can't imagine being without it. And not being able to afford it. We are here to take care of our citizens. But I say all that say this, MR. CHAIRMAN, because exercises this exercise is is wrapped up. We do know about 9.3 million dollars is he's been saved apparently by perhaps bank of the or the clients. But if it actually an average of 3 years or so. We know that might be. And that might be the time to talk about how much we can save. And insuring the uninsured in our contribution. And that's what I got to Thank you. Thank you. Let me go to council areas. We will move on. >> All right. Thank you. Chair. Just a quick question regarding right side. MR. Pearson mentioned how they're only operational Monday to Friday from 9 to 5, whatever the case is a 7 to 11. I think 7, 11, 7 to 11:00pm. >> Right and I'm going off of COUNCILMAN Diamond what he stated earlier, half of the budget. Whatever happens next year. Who do we speak to as a jfrd or dewey's pizza? Mia, right side to say, hey, this other service might be going away. We need services expanding in morning hours. Also on the weekends because emergencies happen all times of day. You can never expect them right? So who do we have to take action on this or something to get? It does, and then the last part would the marketing efforts as well too. He talked about education so that a community whose problem is that like is it Jfrd is right. I like all these things. You mentioned coup need you know, take the lead. Can I address that? Number one, the hours. It's the chicken or the egg situation they wanted they can provide 24, 7 coverage. But the number of referrals. >> That they were receiving. >> It was so small they could not justify expanding their hours if they were the only provider. >> And I think in the city got behind right side as the entity to do this. I think they'd be happy to expand their hours and indicated they would take indigent as well as insurance. Under that scenario. In the marketing is Israeli internal to to jfrd. >> You can train. Been my experience in the private sector. You can train people. You want, but if you're not following up to make sure they're they're utilizing those skills that just goes away. And I think that was a big part of it. >> All right. And then the last question would COUNCILMAN Diamond talk about Detroit. So would there be a scenario where we could also create a private number 4 right side versus having to go through 9-1-1, or is it has doesn't have give other cities that encountered. Is that all 9-1-1 or do they have their own out? It says it through the chair to COUNCILMAN Here's the problem is we're not the executive branch, right? We're not jfrd. So there's a bunch of stuff I would love to see the mayor and the fire chief take on to fix this. >> Right. I'm going to guess that they're not going to jump out it until the money is gone and then they're going to ok, we still want to do something. Let's go work with these free providers and then they can look, there's a bunch of models across the country that are working. San Antonio, I think is the best. I think it is right sites there and they've been working and it's been worked out longer there. That's the one that I kind of like called the people and talk to my buddies on the city council. There. And, you know, learned about it more. So that's that's the mall I think we should go for. But it's gonna take public education. It's going to take probably a private number. Also. And there's no reason we built all this infrastructure that can just borrow app. But it's get the mayor's got to do it with the Jfrd chief. Yeah, it's on that. Thank you. >> We will now move on. The next item is a 2% laps. Any movement there, MR. Peterson threw the chair to the committee, no movement currently its peak with the administration this week. They are waiting for the 3rd quarter projections to come in. So the city council received the quarterly summary no later than JULY. 30th at that point, we'll have a pretty good idea on where each department will finish the year. They intend to address any shortfalls that might be projected with the mayor's transfer authority. Initially. And if they can handle all that administratively, they plan to do so they would only to come back to council if any of those transfers needed exceed the $500,000 Authority. I think that's wonderful idea is to leave the 2% lapse in place and transfer within the various departments. >> Would make a lot of sense to me. And I hope that's what they do. And I'm sure some type of laps or might be a part of the budget process as we get into the next budget. 2% has worked pretty well, but it might have to be significantly higher as we move forward and I know councilmember Laden's listening all this. So okay. We move on to the Bailey group. Who's who's going to present? You have a presentation for us. >> How do correct screen? Okay. >> Please introduce yourself and for the public and everybody. >> Sabrina Hebert with the baby grew and today we have. How's better? Sabrina Hebert with the Bailey Curry and also today from the Bailey group. We have Sherry been yea and Travis Cummings are both going to speak a little bit. >> And we have our to summer interns with us as well. Emily and stuff. So in a Travis is going to wrap this up later. But before really one of the presentation, I just want to take a second to publicly thank the city's benefits team. We asked for a significant amount of data over this process. They provided everything we needed and they did it. They were incredibly easy to work with. So I think that needs to be noted. These projects have become very meaningful to ask. And I feel that we have fulfilled our promises to the committee and we have the feel the same. And with that being said, our first topic today, we're going to talk about employee contributions, the stop loss and then kind of wrap up our final recommendations for the whole process. So that asked on the employee contributions was alternate alternative options in general and also focus on salary bands. >> To benefit the lower salaried employees. These examples that I'm going to go through are intended to be high-level alternatives to your current situation. And to provide overall strategy. We can get in the weeds as much as you want. But there are a lot of numbers and so. >> And that might require a longer more focus meeting. If you