David Levine is a GOVERNING contributor.E-mail: firstname.lastname@example.org
Ben Franklin first posited some 250 years ago that an ounce of prevention is worth a pound of cure. Today, the private and public sectors have started to understand the obvious wisdom to old Ben’s words, especially when it comes to health care.
For several years now, large private companies, including the Walt Disney Co. and American Express, have created on-site health clinics to foster healthy behaviors and to practice preventive medicine among their employees. More recently, public entities have begun to do the same. Several Florida cities, for example, have set up municipal on-site clinics to provide everything from checkups to flu shots to nutrition consults. They also perform municipal health services like pre-employment physicals, drug testing, and police and firefighter physicals. And they provide these services for free, with nary a copay or deductible. Even certain medications, mostly generics, are free to city employees who visit the clinic rather than their regular primary care physician (where they pay through traditional coverage). The result has been fewer long-term health problems, happier employers and lower costs for everyone.
The city of Ocoee in 2005 became one of the first in Florida to try this experiment. Facing annual health-care cost increases of 15 to 30 percent, Jim Carnicella, then the city’s human resources and risk management director, started looking for alternatives. He found a local company called Crowne Consulting, which works with a primary care vendor called CareHere. They hire the doctors, nurses and nutritionists, take care of the liability, handle the billing, and manage the headaches of running a doctor’s office, all for a straight fee of $23 per month per employee, plus direct billing for supplies like bandages and flu vaccine. The city spent about $600,000 refurbishing a building it already owned and buying medical equipment to create the clinic.
“We hoped that, if we could steer enough employees away from their own doctors to here, it would at least pay for the health center,” says Carnicella, now a part-time consultant with the city. “Long term, we thought we could decrease our annual increase from 15 to 30 percent to more like 5 to 10 percent.”
The result was “much better than we anticipated,” he says. More than simply reducing health insurance increases, healthier employees have literally flattened their insurance cost. “We now pay $3.5 million in health insurance -- which is the same amount we had estimated five years ago in 2007,” Carnicella says. “On top of that, we have also reduced workers’ comp costs by 60 percent. Before the clinic opened, we spent about $150,000 a year. Now it’s about $70,000.”
And those savings have been funneled back to the 350 or so city workers. “Over the past five years, we have been able to give a small pay raise each year, we have lowered the cost of family health insurance coverage from $240 a month to $200 a month and we even increased the pension somewhat,” Carnicella says.
Attendance at the clinic has been so high that Ocoee has partnered with other cities with similar on-site clinics to allow employees more options. This summer, nearby Sanford will open its on-site clinic. Fred Fosson, Sanford’s director of human resources and risk management, expects to save about $500,000 over the first three years of the program.
“We’ve been telling our people that if they come here with $5 in their pocket, the physician treats them, writes them a [prescription] that, if it’s generic, can be filled at the front desk and they can walk out with the same $5 in their pocket,” Fosson says. “Our people are really excited about it. And they can still go to their [primary care physician] and pay their $25 if they want to.”
But with lower costs and convenient care, it is easy to wonder why anyone would.
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