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YOURCHOICE ONSITE HEALTH AND WELLNESS CENTER
Proposal Highlights
The focus of this proposal is to establish a Public/Private partnership to create an onsite health and wellness clinic for the employees of Manatee County Government and their families. The intended purpose of this clinic would be to continue to lower our healthcare costs and maximize our employees’ health. This is a model that has been proven with other employer groups, both public and private, to create a return on investment by improving care delivery, improving health and reducing healthcare claim costs by moving away from the traditional “fee-for-service” model existing currently in the industry. To allow for a comprehensive care model for our employees, the existing Employee Health Benefits and Health/Wellness Team will be relocated to the downtown area adjacent to the onsite health clinic. This is a model that makes good sense financially for the County, for our employees and for our tax paying citizens.
Executive Summary
Dating back to 15+ years ago, the Administration and the Board looked “outside the box” to implement onsite clinical services that started with a wellness professional and has grown into a comprehensive clinical treatment team for our members. Additionally, the Administration and Board took a risk in 2006 to implement a very unique plan design, the YourChoice Health Plan, and it continues to reap the benefits of that concept of “spend a little to save a lot”.
Since 2009, the average trend in the state of Florida is 11.4% increases in health plan costs annually and that is reflective of plans that have also cost-shifted to their employees through premium increases and increased out of pocket expenses. The National average trend increases since 2009 has been relatively stable at 7.9%. Over the same period, Manatee County has experienced an average trend of a 2.3% decrease in our health plan costs and we have not increased premiums or reduced benefits.
The model that has been in place has proven to save significant tax payer dollars since its implementation. This proposal of an on-site health center is projected to do the same. Our employees in Manatee County have developed a sense of trust with our onsite programs and Advocates, so the addition of Medical providers will be a natural transition and will compliment an already successful program.
Because we have an aging population, the onsite clinic model is a way to begin to mitigate costs in areas where we have control to protect our fund and still offer a competitive benefit package to employees that will help to create the healthiest workforce. The addition of an onsite clinic along with the health plan and onsite clinical resources that is currently in place can be a key marketing tool to attract and recruit new employees to benefit the future of Manatee County Government as an organization.
History
Employee Health Benefits (EHB) administers the self-funded health plan and ancillary benefits for the employees of Manatee County Government and Constitutional Agencies. The County has had great success with its innovative (nationally recognized and award winning) health plan design and on-site clinical health Advocates and Wellness programming. The costs to the County are significantly lower than state and national trends, yet the benefits enjoyed by County
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employees are significantly better than other companies, including other public sector employers.
This success is due to a variety of factors. Initially, an open-minded Board and Administration implemented our health and wellness programs, along with the gated plan design (i.e.,
employees must complete certain health and wellness tasks to obtain access to richer design options) and most critically, the on-site clinical health providers and Advocates that develop genuine and guiding relationships with our employees and are an integrated component of our Culture of Health at Manatee County.
The existing onsite clinical supports is what sets Manatee County apart from other employers. Below is a timeline of the progression of Manatee County’s Health and Wellness Program:
1999: 1 Wellness Coordinator providing education and outreach across worksites. 2000: Member Advocacy Established. 3 Registered Nurses act as advocates and
assist employees and providers with coordinated care. Eventually began to provide full Utilization and Case Management, coordinating with local Physicians.
2003: Certified Diabetic Educator. Focus on chronic conditions by providing an onsite Certified Diabetic Educator Case Manager and no cost to members for diabetic supplies. 2004: Clinical Pharmacist. Addition of the onsite Clinical Pharmacist to assist patients
with chronic conditions and reduce their pharmacy costs by moving to lower cost medications.
2006: YourChoice Plan Design implemented with evidence-based Qualifying Events.
2006: Onsite fitness center established for employees and dependents.
2007: Behavioral Health Services brought in-house and integrated with the medical, pharmacy and wellness Advocates. Onsite Therapist, Psychiatrist and Coordinator. 2010: Ultimate Plan instituted rewarding nicotine free members. 16% of the nicotine
exposed population engaged in programs to quit using nicotine and qualify for Ultimate Plan.
