Dianne Howard has understandably made a number of changes during her tenure as director of risk and benefits management with the School District of Palm Beach County, Fla. - after all, she's been there for 18 years. One change in particular six years ago paved the way for many other beneficial ones: The district went self-funded. It's a shift that may not be an option for many employers, but Howard - winner of the 2013 Benny Award for Benefits Leadership in Health Care - says it allowed her to be more hands-on with internal policies and institute real, lasting improvements.

"I'm a big believer in self-insurance," Howard says. "I think you can buy excess insurance to protect yourself, you know, specific and aggregate. You can't be too small, but for groups of 1,000 or more, it's the way to go. You can control things, you can subcontract, you can get in there and say, 'Well, why is this costing us so much money?'"

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