HEALTH CARE CLINICS Case Studies from the City of … Care Clinics...HEALTH CARE CLINICS Case Studies from the City of Oshkosh and Waukesha County ... 548-7044 Contacts . Title:

City of Oshkosh,

Oshkosh Area School District,

Winnebago County

Wisconsin Public Employer

Labor Relations Association

Annual Conference

January 21, 2016

HEALTH CARE CLINICS

Case Studies

from

the City of Oshkosh

and

Waukesha County

John Fitzpatrick

Assistant City Manager /

Director of Administrative Services

City of Oshkosh

and

Jim Richter

Human Resource Manager

Waukesha County

Agenda

Waukesha County Experience

City of Oshkosh Experience

Questions

2

Waukesha County Experience

Partnerships

Feasibility Study

Scope of Services

Governance Issues

Challenges and Successes

3

School District of Waukesha

Serving nearly 14,000 students, achieving a

97% graduation rate

26 schools, geographically diverse

1,300+ employees

Vision:

- To be a 21st century learning organization dedicated to equity, innovation, human excellence, and collaboration

Health plan:

- Self Funded, Just implemented CDHDHP

4

Waukesha County

400,000 citizens

1,400 full time employees

Major services: - Law Enforcement

- Corrections

- Administrative Services

- Health and Human Services

- Public Works

- Parks and Land Use

Core values: - Collaboration - Communication - Cost Savings

- Customer Service - Diversity - Efficiency - Innovation - Teamwork

Health plans: - Self-funded PPO

and CDHDHP

5

City of Waukesha

Located in Southeast Wisconsin

Population of 71,000

One of Money Magazine’s 100 best places to live

530 employees

Health plan:

- Self-funded

6

A Shared Vision

7

Project Timeline

8

Consulting

Agreement

October 22, 2012:

RFP for Clinic Feasibility Study Consulting

December 20, 2012:

CBIZ selected

Phase 1:

Feasibility Study

February 4, 2013:

Kickoff Meetings Held in Waukesha

May 21, 2013:

Clinic Feasibility Study Presented

Phase 2:

Vendor Selection

September 6, 2013:

RFP for Clinic Vendor

January 27, 2014:

Healthstat, Inc. selected

Clinic

Opening

October 30, 2014: Open House

November 3, 2014: Grand Opening

Phase 1: Feasibility Study Process

Data analyzed from County, City and School District - Employee demographics and home/work location

- Medical and pharmacy claims

- Workers compensation

- HRA/biometric data

- Employee survey

- Stakeholder interviews

Employee input via focus groups and survey - Scope of services (prescription dispensing)

- Hours of operation (weekend hours)

- Staffing model (physician preference)

9

Phase 1: Feasibility Study Findings

10

Study evaluated cost of independently implementing

and sharing

Sharing resulted in most cost effective option for all three

entities

Enrolled Employees

Enrolled Dependents

Enrolled Retirees

Total Enrolled

% of Total Participants

Waukesha County 1,194 1,853 268 3,315 40%

City of Waukesha 432 755 106 1,293 16%

School District of Waukesha

1,045 2,179 351 3,575 44%

Total 2,671 4,787 725 8,183 100%

Scope of Services:

Scope of Services

Benefit Enrolled Employees

Benefit Enrolled Spouses and

Dependents (over the age of 2)

Benefit Enrolled Retirees

Preventive exams, including well woman and well man

Health risk assessments

Urgent care such as sinus infections, flu, sore throats, etc.

Routine lab services and biometric screenings

Routine immunizations including flu shots, tetanus, hepatitis, etc.

Prescriptions (to include 50-100 generic medications)

Wellness counseling and coaching, including goal setting

- Nutrition counseling

- Exercise and fitness challenges

- Diabetes programming and education

Blood pressure checks

EAP coordination and stress management services (referrals to counselors)

Price transparency tools to aid in referrals to specialists

Worker’s Compensation and Occupational Health:

- Triage of occupational injuries

- Random and pre-employment drug testing

- Pre-employment physicals

- Audiograms

- TB tests

Physical Therapy

Shared Clinic

95 Provider Hours Per Week

Physician-2 Part Time

Physician Assistants – 2 Full Time

Medical Office Assistant 3 Full Time

Receptionist- 2 Part Time

Health Coach

Physical Therapist -- 2016

Eligibility:

Staffing Model:

