Local government hopes to reduce costs
Blount County, TN, is in the same bind as other employers across the country — the self-insured county has experienced annual health care cost increases of 15%-20%, forcing it to consider harsh measures such as cutting benefits for its 1,800 employees or raising employees’ premiums. But instead, leaders of the East Tennessee county of 115,000 decided to dust off an idea that had been entertained and shelved a few years ago: Opening a free health clinic for employees.
With final approval from the county commission, the centrally located clinic will be up and running in July. For the first year, it will offer free medical care only to employees, but planners hope to quickly expand services to dependents.
“We’re self-insured, so all the health care increases we’ve been seeing are true increases for us,” says assistant county mayor and budget director David Bennett. “Three years ago, we started talking about ways to save money. Raising premiums or cutting benefits would save money, but we didn’t want to hurt our employees — their insurance benefits are very important to them.
“We have a good [health insurance] plan, but we wanted to attack this big gorilla we have in our insurance plan.”
Paid for after first year?
Timing was not right when the idea of the clinic first came up for discussion a few years ago, Bennett says, but fiscal years 2005 and 2006 made the idea seem appealing again.
“This year we’re faced with enormous pains, with our premiums going up again, and our taxes are not going up,” he says. “So we began discussions — what would it cost? How do we do it? We wanted to get a good, workable proposal to begin with, so that we could take it to our [county] insurance committee neat and trim.”
What the plan entails is a $218,000 contract with Blount Memorial Hospital, a county-owned facility in Maryville, TN, that operates two occupational health centers. The hospital will provide a nurse practitioner, registered nurse, and medical assistant; the county provides the brick-and-mortar location (probably in the county’s justice center) and pays for supplies. The clinic will provide acute care for employees; a committee made up of county workers will set the clinic’s operating hours.
If, as planners hope, employees take advantage of the clinic, the county’s health care claims will drop, and the clinic will pay for itself in the first year. By the third year, Bennett estimates, the county could be saving as much as twice what it costs to operate the clinic. “We see it as a tremendous opportunity for tremendous savings,” he says. “On our employees alone, we spend $700,000 to $900,000 per year just on office sick visits — sinus infections, urinary tract infections, flu, colds. That’s where the real savings are in terms of actual costs.”
Wellness is planned as another benefit of the free clinic. Bennett says the county not long ago was approached by a vendor offering wellness services to county employees at a cost of $370,000 per year; wellness can be offered at no additional cost through the clinic.
Bennett says he often is asked if the planned staff of three will be enough — he hopes it will not be. “If they’re not enough, that means the employees are using it a lot and the savings will be tremendous,” he says.
Blount County is self-insured for workers’ compensation and is required to offer employees a panel of three health care providers to see in the event of a workers’ comp injury. The clinic will be one of the three choices, and when employees choose to receive treatment there, the county will see savings in those costs as well.
Staff from the clinic will roam to county work sites during the week to make getting care from the free clinic even easier on employees. “We are hoping we’ll see productivity go up as time away from work for doctor visits goes down,” Bennett says. “For the employee, it’s a benefit, because they don’t have to go to the trouble of taking time away from work and, if they haven’t met their deductible, paying out of pocket for an office visit for a cold or sore throat.”
Successful in private sector
On-site acute care clinics are not a new idea, particularly in the private sector. Historically, many manufacturers and large employees had company doctors on site to see injured or ill workers, but as businesses cut their budgets and managed care emerged, the institution all but disappeared. The idea has seen renewed interest, however, as health care costs continue to spiral upward.
Briggs & Stratton Corp. invested more than $600,000 in an on-site clinic at its Wauwatosa, WI, facility three years ago, and has since opened a second health center in Poplar Bluff, MO. Both offer medical services and a gym.
The company is recouping its investment through health care savings it projects could exceed $500,000 per year. The clinic, managed and staffed by Quad/Med — a provider originally developed by a graphics company that now is considered by many to be one of the most successful models for on-site workplace health care — serves Briggs & Stratton employees and their families.
George Thompson, vice president for corporate communications for Briggs & Stratton, says despite some hesitancy on the part of some union workers to accept the company-provided care in lieu of their own providers, the original center had 8,000 patient visits in its first year. That center, too, has exceeded projected traffic levels among certain demographics, Thompson says. “The employees find it very convenient with less time away from work, and they like the fact that their families are covered as well,” he says.
While Briggs & Stratton is happy with the cost savings and the participation of employees, there still remains work to do to get full advantage of the health centers for employees and the company. “We’d like to encourage more of our retirees to take advantage of the facilities — not only the health facility, but also the exercise facility that’s open 24 hours a day,” he says.
Besides holding down company costs and giving employees relief from everyday illnesses and injuries, Thompson says, the on-site clinics greatly reduce the time away from work and presenteeism among employees who might avoid a time-consuming trip to their primary care physician’s office, choosing instead to work sick. “A doctor’s visit off-campus usually takes two hours, including travel. Personally, I’ve been over to the health center and back in my office within 30 minutes,” he reports.
Some resistance from MDs
But cutting down on time spent at a primary care provider’s office doesn’t necessarily please the primary care providers, Blount County officials are learning. Bennett says some physicians in the community have expressed concerns about the program, worrying that the free clinic will cost them patients and income. But the free clinic, he says, is not meant to replace a primary care physician. “The primary care physician will still be who the patient will see for serious, chronic conditions and treatments that they would need more than what could be provided at the on-site clinic,” he points out.
Denia Lash, MD, director of occupational health for Blount Memorial Hospital, says the goal of the clinic will be to help employees get through minor health issues more quickly and less expensively.
For more information, contact:
- David Bennett, Assistant County Mayor, Budget Director, Blount County, TN. Phone: (865) 273-5710.
- George Thompson, Vice President, Corporate Communications, Briggs & Stratton Corp. Phone: (414) 259-5333. E-mail: [email protected].
Blount County, TN, is in the same bind as other employers across the country — the self-insured county has experienced annual health care cost increases of 15%-20%, forcing it to consider harsh measures such as cutting benefits for its 1,800 employees or raising employees’ premiums. But instead, leaders of the East Tennessee county of 115,000 decided to dust off an idea that had been entertained and shelved a few years ago: Opening a free health clinic for employees.
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