In 2009, the City of Sarasota undertook an initiative to redesign its medical plan by exploring changes to their third party administrator, plan features, employee contributions, incentives, and network availability.  The redesigned plan was implemented on January 1, 2010. The initial goal was to expand their in-network offerings and reduce the cost increases they had experienced in the past decade to a level more in line with the overall cost of living index.  The outcome resulted in both reduced costs and national network coverage but also provided a series of wellness incentives linked to outcomes rather than effort.