Cities following business lead to employee clinics

A long-standing cost-control model used by private-sector businesses is making its way into the public sector, as some city governments are investigating opening clinics for employees.

The clinics, which generally offer primary care services to employees and their dependents, are designed to provide a convenient first line of defense for workers who might otherwise allow a chronic condition to go untreated, causing higher costs and lost productivity down the line.

Businesses have embraced the strategy for some time. Now the trend is spreading to municipalities, which are constantly trying to control costs under the constraints of a taxpayer-funded budget.

The strategy is becoming popular, especially in Florida, where cities such as Port St. Lucie, Ocoee, Plantation and Cape Coral are looking at the option. While none have officially had a clinic approved as part of next year's budget or signed a contract with a company to provide the service, several appear ready to launch, said Ray Tomlinson, president of The Crowne Group, an insurance service and consulting group in Ocoee, Fla.

"There's been incredible interest," he said. "With health care costs continuing to increase, employees and employers alike are experiencing less coverage for more money."

Clinics for municipalities are set up in much the same way as they would be for a private business. Contracts, however, take more time to hash out because they have to be approved by a public body, and a city generally deals with several unions, adding to negotiation time.

The employer generally pays for all primary care services, with no co-pay charged to the employee. The savings come because patients develop fewer serious ailments and pay fewer visits to specialists, officials said.

Savings can be immediate. Tomlinson said each time his company has worked with a client to investigate an on-site clinic, the money saved from claims in the first year was enough to fund the clinic's establishment.

Opportunities for physicians

The clinics are generally set up and run, for a fee, by a private company and staffed by a physician and a small support staff. Florida cities, for example, are considering a deal with Lake Mary, Fla.-based WeCare TLC, a subsidiary of Alliance Underwriters. WeCare contracts with the physicians.

Staffing an employer clinic offers physicians an established patient population. Because clinic hours are often limited, physicians can continue to practice elsewhere.

Brenda Salter, MD, an internist and emergency physician in Lake Mary, Fla., provides services at Alliance Underwriters' on-site clinic, and is slated to provide services to a nearby municipality once its contract is signed. She still maintains her position as an emergency physician.

Staffing an on-site clinic "allows me to actually practice in an office setting without having to set up a practice," Dr. Salter said. "I can participate in care without having to be involved in hiring staff, training and scheduling."

Meanwhile, the clinic arrangement can help municipalities balance the ability to raise pay for workers with the need to control costs and the potential backlash of raising taxes.

"Health care costs are so high that they're eating up so much of [a city's] budget," said Judy Garber, president of WeCare and MedWatch LLC, a disease and utilization management subsidiary of Alliance Underwriters. "Costs have escalated to such an extreme that it's tough to raise salaries, and they don't want to cut benefits. This is a very big cost savings."