Catawba County is making use of an innovative health care arrangement in an effort to limit the amount of money it spends on employee health care. The results are promising, with the county realizing significant savings while employees enjoy quicker and less costly access to health care for routine occurrences that would otherwise necessitate a visit to the doctor’s office.
North Carolina’s counties and municipalities have faced difficult financial times in recent years, with a slow economy reducing sales tax collections and the state withholding money meant for localities. At the same time, the cost of providing certain mandatory items has continued to grow rapidly, making every cost savings significant.
“In the private sector, necessity is the mother of invention,” said Chad Adams, director for the Center for Local Innovation and vice chairman of the Lee County Commission. “In local government, crushing mandates can be the mother of innovation.
In June 2002, Catawba County entered into an agreement with Catawba Valley Medical Center for CVMC to operate a special on-site clinic called the Employee Health Connection for county employees. The clinic is open a total of seven hours each business day, with service provided half days at two different locations. It is staffed by a licensed nurse practitioner and a licensed practical nurse. A wellness nurse is also employed part-time.
Catawba County pays CVMC a flat fee to operate the clinic. All medical records belong to CVMC, not the county, though the county will be informed about light-duty restrictions, returns to work, and similar information in workers compensation and Family & Medical Leave cases.
“We believe the clinic is saving the county expense through our self-funded health insurance fund, our workers comp deductible, and time away from work,” said Catawba County Personnel Director Debbie Bradley. “It saves the employee out-of-pocket expense, and use of sick leave.”
“This is a novel idea that exemplifies critical, innovative thinking at the county level, ” Adams said of the clinic.
EHC is not intended to replace a personal physician. It’s meant instead to provide treatment for minor illnesses such as sinus infections, colds, and the flu, minor injuries, and other routine matters that would require a visit to the doctor’s office. The clinic, for example, offers allergy, hormone, and vitamin injections at a nominal cost provided a patient provides serum.
The EHC arrangement is a win-win situation for both the county and employees. Employees are not charged sick leave time for visiting the clinic. The cost of a visit to the EHC is half the usual copay for a trip to a conventional doctor’s office, which saves worker money.
The county benefits in several ways. Most obviously, the county’s insurance plan does not have to pick up the bulk of the cost of a doctor’s office visit. Bradley estimates the savings at about $35 per visit.
The county and employees both benefit from the convenience of the clinic, which reduces wait and travel times considerably. The EHC is designed as a drop-in facility with appointments required only for physicals. Should a line develop to see the nurse practitioner, employees can leave their names and office numbers. The clinic will contact them when an opening is expected.
Workers compensation injuries are treated in the clinic, saving the county a significant amount of deductible cost. Bradley notes that the clinic often provides quicker returns to work as the nurse practitioner can contact her office and/or the worker’s supervisor immediately when an employee is declared able to resume duties after an injury. This arrangement also limits the potential for confusion, as the nurse practitioner can directly relay any restriction, such as a need for light duty, that may apply.
The county also uses the clinic for pre-employment medical screenings and drug tests, federally mandated screenings for tuberculoses, respiratory function, and OSHA-required medical record keeping.
The EHC also plays a key role in Catawba County’s pilot wellness program for emergency medical service personnel. The stated goals of the program are “to enhance physical agility of emergency medical response employees; to reduce the incidence of workers compensation claims and lost time; to reduce sick leave use; and promote physical well being.”
In recent years, EMS personnel have used greater amounts of sick level compared to other county employees. While the typical employee used 58 hours of sick time in 2002, EMS personnel were out an average of 78 hours. From July 1998 through March 2002, EMS staff racked up a total of 2,683 sick days.
EMS personnel also have generated a significant number of worker’s compensation claims. Of the $870,000 in worker’s comp paid to county employees between July 1998 and March 2002, $350,000 went to EMS personnel. The county attributes the quantity of worker’s comp claims to a number of lifting accidents.
Full-time EMS personnel are eligible for the wellness program. After an evaluation personal goals are set for each participant. Areas that might be addressed include weight lose, stopping smoking, lowering cholesterol, or addressing any other physical conditions that might exist. To help motivate participants, the county is offering incentives, including the opportunity to earn $250, for those that meet all their wellness goals.
Catawba County had 72 full-time EMS personnel at the time it implemented the program. Eighteen volunteered to participate in the program.
“The purpose is to improve the paramedic’s overall health to prevent workers comp claims,” Bradley said.
Adams, meanwhile, is encouraged by the overall success of Catawba’s Employee Health Connection.
“In this instance, money is being saved, services are being improved, and the employees are happy. If cities and counties statewide were to adopt similar programs, there is the potential to save hundreds of thousands of dollars.
Michael Lowrey is associate editor of Carolina Journal.