HEALTH CARE CLINICS Case Studies from the City of Oshkosh and Waukesha County

Transcription

1 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 City of Oshkosh, Oshkosh Area School District, Winnebago County

2 2 Agenda Waukesha County Experience City of Oshkosh Experience Questions

3 3 Waukesha County Experience Partnerships Feasibility Study Scope of Services Governance Issues Challenges and Successes

4 4 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

5 5 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

6 6 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

7 A Shared Vision 7

8 8 Project Timeline Consulting Agreement Phase 1: Feasibility Study Phase 2: Vendor Selection October 22, 2012: RFP for Clinic Feasibility Study Consulting February 4, 2013: Kickoff Meetings Held in Waukesha September 6, 2013: RFP for Clinic Vendor December 20, 2012: CBIZ selected May 21, 2013: Clinic Feasibility Study Presented January 27, 2014: Healthstat, Inc. selected Clinic Opening October 30, 2014: Open House November 3, 2014: Grand Opening

9 9 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)

10 10 Phase 1: Feasibility Study Findings 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, ,315 40% City of Waukesha ,293 16% School District of Waukesha 1,045 2, ,575 44% Total 2,671 4, , %

11 11 Scope of Services Scope of Services: 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 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 Eligibility: Benefit Enrolled Employees Benefit Enrolled Spouses and Dependents (over the age of 2) Benefit Enrolled Retirees Staffing Model: 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 Physical Therapy

12 12 Location 615 West Moreland Blvd. Waukesha, WI % 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

13 13 Phase 2: Vendor Selection Process 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

14 14 Clinic Utilization 11/ / 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

15 15 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

16 16 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

17 17 Successes Mutually committed leadership Ample time planning Accountability Intergovernmental agreement with clear terms Clear, data-driven analysis guided decisions Outstanding Providers Health Coach

18 18 City of Oshkosh, Oshkosh Area School District, Winnebago County Our journey Implementing a shared employer clinic

19 19 City of Oshkosh Experience Considerations / Research Partnership Due Diligence Scope of Services Challenges and Successes

20 20 Considerations / Research Private vs. Public Employer Sponsored Health Clinics Employer / Employee Savings Convenience Primary Care Wellness Labor Relations Future Issues

21 Top Reasons for Establishing and Continuing Onsite Health Centers (Towers Watson, 2012) 21

22 22 City of Oshkosh, Oshkosh Area School District, Winnebago County Partnership Impact: 7,000 Covered Lives

23 23 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

24 Medical Services Currently Offered or to be Offered Within 12 Months (Towers Watson, 2012) 24

25 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

26 How Do You Staff Your Onsite Health Center? (Towers Watson, 2012) 26

27 Other Services Currently Offered or to be Offered Within 12 Months (Towers Watson, 2012) 27

28 28 Scope of Services Scope of Services: Eligibility: 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) Benefit Enrolled Employees / Retirees Benefit Enrolled Spouses Benefit Enrolled Dependents (Age 2 and Above) Staffing Model: 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

29 29 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

30 30 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

31 31 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.

32 Contacts Questions? John Fitzpatrick Assistant City Manager / Director of Administrative Services City of Oshkosh jfitzpatrick@ci.oshkosh.wi.us (920) Thank you! Jim Richter Human Resource Manager Waukesha County jrichter@waukeshacounty.gov (262)