2014: No-cost Health Coaching onsite added to benefit package
However, as our employee population ages and health care costs increase, it is expected that our health care claims costs will increase. The County and employers across the country are experiencing similar scenarios as a result of the implementation of the Affordable Care Act and the individual mandate. Access to care is and will become more and more difficult due to the increase in utilization of the healthcare system causing employees to be away from their
worksite and job responsibilities for longer periods of time because of longer wait times with and delays in scheduling. Furthermore, the opportunities for Providers to engage in highly
coordinated care for the benefit of the patient is limited by the sheer fact that that the nation’s medical system has become more and more complicated and procedural and puts up barriers for Providers to consistently engage in this type of care that has proven to be effective.
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Many employers have already successfully implemented on-site health centers in order to enhance the quality and cost effectiveness of medical health services. Locally, the City of Sarasota, Charlotte County Government, Pasco County, Polk County all have thriving clinics that have brought significant return on investment and soon Pinellas County Government will be opening their onsite clinic. Private employers across the Country such as Walt Disney
Corporation, Rosen Hotels, and Johnson and Johnson have all seen the value-added benefits for their businesses. On-site health centers offer the promise of:
Improvement in chronic conditions through high quality, highly engaged Providers utilizing evidence-based practices.
Improving employee morale, workforce productivity and recruitment efforts; Saving money by eliminating fee-for service care at the clinic.
Redirecting care from expensive, un-integrated and time consuming settings; and Promoting wellness, health coaching, chronic condition management and preventative
services.
The proposal by Employee Health Benefits (EHB) is to provide through a third party, an onsite health center that will consolidate all of EHB Services – including existing EHB offices - into one location at the downtown Merrill Lynch building where our current fitness programs reside. By consolidating, employees and their dependents can access all service offerings related to their health and wellness benefits from initial enrollment, to Qualifying Events, Nurse Advocates, Behavioral Health, Diabetes Care, Fitness Programs and onsite Medical Provider (onsite health center) at one central location. This consolidation also emphasizes to our employees and the onsite health center vendor that the YourChoice Health and Wellness Center is an integrated program which has been a component of the success we have seen over the last several years. It the concept of a medical home where the patient is supported by a comprehensive treatment team of professionals and referrals to necessary Providers are made and care continues to be coordinated.
If approved, EHB will engage in a local and national search for a third party provider to operate the clinic. Once selected, this vendor will be the entity responsible for the operations, liability and performance of the onsite health center. This vendor would be expected to work seamlessly with the existing health and wellness Team and would be subject to rigorous performance guarantees to ensure effective use of our funds and the high quality of care.
It should be noted that it would be recommended that all employees of the YourChoice Health Plan and any members of the Health Plan with the County would have access to this facility, this includes the employees and covered dependents of the Constitutional agencies. The proposed location is centrally located in our workforce geographic region and would be accessible to many employees and their family members.
Additionally, the onsite clinic could utilize advanced virtual technology and a travelling nurse to serve employees at our remote worksites for minor medical needs. This would allow for an employee to be seen by the Physician virtually with a Nurse present at the employee’s worksite for issues that simply require a prescription to be ordered and picked up on the employee’s way home from work. It’s important to note that between January 1, 2013 through December 31, 2013, 1,045 BCC employees consumed a total of 14,914 sick/vacation hours for personal medical appointment reasons at a combined salary cost of $310,115. Between January 1, 2014 through December 31, 2014, 1,020 BCC employees consumed a total of 15,397 sick/vacation
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hours for personal medical appointment reasons at a combined salary cost of $308,940. On average, an employee is away from work for about 3 hours when seeing a Physician in the community, this model would limit that time away from the worksite significantly.
The proposed services added to the current health and wellness programs would be acute episodic and primary care services by a Physician and Advanced Registered Nurse Practitioner (ARNP), along with part time Physical Therapy onsite, laboratory services and limited
pharmaceutical dispensing. It should be noted that dispensing controlled substances such as narcotic pain management drugs or stimulants would not be a component of this health center. What would be dispensed would be the most common generic medications that are used for acute episodic conditions such as the flu or infections or common chronic conditions such as high cholesterol, high blood pressure, diabetes, etc. that require maintenance medications. In conjunction with the existing Health and Wellness Team, these new Providers would be integrated for highly effective coordinated care. For example, if a member is being seen by the onsite health center Physician and identified to be newly diabetic, there is opportunity to
immediately get the patient involved with the onsite Diabetes Case Manager to ensure coordinated and comprehensive care by simply walking the patient down the hall to get established with the Diabetic Case Manager.
