The Other 60 Percent

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 site of the new walk-in clinic for Poudre School District employees, set to launch September 3.
The site of the new walk-in clinic for Poudre School District employees, set to launch 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.

academic insurance

Children’s Health Insurance Program is on the brink. Here’s why that matters for education

The fate of the Children’s Health Insurance Program is in Congress’s hands — and children’s education, not just their health, may be at stake.

Congress passed a temporary extension of funding for of CHIP in December, through some states will run out of money shortly. The end of the program would come with obvious potential consequences, as CHIP, which covers approximately 9 million children, gives participants more access to health and dental care.

There may also be a less obvious result: Research has found that access to health insurance helps kids perform better on tests and stay in school longer.

A 2016 study, published in the peer-reviewed Journal of Human Resources, found that expanding Medicaid in the 1980s and 1990s increased students’ likelihood of completing high school and college.

“Our results indicate that the long-run benefits of public health insurance are substantial,” the researchers wrote.

Similarly, an earlier paper shows that broadening access to Medicaid or CHIP led to increases in student achievement.

“We find evidence that test scores in reading, but not math, increased for those children affected at birth by the increase in health insurance eligibility,” researchers Phillip Levine and Diane Whitmore Schanzenbach wrote.

In short, research suggests that when kids are healthier, they do better in school. That’s in line with common sense, as well as studies showing that children benefit academically when their families have access to direct anti-poverty programs like the earned income tax credit or cash benefits.

(Even if CHIP ends, affected children might still have access to subsidized insurance through the Affordable Care Act or other means. The Congressional Budget Office estimates that will be more costly in the long run.)

Congress appears likely to vote on a bill this week that includes a six-year CHIP extension, as as well as a temporary spending measure to avoid a federal government shutdown.

Business of education

Memphis leaders say diversifying school business contracts will help in the classroom, too

PHOTO: Laura Faith Kebede
Winston Gipson confers with his wife and daughter, who help run Gipson Mechanical Contractors, a family-owned business in Memphis for 35 years.

Winston Gipson used to do up to $10 million of work annually for Memphis City Schools. The construction and mechanical contracts were so steady, he recalls, that his minority-owned family business employed up to 200 people at its peak in the early 2000s.

Looking back, Gipson says being able to build schools was key to breaking through in the private sector.

“When we got contracts in the private sector, it’s because we did the projects in the public sector,” said Gipson, who started Gipson Mechanical Contractors with his wife in 1983. “That allowed us to go to the private sector and say ‘Look what we’ve done.’”

But that work has become increasingly scarce over the years for him and many other minorities and women. The program designed to address contract disparities in Memphis City Schools was cut during its 2013 merger with Shelby County Schools.

A recent study found that a third of qualified local companies are owned by white women and people of color, but such businesses were awarded just 15 percent of the contracts for Shelby County Schools in the last five years.

It was even worse for black-owned construction companies, like Gipson’s, which make up more than a third of the local industry but were awarded less than 1 percent of contracts.

The disparity is being spotlighted as the city prepares to mark the 50th anniversary of the death of civil rights leader Martin Luther King Jr., who was assassinated in Memphis while trying to fight for the rights of minority workers in 1968.

On Jan. 25, Chalkbeat will co-host a panel discussion on how Shelby County Schools, as one of the city’s largest employers, can be an economic driver for women- and black-owned businesses. Called “Show Me The Money: The Education Edition,” the evening event will be held at Freedom Preparatory Academy’s new Whitehaven campus in conjunction with MLK50 Justice Through Journalism and High Ground News.

Community leaders say school-related business contracts are a matter of equity, but also an education strategy. Since poverty is a crucial factor in why many Memphis students fall behind in school, the lack of job opportunities for their parents must be part of the discussion, they say.

The district already is taking steps to improve its record on minority contracting, starting with setting new goals and resurrecting the city district’s hiring program.

Big district, big opportunity

Shelby County Schools is Tennessee’s largest district. With an annual budget of more than $1 billion, it awards $314 million in business contracts.   

