School district health clinic may be in the works for Manatee

In an effort to promote better employee health and control healthcare costs, the Manatee County School Board has signed off on having staff explore creating a free walk-in clinic.

“How do we get this on the agenda for approval on June 7?” board vice-chair Charlie Kennedy joked after seeing a presentation last week. “It seems, looking at the statistics and patient satisfaction, it looks like we’re about five or six years behind.”

The district is looking at other Florida school districts, including Charlotte, Escambia, Polk and Pinellas, that have implemented walk-in clinics for employees. The clinic has extended hours for employees, there’s no co-pay for using the clinic, and some generic prescription drugs would be provided free to employees.

Bill Kelley, the director of risk management for the school district, presented the school board a “high-level lookdown” at what it might take for the district to move forward with the plan. The biggest barrier is the start-up cost, but Kelley presented numbers from other school districts that show high rates of return. Kelley said it would also be wise for the school district to see if Manatee County government is interested in pursuing a joint clinic, an idea county commissioners have talked about but have not taken any formal action on.

In the county

As of March 2016, the school district covered 4,811 employees and 9,450 people total in its health insurance plan. The district spends a little less than $60 million per year on health care costs, and is self-insured.

Only about 40 percent of people on the district plan utilize a primary care physician. That’s not necessarily a low mark compared to other institutions, but studies show primary care physician visits help detect illnesses and diseases at an earlier stage, when it’s cheaper to treat and the prognosis is better.

The reasons people don’t take advantage of their plans is the same across the board, Kelley said. Inconvenience getting an appointment, cost and time away from work are big ones. A clinic designed for school employees can help solve some of those problems.

“The key to saving is getting employees engaged,” Kelley said.

Other districts that have implemented clinics are seeing increased rates of participation.

Pasco County opened Health and Wellness Centers in January 2011 with three clinics across the county. They have a total of five clinics now and 68 percent of those covered by Pasco’s insurance plans use the centers for primary care.

Polk County opened its first clinic in June 2012 and a second one in January 2016. About 60 percent of employees use those clinics.

Kelley said he recognizes some employees won’t want to leave their primary care physicians with whom they’ve developed a relationship to visit a clinic run by the school district. But a free school district clinic may help bring the 40 percent number up to those seen in Polk and Pasco.

Across Florida

For school board members, the savings other districts across the state have seen since opening their clinics were shocking.

Escambia County, which has 5,300 total employee and 50 schools — similarly sized to Manatee County — says it has saved $18 million from June 2013 through December 2015.

“Wow,” school board member John Colon said.

Sometimes calculating the savings can be difficult, Kelley said, because some savings are “cost avoidance” and are determined by using trend data, and some are “hard savings” that are easier to see. The difficulty in seeing the cost savings clearly can often be a stumbling block when starting out.

“Sometimes it’s difficult to see spending money to save money, yet that’s kind of what you have to do,” he said.

Plus, the real benefit is promoting good health among employees. A patient survey in Escambia shows 98 percent of people who attended the clinic said they were either satisfied or very satisfied with their experience.

That’s the same experience for those in Charlotte County, said Mike Robishaw, the district’s supervisor of employee wellness, health services and safety education. The county has one clinic right now, and employees have expressed a desire to work on opening a second one. One of the biggest factors in the positive clinic experience is that it’s free.

“That’s a big plus,” Robishaw said.

The hours are also a big plus. The clinic is open a half-day on Saturday, open late three days a week and open early in the morning before school starts.

“Those morning hours are very important,” Robishaw said. “They can go in and be seen before work to avoid having to take that time off from the classroom.”

Polk County, which is a large district with 13,000 employees, paid $500,000 to renovate a building and buy equipment. Polk also spent $1.5 million on a contract for management and staffing through HealthStat, one of two major companies that typically operates these clinics for districts. The total budget for the two clinics in Polk, Kelley reported, was $4.5 million.

“We all know the budget is tight, it’s tough to come up with the money,” he said.

A focus on local

To put it lightly, Manatee school board members are thrilled by the idea.

“Every year we realize more savings, we pass that on to the employees,” Colon said.

“I think the timing is right,” board chairwoman Karen Carpenter said.

Board members Bob Gause and Dave Miner want to explore the option of having a local group of doctors or a local organization, like MCR Health Services, get involved with running the clinic, so the district could keep the money local.

When the county government explored the option of opening a clinic for its employees, board members said, there was some pushback from the local medical community. If the district moves forward, they’d submit a request for proposal for companies who are interested in running the clinic, and Gause said he wants to be sure local doctors know about it.

“I don’t want to preclude them from that opportunity,” he said.

Kelley didn’t rule out the idea, but cautioned against moving too far in that direction. Unlike the district operating its own clinic, a doctor’s group operating the clinic has its own bottom line to be a sustainable business making money.

“Once you take the bottom line out of the picture and have us funding the clinic, then the focus is totally on the patient where it needs to be,” he said. “Any other arrangement to me brings the bottom line back to someone else.”

A joint venture?

In September, Manatee commissioners heard information about what it would take for the county to start its own clinic for county employees and families. The idea was to put a clinic in the old Merrill Lynch building on Manatee Avenue West adjacent to the County Administration Building in Bradenton.

A feasibility study in September estimated the county clinic would cost $80,000 a year to operate, and would break even in three to four years, depending on use. The cost to renovate the 21,000-square-foot Merrill Lynch building would be about $3 million, and the clinic would take up about 2,300 square feet of the building.

Some county commissioners weren’t sold on the idea, and neither were those in the local medical community.

The county discussed the idea again in January, but has not gone any further. The county asked the health benefits department to gather some more data about other clinics run by public entities, said county government spokesman Nick Azzara.

School board members haven’t voiced opinions on whether they want to explore partnering with the county. The school board said they’d like to hear more information from Kelley on some of the hard numbers and costs it would take to start the clinic.

Kelley is firmly in favor of the district exploring a joint-clinic operation with the county.

“I personally think probably the wisest thing we could ever do is getting into a joint venture with them,” he said. “It’s a buy-one, get one-free deal.”

This story was originally published May 28, 2016 at 12:00 PM with the headline "School district health clinic may be in the works for Manatee."