This is a critical piece of the onsite clinic as this type of coordination often does not occur when our employees utilize the community Providers simply because of the design of the industry. While Providers may make referrals or recommendations to patients about engaging in their own care to make lifestyle or clinical changes, once the employee leaves that Physician’s office, it is solely up to the patient to follow through with those recommendations. Human nature shows that people don’t always do what is good for them. By having Nurse Case Managers, Diabetic Case Managers, Clinical Pharmacists, Health Coaches and Behavioral Health
Therapists on-site working in conjunction with the clinic, we have already proven with our own engagement results that a patient is more likely to follow through with the recommendation from the Physician when the barriers to access care are minimized..
There are several different models of cost-sharing with onsite health centers and much is dependent upon the type of health plan the employer has in place. The savings from an onsite health center come from the improvement in coordinated care as well as the reduction in fee for service medical claims by increasing utilization of the center and improving employee
engagement in managing their health. Employees will utilize the clinic for a flu shot but while there, they may be identified as having other risks and engagement can take place immediately. The more utilization in the center, the higher the savings to the County. Additionally, the health center would have expanded hours to accommodate our shift workers as well as Saturday hours, all operated by the onsite health center vendor.
Local Physicians, Hospitals and Outpatient facilities would continue to play a significant role in the care of our employees and their dependents as the onsite health center would make appropriate referrals when necessary and coordinate the care ensuring high quality and
effective care. Many employees have well-established relationships with our local Physicians in the community and the County would encourage that relationship to continue. Aon Hewitt reports that 30-40% of an employee population are not established with Primary Care Providers in their community. The reasons could be varied, but this is the population that the clinic can
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capture and subsequently make appropriate referrals out in the community while helping to engage that employee in taking charge of their health.
The most significant difference with an onsite health center in comparison with the community model is that the Physicians/Practitioners working with the health center are not burdened with a fee for service model, but are paid employees of the vendor, regardless of the number of
services they provide. It allows for quality and extended time to develop relationships with patients and make appropriate referrals to community Physicians which has been proven to create better outcomes. Additionally, one of the most significant features of onsite clinics are the highly effective and flexible Electronic Medical Records (EMR). This benefits the local
Physicians and Hospitals as well as clinic vendors will work with local HIE’s and facilities to share clinical data while following all federal regulations regarding data protection and confidentiality.
Feasibility Study-Aon Hewitt
Particularly because we have a more unique model, it was important to determine the return on investment for a clinic therefore, Manatee County utilized a subject matter expert through our contract with Aon Hewitt to conduct a feasibility study related to an onsite health center utilizing actual claim data and employee demographic and utilization data to determine return on
investment feasibility with this project. Through this exercise, the conclusion was that “there is a financial reward associated with offering primary care and acute episodic care at the on-site health center, as well as intrinsic value to the employees and to Manatee County”.
Facilities
Property Management and EHB have worked with local architects to create a conceptual design the potential space for a renovation at Merrill Lynch to incorporate EHB offices and the new health and wellness center, if approved. The space allows the County to not only increase its value-add services to employees through the onsite clinic, fitness facility and health/wellness advocates located together, but also provides additional conference room space downtown that is highly needed as well. The proposed fitness facility will accommodate the proposed added services of onsite physical therapy. There is significant need for physical therapy with our workforce as back and neck pain are two of the top conditions in our claim spend. Utilizing the fitness center during non-peak hours will allow for the space to have multi-purposes.
It is recommended that the current EHB building be sold to support the cost of the renovations of the Merrill Lynch building and the health center. All facility improvements, startup costs and operations will be funded through the health self-insurance plan.
Final Points
For the last 15 years, Manatee County has made great efforts to help our employees and their families become the healthiest they can be, we have done this through the plan design and creating a program that minimizes barriers of cost and access by providing critical supports on-site and invested in the County culture. Our goal for this onon-site clinic is to create the healthiest
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workforce possible that will ultimately result in happy and productive employees and family members who provide high quality services to the community and who desire to live, work and play in Manatee County and contribute to the economy all while saving tax payer dollars thru the reduction in the self-funded health care costs.
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The following is the recommendation section from Aon Hewitt’s feasibility study pertaining to the exploration of an onsite clinic.
