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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
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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.
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Thank you!
Questions?
John Fitzpatrick
Assistant City Manager /
Director of Administrative
Services
City of Oshkosh
(920) 236-5110
Jim Richter
Human Resource Manager
Waukesha County
(262) 548-7044
Contacts