want to get into the details. But there are a lot of moving parts. So stop me if you need to. We stay on this one treatment. >> So exhibits focus on the bulk of the active population. We excluded some of the employee classes that pay higher amounts. Why cobra retirees? Former elected officials are a couple other ones that we made it out of this. Mark Bailey talked at the last meeting about the importance of setting your funding rates appropriately. And this is one area that would be affected because these classes of employees. Contributions are based on the funding rates. So if you set the funny rates appropriate appropriately, you would generate some extra contributions for what these classes payment. Contributions. Another comment plan design was outside of the scope of our part particular project. But we do recommend looking at the plan designs and differentiating the plans more so that they can have further apart. Actuarial mathematical values. Cherie been a mention in the last meeting about trying to encourage people to be in the high deductible health plan. And so it would be beneficial to look at your plan designs and get them actuarially more a part so that you can strategically use your contributions. >> To drive people to more efficient plants. >> And then just and then on the salary band options. Sometimes hr teams don't love them. They're they're administratively difficult to administer because you have a lot of work, payroll codes and you have a lot of changes when people change salaries up or down or whatever. So you MAY think about benefiting, you know, like taking one of your plans and just >> paying more for that plan. To help out some of the defendant tears that I am showing Any questions on that. That was kind of a want to reset. >> Okay. This first slide is the baseline. Which is where it uses are in Fpd recommended funding rates for 2027. And it uses current employee contributions. So this is your baseline. The top numbers are the overall funding rates. Proposed. And then the 2 sections below break out the employer and the employee. And like I said, we just backed into what you're. Projected to pay as an employer since we kept the employee rights the same if they are right now and this works out to about 10% employee contribution to the overall. We see closer as we talked about before to 25 to 30% and our other public sector groups. Employee contributions. So there's room there you would never get there any year. Know that. But there's room for improvement there. >> just to stop you there, work, we're presently. The employee contribution is 10% of the actual expense. Other public entities similar to ours across the state are up in the 2025%. >> Sure, yes. But this is projected for 2027. But roughly what you're saying correct. >> Ok, I just want to make sure the committee understands that Councilmember Diamond, thank you, MR. Chair, it's funny said this is the of all the stuff the Bailey group has been doing. You guys done really great work. This has been like the one thing that's in the back of my head that assuming the referendum passes on property taxes and we have to find other revenue. >> The subsidy that the taxpayers of people Jackson are fall are doing for cj employees is higher and better than other places. I mean, put it grok in Crockett back the same answer to me that Tampa and other big cities are employees or pay more. And so I think >> that is going to be the number one thing I'm going to be talking about over when we talk about this particular issue that that needs to go up, I don't want to do to our voices. I love our team. We're gonna have to balance its budget. Not me will. And Raul and and Mike went with who are gone? We're gonna have to find money somewhere. And that's going to be one place. Thank you. I appreciate mentioned. It's I think that was my moment to say >> And not to get ahead because Travis could wrap up You know, it's it's a combination of things. It's it's looking at your pharmacy and looking at your funding rates and looking at all the things. So it doesn't have to get pushed on to the employee. The hope that we've shown, you recommendations that don't you know, her employees. Okay. So this this is the first scenario option that's not salary banded. So it set up the same way as the first one with the funding rates of the top. >> Then employer, the employee and the sex and the sections. >> And each of the scenarios we did, we focused on the outcome being budget neutral, which is kind of why we do these employee contributions at the end because you're funny. Rates have to be all the other things have to fall in place. So we focused all of the alternatives on the dependent tears because your employee only. >> Rates low already. So there's not much to be done with those. The other employee. Only rates are at or below the benchmark data for all the plans. When we did the benchmark them. So the first. Optional set of plans. So this includes the proposed 2027 funding rates of the top. And then this strategy would pay the same employer contribution for all the plans and all the tears. Thought being that you use your 2 plans that there's no cost no employee costs as your baseline. And then you would pay the same employer. The PRESIDENT, same employer funding across all the plans. What I like about this is that but a terribly, you know, when someone is hired, this is the budget member like it doesn't matter which plan they picked Gore. Or whatever, you know, with a budget number is, but also the actuaries of already done the math for you. They know what you know, what the plans are worth. And so contributing the same. Lets the unit. It seems like a logical solution to me. And if you did that, it actually. Gains back about 7%. And the budget. So that's one of the thoughts. New questions about. And then the next one is the same funding right at the top. And then we just looked at increasing employee contributions. 10%. On the defendant tears. It at the bottom line. It really doesn't help that much to do that except that it probably news you in the right direction financially speaking. That's not. Significant. Okay. So now as we move into >> salary bands. These illustrations, the dark blue represents salaries 0 to 50,000. The pink is 50,100 1000 and the Light Blues salaries over 100,000. These this is what I chose from looking at your census and dra