Nurse practitioner Nicole Burrow-Haag, left, talks with patient Tania Ray at the Jeffersonville/Clark County government health clinic. | Photo by Boris Ladwig

Early Monday afternoon, Jeffersonville Police Department employee Niesha Ray took her 17-year-old-daughter, Tania, to the city employee medical clinic just north of Jeffersonville City Hall.

They walked in without an appointment, saw the nurse practitioner right away and left with a diagnosis and medication about 15 minutes later. Cost to the family: $0.

Jeffersonville city employees — and their dependents — have had access to the clinic, run by Louisville-based Alternative Health Solutions, since February 2015.

“We use it quite often,” Niesha Ray said.

The mom has received treatment at the clinic for an injured hand. Her daughter sought help when she hurt her knee. Her son received medicine for asthma.

Ray said she likes the convenience of just stopping by the clinic without having to make an appointment. And being able to receive care without paying. She said even many of the prescriptions are available on site and for free.

Clark County officials were so impressed by the city’s success with the clinic that they decided recently to make it available to county employees as well, starting next month.

City and county government officials said the clinic, which resembles so-called minute clinics at national drugstore chains that are open to the public for minor medical needs, allows them to offer a benefit that makes it easier to recruit and retain employees and enables them to mitigate rapidly rising health insurance and health care costs.

“We thought it would be a great benefit,” said Clark County Commissioner Connie Sellers.

Examining the clinic

The 2,600-square-foot clinic features two examination rooms, a lab, a conference room and two offices, though some of the space can be converted to additional exam rooms. It employs a receptionist, a lab tech and the nurse practitioner. The staff can take care of basic non-urgent medical needs such as looking at sprained wrists, bug bites or persistent coughs. The staff can check a patient’s eyesight, hearing, lung function, heart beat and run blood tests, the results of which can be available in 10 minutes.

The clinic sees about 10 patients per day. The afternoon that the Rays showed up, the facility already had treated four patients. One of them had woken up feeling unwell. The patient came to the clinic, which ran a urine screen, detected a bacterial infection and sent the patient home with an antibiotic, said Nicole Burrow-Haag, the nurse practitioner

The clinic handles many routine cases, such as people waking up with a sore throat. Burrow-Haag said that recently she also has seen a lot of students who need to undergo physical exams so that they can play sports in the fall.

A boy once came in and said that he felt as though his ear was stopped up. Turns out, it was. He had a dead bug in his ear. The critter was flushed out, and the boy sent home.

Not all cases are that benign, however, Burrow-Haag said.

One patient came in with dizzy spells, which sounded suspicious to the nurse practitioner. The clinic ran an EKG, which came back abnormal. Clinic staff sent the patient for more testing at a nearby hospital. He remained there for days in intensive care because of a serious heart problem.

That case serves as an example of how municipalities hope to catch employees’ health problems early, before they become serious, so that a little investment at the front end — on medication to lower blood pressure for example — can save a lot of costs on the back-end — by avoiding emergency heart surgery.

Michael Dees

About 30 percent of people with insurance spend about zero dollars on health care annually, said Michael Dees, chief executive of Louisville-based Alternative Health Solutions, which runs the clinic.

Many of those people avoid going to doctors because they may have to take time off work, they lose money or vacation time, they have trouble getting an appointment or they’re too busy driving their kids to soccer practice and piano lessons.

On-site clinics without wait times that provide access to no-cost care eliminates many of the hurdles that keep people from seeing doctors before their conditions — some undiagnosed — become serious — and expensive.

Burrow-Haag said some patients she had met at the clinic had not seen a medical professional in years.

“This arrangement allows them access,” she said.

Cost and benefits

Providing the service to the county and its dependents — even those not covered by the county’s insurance plan — costs $65 per month per employee. If all of the county’s 360 employees sign up, that would be about $280,000.

Jack Coffman

Jack Coffman, president of the Clark County Commissioners, said that if all employees signed up, which he expects won’t happen for a couple of years, the county probably would save hundreds of thousands of dollars. The savings would come primarily from avoiding insurance claims.

