MIKE LAWRENCE / COURIER & PRESS Kathalene Keller, FNP listens with a stethoscope during Robin Woebkenberg’s examination at the Evansville Vanderburgh School Corp. Wellness Clinic on Mt. Pleasant Rd. in Evansville, January 26, 2016
January 31st, 2016
School dollars are precious, said Joseph Neidig, CEO of Tri State Community Clinics.
With limited funds and increasing health insurance costs, Neidig said the healthier an employee can be, the better.
So four local school districts in the past four years made changes in health insurance plans to help reduce and stabilize health care costs. Part of everyone’s final decision included a health and wellness clinic, available — at no cost — to employees, dependents and retirees covered by the school corporation’s group health insurance plan.
“Then there’s money left for increases,” Neidig said. “Or money left for investment in other areas. So it’s a strategic way a school system can collaboratively work as a unit to be healthier and smarter with the dollars they have.”
In their fourth year, the Metropolitan School District of North Posey County was one of the first school districts in Southern Indiana to offer a clinic. After researching northern schools, North Posey opened a clinic operated by Tri-State Community Clinics.
“Our thought process was: if we go to high deductible plans, we reduce our insurance premium, and we offer a clinic to offset some of that cost,” said Superintendent Todd Camp. “And the clinic’s dollar per dollar is a lot cheaper than insurance.”
In February and April 2014, the Evansville Vanderburgh School Corp. opened two clinics through Tri-State Community Clinics. This was part of the school board’s decision to move from a fully insured plan, to a partially self-funded plan.
The Metropolitan School District of Mount Vernon opened their clinic last January, and moved to a renovated and larger space in the same building — the old Hedges Central Elementary School — that May. Evans said the district switched to a self-funded health insurance plan in 2014.
Warrick County School Corp. opened two similar health care clinics, with QuadMed as the provider: one in April 2014 in a separate and renovated wing of Castle Middle School; and the second in September 2014 in an old Buehler’s Buy-Low.
The clinics are staffed by experienced primary care physicians and/or nurse practitioners whose services include primary and preventive care, annual physicals, laboratory work, as well as basic maintenance and antibiotic prescriptions. All at no cost to the employee.
The clinics cut in-office wait times, as well as the possibility of patients being sent to other locations such as a lab or pharmacy.
Goals are to ensure employees and their families are healthy, understand and become wise consumers of health insurance, and to reallocate compensation resources so more money goes into wages while still providing access to high quality and affordable health care.
‘Busting at the seams’
The EVSC clinics each average 110-115 percent usage a month.
“We are squeezing in people at every available time slot,” said EVSC Chief Human Resources Officer Debbie DeBaillie. “And beyond that we have staff that are staying after hours trying to accommodate employees. So we’re busting at the seams.”
But it didn’t start that way.
In part, DeBaillie said, because it was such a new concept. But once more and more employees started to take advantage of it, she said they realized the benefit.
Speaking as an employee and parent of two children, EVSC Chief Financial Officer Carl Underwood said the convenience and quick appointment times — which average 55 minutes to commute, wait, get the service and return to work — have been a “great benefit.”
And with any new project or business, there are glitches at the beginning. But DeBaillie said issues have been “worked through” and things are running seamlessly.
While there isn’t yet an annual report for the first year of operation in Mount Vernon, Director of Business and Technology Loren Evans said with about 260 employees plus dependents, the clinic is “well above the 80 percent target.”
“That tells us that it’s being used the way we expect it to be,” Evans said.
Clinic usage for Warrick County’s two locations is at 60-65 percent utilization. Assistant Superintendent Todd Armstrong would like to see that number higher, and noted utilization is growing because employees continue to have positive outcomes and share their experiences.
“They were hesitant,” he said. “And they were a little bit scared about the whole idea. So it took a while to get the buy in. … We kind of had to guide them through that fear. You have to get rid of the idea it’s a clinic, because it’s really a health care facility that focuses on wellness.”
Since the clinic opened, more than 300 people have chosen to be on the high deductible health plans, Armstrong said.
More patients mean more savings
The investment in a clinic would be 5-10 percent of a company’s total health care costs, Neidig said, and they could save up to 20 percent.
