District 51 considers employee clinic
School District 51 is considering proposals for an employee medical clinic similar to the one opened Nov. 1 by Mesa County.
The district received clinic proposals Friday from local organizations Community Hospital, Primary Care Partners and Western Valley Family Practice, as well as Indiana-based Novia CareClinics LLC, the company that runs the county’s clinic. The proposals detail how each organization envisions offering basic services, lab work and a short list of common prescription drugs to District 51 employees who have medical insurance through the district. Employee spouses and children who also have insurance through the district could use the clinic as well.
Proposals for the clinic, which could be open as soon as Jan. 1, were due Friday, according to District 51 Executive Director of Support Services Melissa Callahan DeVita. District officials and the district’s insurance committee will review the proposals.
“Our expectation is something’s going to work, and we’re going to move forward,” DeVita said.
A plan for offering a clinic in an existing office or a new building could be in place as soon as next month.
The goal of the clinic, according to DeVita, is to provide a place for employees to get quick medical care, such as a throat culture or stitches, at an affordable price. Employees could still use district insurance to see a primary care doctor, and employees would be expected to see that doctor for serious diagnoses.
The school district is the largest employer in Mesa County with about 2,700 full-time and part-time employees eligible for medical insurance. On average, 1,970 employees choose to participate in the district’s insurance program. Combined with family members of employees, the district covers about 3,300 people a year.
Cost savings for employees, district alike
District employees will have higher deductibles and will pay an average of 20 percent more for employer-offered insurance when the 2011–12 insurance year begins this October and ends September 2012.
The school district covers the $358.50 a month cost of premiums for employees. That figure will increase to $430 a month when the new insurance year begins in October to cover an expected increase or continuation of expensive claims. The district cut $1.7 million from the 2011–12 budget to cover the increased cost of covering employees’ insurance premiums.
Last year was a particularly expensive one for insurance claims in the district, DeVita said, with twice as many instances of cancer reported and four times as many instances of kidney failure among district insurance-holders.
The district had to transfer $1.5 million from reserve funds to pay $9.2 million in claims since October. By comparison, the district paid $7.77 million in claims between October 2009 and July 2010.
Two-thirds of those 2010–11 claims came from 58 people who had “shock claims,” meaning the medical treatments they received cost more than $25,000 apiece.
While those shock claims have led to higher employee premiums for the district to pay, they are leading to higher premiums for some employees to pay. Employees are responsible for paying the premiums for their spouses and children on the district’s plan. An employee-plus-spouse plan costs an employee $286.50 a month, and a family plan costs $481.50. Starting in October, employees will pay $345 per month for each child or $670 a month for a family, or $520 a month to have a spouse on their plan.
Deductibles will increase from $4,000 for an employee to $5,950 in October and increase from $8,000 for a family to $11,900.
At the same time, premiums are set to increase, pay has been cut in the form of three furlough days for all employees. That combination may lead to more employees choosing between necessities and a doctor’s visit. And if whatever ails them turns into something worse, it may lead to an expensive trip to the emergency room and/or the progression of a serious illness.
“We have employees who aren’t getting the regular medical treatment they need,” DeVita said. “If they don’t get regular treatments, it could easily turn into one of those shock claims.”
DeVita said she hopes a clinic will help people find it affordable to go to the doctor and subsequently decrease the number and cost of claims. That may allow the district to decrease premiums or at least allow it to avoid making budget cuts or fund transfers to keep the insurance program soluble.
“If (a clinic) helps people not have those complications, we’re all going to save in the long run,” DeVita said.
County clinic opened
nine months ago
The school district began considering a clinic for employees after Mesa County opened its own employee clinic last year.
Like the school district, the county is self-insured and had seen an increase in the number of large claims, according to Mesa County Compensation and Benefits Manager Sheryl Coffey. DeVita said there is the potential for a “co-op” agreement with Mesa County’s self-insurance program if it would help both entities, but she did not say if that’s something the district is actively interested in pursuing.
DeVita said the school district hopes to use a local provider to set up its clinic, even though the district received a proposal from the out-of-town administrator of the county’s clinic.
The clinic promotes wellness, Coffey said, which can decrease absenteeism. The county also hopes to benefit from smaller claims because the clinic doesn’t have to pay for a medical transcriptionist or billing, and it saves money by buying equipment and generic medications in bulk.
Coffey said she won’t have data to demonstrate how much the clinic has or hasn’t saved the county until it has been open for a year.
The county employs just under 1,000 people and is the fourth-largest employer in Mesa County. About 1,300 employees and their family members are enrolled in the county’s insurance program and have access to the clinic.
Coffey said it took a few months for employees to start using the clinic regularly, but now 75 percent of county employees who have insurance through the county use the clinic at 1060 Orchard Ave.
“The majority of our employees have given us positive feedback on their experience there,” Coffey said.