An otherwise dismal 1994 study of local government contract spending highlighted Memphis City Schools’ program to increase participation of historically marginalized businesses as one of the county’s most diverse, though some areas were cited as needing improvement. The same study criticized the former county school system, which lacked such a program, for its dearth of contracts with Minority and Women Business Enterprises (MWBEs).

But when the two districts merged in 2013, the program in Memphis City Schools disappeared.

“We had to cut, cut, cut,” said school board member Teresa Jones. “We were trying to stay alive as a district. We did not focus as we should have.”

Jones, a former school board chairwoman, said it’s time to revisit the things that were working before the merger. “We have to get back,” she said, “to make sure there’s equity, opportunity, access, and an atmosphere that promotes business with Shelby County Schools.”

District and community leaders say the consolidated district has lost its ability to develop relationships with qualified minority-owned businesses.

“There was an infrastructure where African-Americans felt comfortable enough approaching the school system” for work, said Melvin Jones, CEO of Memphis Business Contracting Consortium, a black business advocacy group formed in 2015. “There was trust. During the merger, they dropped the infrastructure.”

Brenda Allen

Without the outreach, “we’re seeing the same vendors,” said Brenda Allen, hired last summer as procurement director for Shelby County Schools after working in Maryland’s Prince George County Public Schools, where she oversaw a diversity contracting program.

“We’re not marketing the district like we should,” she told school board members in November.  

Shelby County Schools is not alone in disproportionately hiring white and male-owned companies for public business. Just 3 percent of all revenue generated in Memphis goes to firms owned by non-white people, even though people of color make up 72 percent of the city’s population, according to a 2016 report by the Mid-South Minority Business Council Continuum.

Not coincidentally, district and community leaders say, Memphis has the highest rate of young adults who aren’t working or in college, and the highest poverty rate among the nation’s major metropolitan areas. About 60 percent of students in Shelby County Schools live in poverty and all but three of the district’s schools qualify for federal funding for schools serving high-poverty neighborhoods.

Jozelle Luster Booker, the CEO of the MMBC Continuum, developed an equity contracting program for the city utility company following the 1994 study that was so critical of the city. The program funneled half a billion dollars to minority-owned businesses — an example of how government policies can promote equitable contracting, and grow businesses too.

“When that happens, you could basically change the socioeconomic conditions of that community, which impacts learning,” Booker said. “They’re ready to learn when they come to school.”

Shelby County Schools plans to hire a consulting firm to help develop a procurement outreach program and set diversity goals for its contractors and subcontractors. The program will launch in July, and Allen plans to hire three people to oversee it.

PHOTO: Brad Vest/The Commercial Appeal
Bricklayers from TopCat Masonry Contractors LLC work on an apartment complex in downtown Memphis in 2014.

The district also is part of a city-led group that provides a common certification process for businesses seeking contracts with city and county governments, the airport, the transit authority, and Memphis Light Gas & Water. The city’s office of business diversity and compliance also has a list of qualified minority businesses, offers free business development courses, and accepts referrals from other government entities to reduce redundancy.

“As you spend public dollars, you always want those dollars to be spent in your neighborhoods because that money comes back into your economy,” Allen said. “When people have jobs, you should see crime go down. You should see more people wanting to do business in the community if you have a good program.”

Leveling the playing field

In order for it to work, there has to be consistent reports, measures and, most of all,  accountability, according to Janice Banks, CEO of Small Planet Works, who helped the district with its disparity study.

Gipson agrees.

A wall of his second-floor Memphis office is lined with photos of some of his most significant projects during his 35 years of business, including a multimillion-dollar mechanical contract with AutoZone when the Memphis-based car part company moved its headquarters downtown in the early 2000s.

The work was made possible, he said, because of public sector jobs like constructing nine schools under Memphis City Schools. But that work evaporated after the merger. “It’s mostly been Caucasian companies that do the work (now),” he said. “It’d be one thing if you didn’t have anyone qualified to do it.”

Shelby County Schools will have to show commitment, he said, if it wants to level the playing field.

“You have the mechanism in place to make a difference,” he said. “Now do you make a difference with that mechanism or do you just walk around, beat your chest, and say we have a disparity study and let things run the way they’ve been running?”

“If you don’t make it happen, it will not happen,” he said.