11

Location

97% of the County employees

work within 5 miles

100% of the City employees

work within 2.1 miles

100% of the School District

employees work within 5 miles

RFP respondents were asked

to review the floor plan

12

12

615 West Moreland Blvd.

Waukesha, WI 53188

Phase 2: Vendor Selection Process

13

12 Responses to RFP

5 Selected for Finalist Presentations - Froedtert, Wellness For Life, CareHere,

QuadMed and Healthstat

2 Finalists Selected - QuadMed and Healthstat

Reference Site Visits - QuadMed: Miller-Coors and Rexnord

- Healthstat: West Bend School District

Recommended Vendor - Healthstat

13

Clinic Utilization 11/2014 – 12/2014

828 total visits - 15% City

- 35% County

- 50% School District

450 pre-packaged prescriptions dispensed

90% of patients seen with less than10 minutes wait time

100% felt their privacy and confidentiality was

maintained

95% of patients stated services received were excellent/good

14

Governance Issues

Division of Expenses

Location

Decision making process

Contractual relationship

Varying timelines and decision making processes

Political hurdles

Agreement on scope of services

- Standardized vs. customized

15

Challenges

Recruiting - Perceived complexity of clinic

- Finding the “right” candidate

- Challenging labor market

- Mixed provider clinic

Multiple carriers and plan designs - Training complexity

- Compliance with copay accumulators and HSA plans

Timeline – 3 projects

ACA implementation overlap

Wellness services

Marketing

16

Successes

Mutually committed leadership

Ample time planning

Accountability

Intergovernmental agreement with clear terms

Clear, data-driven analysis guided decisions

Outstanding Providers

Health Coach

17

City of Oshkosh,

Oshkosh Area School District,

Winnebago County

Our journey Implementing a shared employer clinic

18

City of Oshkosh Experience

Considerations / Research

Partnership

Due Diligence

Scope of Services

Challenges and Successes

19

Considerations / Research

Private vs. Public Employer Sponsored

Health Clinics

Employer / Employee Savings

Convenience

Primary Care

Wellness

Labor Relations

Future Issues

20

Top Reasons for Establishing and Continuing Onsite Health Centers (Towers Watson, 2012)

21

City of Oshkosh,

Oshkosh Area School District,

Winnebago County

Partnership Impact: 7,000 Covered Lives

22

Due

Diligence Request for Information, then Proposals

Vendor Visits

Model Determination / Current and Future

Waukesha Feasibility Study / ROI Sought

Financial Responsibilities / Current and Future

Vendor Interviews and Selection

Site Selection

Branding / Copyright

Future Issues

23

Medical Services Currently Offered or to be Offered Within 12 Months (Towers Watson, 2012)

24

Do You Currently or Plan to Allow Any of the Following to Use the Services of the Health Center Within 12 Months? (Towers Watson,

2012)

25

How Do You Staff Your Onsite Health Center? (Towers Watson, 2012)

26

Other Services Currently Offered or to be Offered Within 12 Months (Towers Watson, 2012)

27

Scope of Services:

Scope of Services

Benefit Enrolled Employees / Retirees

Benefit Enrolled Spouses

Benefit Enrolled Dependents

(Age 2 and Above)

Shared Clinic

Schedule & Staff Expand Based on

Utilization

Physician Assistants /

Nurse Practitioners – 3.75 Total FTE

Medical Assistants /

Office Assistants 4.75 Total FTE

Health Coach(s) - Future

Chiropractor(s) – Future

Physical Therapist(s) - Future

Eligibility:

Staffing Model:

28

Provide primary and preventive

medical care

· Diagnose and treat illnesses

· Prescriptive authority

· Focus on health promotion and

wellness

· Partner to manage chronic illnesses

(non-insulin dependent diabetes,

asthma, cholesterol, etc.)

· Order, perform and interpret

diagnostic studies such as lab work

and x-ray (x-rays not performed at

clinic)

Challenges

Recruiting - Perceived complexity of clinic

- Finding the “right” candidate

- Challenging labor market

- Lengthy notice requirements for NPs / PAs

Multiple carriers and plan designs

- Labor relations suspicion of Clinic as a stepping stone to substandard H. Ins.

Timeline – 3 projects

ACA implementation overlap

Wellness services

Marketing

29

Successes

Mutually committed leadership

Ample time planning

Accountability

Intergovernmental, vendor, and office lease

agreement with clear terms

Clear, data-driven analysis guided decisions

Top management and elected official support

30

Keys to Success

Select a clinic partner with experience – You may only have one chance to be successful.

Evaluate utilization patterns in order to determine staffing needs.

Start small, provide for a positive experience, and build confidence in the clinic. Plan for Employer/Employee Savings - Incentivize participation. It does not matter

if the clinic is less expensive, if no one visits.

Make it Convenient – Again, if the clinic is not accessible it will not be utilized and it will not reduce ancillary issues, such as excessive sick leave use. With the increased usage brought about by the Affordable Care Act, this option can help stem health care avoidance by providing another access point.

Plan for Primary Care – Managing primary care can reduce self-referrals and correspondingly the increased costs of specialty care.

Integrate Wellness – By providing a vehicle for a holistic approach to medicine, high cost claims can be avoided. Healthier employees & their family members can be the outcome.

Carefully consider Labor Relations – Ensure record and visit privacy, focus on wellness, reduce health care costs for the employer and employee rather than shifting costs to the employee without addressing core issues. Frame the clinic as a benefit. Become an employer of choice. Engage employees in the programming and development.

Future Issues – Carefully monitor usage, consider enhancements when prudent, keep employees involved, and re-invest savings when warranted.

31

Thank you!

Questions?

John Fitzpatrick

Assistant City Manager /

Director of Administrative

Services

City of Oshkosh

[email protected]

(920) 236-5110

Jim Richter

Human Resource Manager

Waukesha County

[email protected]

(262) 548-7044

Contacts