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Districts push prevention with employee health clinics

Thousands of Poudre School District employees and their dependents will soon have access to a free walk-in health clinic not far from the Whole Foods Market in central Fort Collins. The clinic, along with a raft of related wellness efforts, is set to launch on September 3.

The clinic is part of a new effort by the school district and three community partners to change the way employees get and pay for health care, with the twin goals of promoting wellness and containing health care costs over the long term.

Poudre is not the first Colorado district to launch a free clinic for employees. Mesa County School District 51 launched its clinic in partnership with a local hospital in March 2012. Steamboat Springs School District joined the club in September 2012, creating a free on-site clinic in its administration building.

Still, as the state’s 10th largest district in its fourth-largest city, Poudre may well be the biggest player in the game right now and a key district to watch as its health care initiative unfolds.

“It’s a very exciting venture for all of us,” said Dan Robinson, CEO of Colorado Health Medical Group, a division of University of Colorado Health, one of the partners in the effort.

“I would think every school district would be looking at what Poudre School District is doing and would want to provide those same services to their employees.”

Focusing on prevention

Poudre’s new clinic, which will be called the University of Colorado Health Walk-In Clinic, has been in the works for around two years and envisioned for around eight, said Chuck DeWayne, the district’s executive director of human resources.

Currently, it is a public clinic and urgent care inside the central location of Miramont Lifestyle Fitness, another partner in the effort. In September, although its name will change and it will add Sunday hours, it will continue to be open to the public as it is now. For Poudre school district employees, the biggest change will be that they will no longer pay co-pays or portions of their deductibles to visit.

Instead, the visits will be free for all employees on district’s health plans as well as their dependents, nearly 8,000 people all told. Charges will apply for things like lab work or radiology, but those can be applied to the health insurance plan.

The clinic is not necessarily meant to serve as a medical home for district employees, rather a place they can go for same-day care for minor illnesses and injuries. It will be staffed by doctors and nurse practitioners from Associates in Family Medicine, the fourth partner in the effort.

“The goal is not to be a primary care clinic,” said Robinson.

The clinic is just one component of the district’s four-part health and wellness plan, dubbed the “Integrated Health Management System.” In addition to the clinic, the district plans to launch a program through Miramont providing one-on-one health and lifestyle coaching for employees who have or are at risk of chronic diseases. It already provides confidential mental health counseling for employees who are having trouble coping with work or personal problems.

Finally, the district will begin offering a series of free wellness classes at Miramont next month, covering topics such as weight loss, mindful relaxation and stress relief. The classes, like the mental health counseling, are open to all employees, not just the ones enrolled in district health plans.

Ashley Schwader, the district’s wellness coordinator, said the district previously offered occasional wellness classes at specific schools, say during a professional development day. The latest effort is meant to pull the offerings together at a convenient central location.

Paving the way

Although a handful of districts in Colorado, along with dozens nationally, are experimenting with some version of employee health clinics, it’s not a new concept. Some corporations have been doing it for years, and more recently public entities like cities and counties have added such amenities.

In District 51, talk of an employee clinic began in 2010 around the time Mesa County was preparing to launch its employee clinic. Health care costs were rising and the district was struggling to contain them by raising employee premiums and deductibles.

But that solution backfired, in part because rising deductibles prompted employees to delay or skip going to the doctor altogether, setting the stage for major health problems that produced enormous insurance claims.

About 18 months ago, the district contracted with Grand Junction’s Community Hospital to offer free appointment-based primary care services at an existing community clinic and $25 urgent care services at an existing urgent care center in the city. In addition, about 65 common prescription drugs are available at no cost and the district offers free health coaching to employees dealing with conditions such as obesity or diabetes.

About 1,900 of 3,000 District 51 employees are insured by district health plans and eligible to use the clinic, along with their dependents. District officials initially assumed about 40 percent of those eligible would visit the clinic, but the number is closer to 60 percent.

“A lot of people didn’t even have a physician and now they have a physician within the clinic,” said Sheila Naski, the district’s Risk Manager. “We are really encouraging health and wellness…We’re going to avoid those heart attacks or diabetic comas or whatever it is.”

In Steamboat Springs School District, which has 392 employees, the nearly-one-year-old clinic is somewhat smaller scale. Housed in the district’s central office and run by Healthstat Inc., it contains one exam room, is staffed by a physician’s assistant and receptionist, and is open three days a week for a total of 20 hours.

Clinic visits as well as common prescriptions available on-site are free for employees covered by district health insurance as well as their dependents. Unlike in District 51, the clinic is not meant to be a primary care facility.

“It is well utilized,” said Katie Jacobs, the district’s director of human resources. “They are very busy when they are there.”

Cost containment

The employee clinic in District 51 already seems to have made a significant dent in the district’s annual health care costs. In fiscal year 2010-11, those costs were $11.5 million and the following year they rose to $12.4 million. Then, in 2012-13, costs dropped to $10.8 million, a number that includes the $365,000 cost of the contract with Community Hospital.

She said the clinic is at least partially responsible for the drop in costs.

“It’s probably the combination of the clinic and a good year,” said Naski, noting that health care costs naturally fluctuate depending on the specific claims each year.

While the district’s two-year contract with Community Hospital will come up for renewal next spring, Naski said, “It’s just been so successful. I wouldn’t even think about taking it out of our plan.”

In Steamboat Springs, Jacobs said the district hasn’t yet calculated the return on its clinic investment since it hasn’t even been open for a year.

Still, she said, “This seems to be helping with those costs and keeping our costs down.”

In Poudre, annual health care costs are about $12-13 million, with average yearly increases of about three to four percent, said DeWayne. While that annual increase is relatively modest, he said the district does incur high costs in cases where employees visit the emergency room for problems that could be handled in a clinic.

Therefore, officials anticipate that it will be cheaper to pay for the employee clinic on the front end rather than for the emergency room claims on the back end. DeWayne noted that the $650,000 the district is spending on the new clinic and its other wellness efforts doesn’t represent an additional expense.

“It’s money we already spend. We’re just spending it on the prevention side,” he said.