It’s a tradition born in America’s industrial past, when miners, factory workers and their families lined up to visit the company doctor whenever they got sick. As part of an effort to rein in rising health costs, Billings School District 2 is the latest in a series of local employers to establish in-house health clinics that provide primary medical care to employees and their dependents. The clinics offer free medical exams and lab work.
The district opened two miCare clinics recently — one at Lincoln Center, the other in the Heights — as part of a comprehensive plan to save money on health care, while improving employee health. MiCare is a subsidiary of Billings-based Employee Benefit Management Services Inc. As a third-party administrator, EBMS administers health plans for employers that have self-funded insurance plans.
The clinics are staffed by a doctor, a nurse practitioner and two licensed practical nurses. Although School District 2’s clinics have been in operation for only a few months, employees have embraced them.
Deb Klusmann, a kindergarten teacher for School District 2, stopped by the miCare clinic at Lincoln Center recently. She described the clinic as a welcome convenience. Because she often stops by Lincoln Center, she doesn’t have to make a separate trip to a medical office.
These days, many employers find themselves caught in a bind as they prepare for the implementation of the new national health care law, the Affordable Care Act. Beginning in 2015, employers with more than 50 full-time workers will be required to provide health insurance or face a penalty.
The plan also calls for the establishment of state exchanges where people can shop for health care. The mandates were originally scheduled to take effect in 2014, but the deadline has been extended because of complications in establishing the insurance exchanges.
While the ACA has few direct effects on self-funded insurance plans, the federal law will likely make the self-funding option more appealing to employers, EBMS officials say.
Jerrod Weenum, director of miCare and prescription services for EBMS, describes miCare as grass-roots health reform that has succeeded in limiting health costs. The concept involves purchasing medical care at wholesale and deliver it to clients it in a cost-effective manner, he said. MiCare charges the district an administrative fee in exchange for the services.
“There’s no markup, no margin on any supplies or services, just the true cost of delivering health care,” Weenum said.
Before establishing an in-house clinic, miCare carefully designs a plan that suits the client’s needs.
“We look at a client’s historical utilization and we come up with a number of clinical hours that they’re going to need,” Weenum said.
Typically, a clinic’s staffing is split evenly between a doctor and mid-level medical providers who are either a nurse practitioner or a physician’s assistant, Weenum said.
“The whole goal is to remove barriers to care. So everything an employee goes there to do is completely free, from an office visit to the labs. Appointments can be scheduled online or by a toll-fee number, and you can generally get in that same day or the next day,” Weenum said.
MiCare focuses on wellness and reducing risks for chronic disease.
“The school district has a lot of long-term employees, and you want to keep them healthy and well,” Weenum said.
Another feature of miCare is that the provider spends up to 20 minutes with a patient.
“We don’t double book appointments, so you don’t have to take a half day off work to go to the doctor,” he said.
EBMS began its first miCare clinic in 2006 to serve 220 EBMS employees and their dependents, about 400 people. Other Billings-area clients that have joined the program include the Laurel School District, TrueNorth Steel and Wood’s Powr-Grip Co.
Tom Partlow, chief executive of EBMS, said on-site health clinics are part of a trend where health care is moving closer to the consumer.
Many health experts worry that the ACA will create more demand for health care, and the industry will have a hard time providing enough doctors and services to meet the demand.
By establishing on-site medical clinics, “our clients are saying to their employees, ‘I think quite a bit about you and I’m going to get some primary care where it’s more convenient for you,’” Partlow said.
According to the Kaiser Family Foundation’s 2012 Employer Health Benefits Survey, 60 percent of employees who receive health insurance at work are covered by self-funded plans, up from just fewer than half of employees who received such coverage one decade earlier.
Kevin Larson, president of EBMS, said the company is well positioned for growth as the nation’s health system evolves. Based on certain rules that are included within the ACA, the self-funded insurance industry is expected to grow.
“It’s becoming more attractive for employers to look at self-funding,” Larson said.
In self-funded insurance, a company sets aside money to pay for anticipated health costs for their employees rather than paying a premium to a health insurance company. Most self-funded plans hire a third-party administrator such as EBMS to handle claims and provide other services.
Typically, the self-funded model has appealed to employers with 100 or more workers. But because of changes resulting from the ACA, small companies, with perhaps 25 to 50 employees, are looking at self-funded plans as an option, Larson said.
While EBMS seems to be well positioned moving forward, third-party administrators face competition from traditional insurers such Aetna and United Health Care, which are looking at expanding into the self-funding arena, Partlow said.
A self-funding option provides flexibility to employers and allows them to customize the types of programs to meet the needs of the organization, Larson said.
“It’s a plug-and-play type of scenario where you can provide wellness programs or a vision plan and you can select what you want,” he said.
EBMS operates 12 miCare clinics for its clients, and that number is growing.
“We’re uniquely positioned as far as third-party administrators go,” Larson said. “Historically TPAs have been transactional types of companies. Many years ago we decided to expand into additional offerings that help employers control costs by offering nursing programs, disease management programs, prescription management programs. We have a pharmacy that mails prescription drugs to eight states.”