The county, like the city, is self-insured, which means the county and each employee pay a share of their insurance premiums, and the county pays for a share of the claims up to a certain amount, after which insurance pays the rest.

Filing fewer claims means the county pays less in health care costs. Lower claim utilization can even help the county get better insurance rates next year.

Dees told Insider that Jeffersonville this year would spend less money on access to the clinic than it would save in health care costs. So far this year, the city has avoided $205,000 in health claims, which already exceeds total claims avoidance for 2016.

Whenever an employee goes to the clinic rather than an urgent care clinic, the city avoids a $300 claim, Dees said. A trip to the emergency room starts at about $1,000.

Kim Calabro, the city’s human resources director, said that before the clinic, the city also incurred occupational medicine-related costs of $12,000 to $15,000 per year, on pre-employment and routine drug screens, sprained ankles from police officers and firefighters and workers getting injured while slipping on ice. Instead of trips to an off-site clinic, employees now go across the street from city hall. They also get flu shots there in the fall. Calabro said an employee recently went to the clinic after he got bitten by a kitten.

Some of the city’s employees initially reacted with skepticism toward the clinic.

“We couldn’t get people to go over there,” Calabro said.

Some thought it was too good to be true, she said, and others just didn’t know what to make of it. But the clinic’s use has increased as employees have told others about their positive experiences.

 

City Controller Healther Metcalf said that the benefit served as a recruitment tool, as well.

Connie Sellers

And that’s a reason Sellers, the commissioner, pushed for it. She had served on the City Council when the city adopted the benefit.

Health care costs are taking an ever-increasing bite out of county government funding and that’s made it difficult for the already cash-strapped county to offer even inflationary raises to employees, who also are paying higher health care costs and insurance premiums. The county has paid about $400,000 of its nearly $4 million annual health care bill with economic development income tax dollars.

“We cannot continue doing that,” Sellers said.

She said she hoped access to the clinic would help the county better recruit and retain employees — even if it takes some time to generate a return on the investment.

Sandy Halstead, the county’s insurance agent with Assured Partners, said that the county expects the clinic to generate net savings for the first year of about $36,000. Thanks to greater participation in subsequent years, the savings for the county are expected to reach $178,000 by year five.

Halstead said AHS has agreed to pay back a portion of the county’s costs if the clinic benefit fails to meet agreed upon targets.

The business model

Dees said his customers — businesses, government agencies, nonprofits — see the clinics as way to save money and to expand their benefits package.

He uses software developed by Indianapolis-based Springbuk to analyze the client’s health claims data to customize that client’s clinic’s offerings.

Patients like the clinics because they do not have to wait days or weeks to see their doctor, he said. As hospitals and hospital systems buy up doctors offices — in part because they refer business to the hospitals — and more people obtain insurance because of the Affordable Care Act and Medicaid expansion, many doctors offices are jammed.

Dees said he sees his clinics as a way to alleviate some of the pressure on physician offices, because the clinics can address medical needs of people who do not need to see a doctor.

Alternative Health Solutions, which is supported by seven local investors, runs three clinics, each of which is profitable. AHS leases the spaces, buys the equipment and furniture and pays for the staff and operations.

Dees hopes to open two more by the end of the year, and then at least three more in 2018.

UPDATED: The story was updated to add comments from the county’s insurance agent.

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Boris Ladwig
Boris Ladwig is a reporter with more than 20 years of experience and has won awards from multiple journalism organizations in Indiana and Kentucky for feature series, news, First Amendment/community affairs, nondeadline news, criminal justice, business and investigative reporting. As part of The (Columbus, Indiana) Republic’s staff, he also won the Kent Cooper award, the top honor given by the Associated Press Managing Editors for the best overall news writing in the state. A graduate of Indiana State University, he is a soccer aficionado (Borussia Dortmund and 1. FC Köln), singer and travel enthusiast who has visited countries on five continents. He speaks fluent German, rudimentary French and bits of Spanish, Italian, Khmer and Mandarin.