Would having clinic on-site or nearby, possibly at SSM Health in Edgerton, benefit the Milton School District and its employees, retirees and their families?
That’s something the district is looking at.
Before a recommendation is made to the school board in fall, Director of Human Resources Chris Tukiendorf said data, including a full year of health insurance claims (employer group report), will be reviewed to determine if a clinic model is the best approach to support employee health and wellness and address escalating health care costs. The clinic model could be put in place as soon as July 1, 2022.
In the last two years, Tukiendorf said the conversation about employee health benefits has centered on the wellbeing of employees and moved from a reactionary approach to a proactive approach, and employee and employer savings.
One of those approaches has been moving to one health plan, which over three years could lead to a savings of nearly $1.5 million (about $175,000 to employees and $1.3 million to the district).
At the start of the school year (July 1, 2020), the Milton School District began offering insurance only through the Dean Health Plan. Previously, employees could also choose a plan through Mercyhealth.
Tukiendorf said having two health plans resulted in fragmented care, fragmented or no wellness programs and fragmented reporting.
One of the goals of looking at 2020-21 claim data is to show why people are going to the doctor and what types of services are needed.
Sandy Cowan, director of employer services for SSM Health Dean Medical Group, talked about what an employer clinic – with no expense to eligible members – might offer. She and others from SSM Health spoke at a school board meeting earlier in the school year.
“We hire specific dedicated staff to your employer group,” she said. “It’s not the same as primary care. It’s fairly low acuity care (burns, cuts, sinus infections) normally things you would perhaps see in an urgent care because you don’t have ready access when you’re at work.”
Employer clinics also provide routine care, disease management and wellness support.
SSM Health manages and operates about 20 employer clinics in Wisconsin, she said.
For 1,000 members (employees, spouses, children and retirees), based on known utilization rates, Cowan said SSM Health would recommend a clinic staffed 24 hours per week with a nurse practitioner or physician assistant, and a medical assistant. Hours could be customized to meet employer needs.
In October 2020, she said the cost for the clinic would be about $170,000 per year. Space for the clinic could be leased from SSM Health in Edgerton.
In addition to insurance rate caps, Cowan said savings could be realized through pre-employment screenings done at the clinic, reductions in workers’ comp claims and keeping employees at work.
Traditionally, Tukiendorf reported a return on investment is witnessed in three years.
The clinic model could be a hybrid with a combination in-person and virtual visits. It would include continued access to SSM Virtual (no expense to employee) and Dean on Call (no expense to employee or employer).
Covid-19 forced health care systems to figure out how to take care of patients without in-person visits, she said.
“We were all in a projection to go to telehealth visits probably two to three years from now,” she said. “It (Covid) forced us all into that technology very quickly and it forced government to reimburse us for those service really quickly.”
Although some things like listening to lungs need to be done in-person, she said video visits today can be offered for a good portion of care.
Eric Thornton, president at SSM Health St. Mary’s Hospital – Janesville, said, “I think telemedicine is here to stay. From the provider side and the patient side, there’s so much efficiency. We can see people so much faster.”
To reduce the cost of a clinic model, Tukiendorf said Milton is looking at partnering with other school districts.
In 2014, the school district formed a benefits advisory group to allow for an exchange of ideas and to learn about approaches to benefits. The group includes administrators, staff and board members and met last week to share updates since they last met in September.
Last month, Kathy Chambers, a health transformation consultant, who works part-time and is paid by Dean Health Plan, began introducing herself in the school district. A health transformation consultant also helps school district employees navigate the Dean MyChart website and determine health plan benefits and find doctors. Wellness and coaching is also part of her job and through the Living Healthy Program, employees can complete activities and earn up to $150 in wellness rewards. She can help with that, too
Chambers assists virtually and on site. She began by introducing herself to staff at Milton East Elementary School.
“It is our goal to be able to improve the overall health and engagement of our staff and of our provider,” Tukiendorf said. “We want to implement a phased model to improve the support, and effective and consolidated reporting with data that provides actionable follow up and solutions.”
Phase 1 is navigating the new health plan and benefits. Phase 2 is possibly a clinic model.
“Before we commit to a near-site or on-site clinic,” Tukiendorf said, “we will collect and review a full year of claim data under Dean (including employees that changed from Mercy to Dean), to analyze and determine if the clinic model is still the best solution for the School District of Milton’s employees and their families.”