“It’s a very small investment to begin to change your long term trend,” he said.
Underwood said the EVSC budgeted about $1.6 million total for both clinics to cover labor and fixed costs. Before the district made the health insurance switch, Underwood said it would have been a renewal of about $30 million.
“It’s been an expense we’ve taken on, but we’ve seen a drop in costs of our overall health and wellness programs,” he said. “It was a wise financial decision, but it was also a wise decision just as a benefit to our employees and their families.”
Obviously the larger a group is, the larger the investment, Perkins said. He estimated the EVSC was able to save almost $4 million during the first year with the clinic. While medicines could cost the school district around several hundred thousand dollars a year, Perkins said the potential savings they’re generating is a “better deal.”
“The real recipe is the more these clinics are utilized, the more they save,” Perkins said.
In Mount Vernon, Evans doesn’t yet have a year-end report, but said the clinic costs about $15,000 a month for all services.
“Simple math says we are providing a clinic visit less expensively than if we pay area providers,” he said.
For Warrick County, Armstrong said the district put money into renovating space for the two locations. He said between $150,000 to $180,000 was spent on the Castle locations. While Boonville’s location is inside a portion of the old Buehler’s Buy-Low, purchased by the district in 2014 for more than $570,000. But all of that money wasn’t strictly for the health clinic, the building also contains a fitness room for employees, warehouse, professional development room, and the school board room.
Money saved by the corporation last year went back to employees by lowering premiums, Armstrong said.
“Once I got my savings and we got our return on investment calculated, I took all of those dollars and recalculated everybody’s health insurance premium for the remainder of year,” he said. “And lowered their premium $50 a month for rest of the year. … We saved money, but we turned around and had the employees save money.”
North Posey officials could finally start proving the savings during the second year having a clinic because they had switched to a high deductible, partially self-funded plan. Over two years, Camp said there was a 7-percent increase, which he said is “way below trend and a clear savings on medicines.” And for 2015, there was another 7 percent increase.
It’s about a $1.5 million investment per year for North Posey’s health care, Camp said. But with a clinic, medicine for blood pressure costs about $5, where at a doctor’s office it’d be between $70 to $100.
Starting this year, Camp said every employee — even those not covered by the corporation’s health plans — are able to take advantage of the clinics.
“That’s another thing our wellness committee wanted to do,” Camp said. “Because if we’re promoting wellness, we want to promote wellness to our entire staff.”
Co-founded in 2009 by Neidig and Perkins, Tri State Community Clinics has about 20 clients. In every instance, insurance premiums go down for any employer — big or small — because the clinics help reduce high claims.
With continually increasing health insurance costs creating a strain on school corporations, Perkins said a patient-focused, convenient and free health clinic will cost about half what the school corporation would have spent in the traditional market.
“Keep in mind we are not a replacement product for insurance. … The clinic serves as a convenient buffer ahead of high cost spending on traditional health care,” he said.
Room for growth
As health care continues to be a challenge for school corporations, Perkins sees the need for the clinics to be “greater and greater.”
The challenge, Perkins said, will be developing new ways of providing care and services to create additional savings.
Neidig said the clinics are a win for everybody.
“The patient-centric health delivery has to continue to evolve,” he said. “It’s smart, convenient in location and the service model so people can get what they need, where they need it. And they can get in and out.”
School district officials are optimistic how the clinics can grow. Some ideas for expansion include adding more locations or appointment times, the possibility of weekend hours, and additional medicines.
In Warrick County, a free fitness facility was opened which also created a social network of support between co-workers.
“When you have healthier people, you have better productivity,” Armstrong said. “And less absenteeism. And then you get increased morale.”
North Posey has partnered with Expressway Auto World, so employees from both companies can use the other company’s clinic. Camp hopes to possibly expand this to Mount Vernon and other area companies to provide easier access all around.
“Medical care and wellness are things that are always going to be changing and evolving,” Camp said. “I don’t think you can do any one thing and say, ‘All right, I’ve got it fixed.’ … As things change, we’ve got to keep changing with it to keep it the best for all of us.”
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