1. On-site Health & Wellness Clinic City of Wauwatosa February 23, 2016

2. The Team Hays Companies of Wisconsin HR Staff Health Department
Outside Counsel
After finalist selected Froedtert has become of a part of the team

3. We have need and opportunity.

4. The Need Constraining Health Insurance Costs
Attracting and Retaining Talent

5. Constraining Health Insurance Costs
Upward trend of cost of health insurance
Uncertainty about future increases
Even when “successful” in managing increases the amount of inflation on claims consumes high percentage of available new revenue each year

6. Healthcare Costs
2016 Health Insurance related expenses in health/life budget
Claims budget $6,866,701 (72.8% of health/life expenditures)
Administrative fees $1,456,542
HRA contributions $ ,000
$ 8,768,243

7. Recruiting and Retaining Talent
City of Wauwatosa Strategic Plan: “Develop a high-performing organization through strategic employee development and compensation programs.”
Employers Emphasizing Benefits to Recruit Talent
Employees view health insurance as the most important benefit
Source: SHRM HR Magazine Vol. 60 No. 9 11/1/2015

8. Mercer study

9. The Opportunity
Space
Funding

10. Space Space adjacent to the Health Department in City Hall
1. Furnish existing waiting area at bottom of steps in City Hall
2. Remodel storage room, convert to consultation room for medical assistant
Update existing overflow exam room
Move health department storage and create new overflow exam room and storage space

12. Funding Opportunity to re-invest funds
Above target in reserve funding for health claims
Cost of opening clinic covered by 2015 surplus health claims

13. RFP Process 6 proposals Froedtert Workforce Health finalist
Community partner
Flexibility
Ability to staff clinic from local resources
Credibility with employees
Familiarity with wellness program for seamless integration
Lowest cost proposal
EPIC (electronic health record)

14. ROI MEASURES Hard Costs Avoided Costs
Cost of providing care at clinic compared with cost of care through health plan
Avoided Costs
Emergency room visits
PTO costs
Loss of productivity
Long-term Savings Through Improved Employee Health
Managing chronic diseases
More convenient
Appointments longer
Build relationship with provider

15. ROI Illustration – Example 1
Utilization Assumptions
Total Visits per Month 70
# of Eligible Participants
1300
PTO $ Value Per Hour $
Lab Cost $ Value (market rate) $
Vaccine Cost $ Value (market rate) $
Physician Office Visit $ Value (market rate) $
On-Site Clinic Expenses
PA Hourly Costs ($75 per hour x 20 hours per week)
$ 6,000.00
MA Hourly Costs ($30 per hour x 20 hours per week)
$ 2,400.00
Vaccine Charge ($25 per vaccine) $
Basic Lab Tests (included in total fees) $ Rx
$ 1,000.00
Supplies (included in total fees)
Monthly Management Fee
$ 5,000.00
Total Monthly Costs
$ 14,825.00
Health Plan Expenses (had visits run through plan, not the on-site clinic)
Office Visit ($130 average charge x 66)
$ 8,580.00
ER/Specialty Visits ($500 average charge x 4)
$ 2,000.00
Vaccines ($30 average charge) $
Labs ($25 average charge) $ Rx
PTO Expense (75% of visits x 3 hours x avg PTO rate)
$ 7,875.00
Total Monthly Costs
$ 21,265.00
Savings Summary
Monthly Health Plan Expenses
Monthly On-Site Clinic Expenses
$ 14,825.00
Total Monthly Savings
$ 6,440.00
Return on Investment Estimate
Margin over Expenses per month
Margin over Expenses per year
$ 77,280.00
*Illustration only

16. ROI Illustration – Example 2
Utilization Assumptions
Total Visits per Month 80
# of Eligible Participants
1300
PTO $ Value Per Hour $
Lab Cost $ Value (market rate) $
Vaccine Cost $ Value (market rate) $
Physician Office Visit $ Value (market rate) $
On-Site Clinic Expenses
PA Hourly Costs ($75 per hour x 20 hours per week)
$ ,000.00
MA Hourly Costs ($30 per hour x 20 hours per week)
$ ,400.00
Vaccine Charge ($25 per vaccine) $
Basic Lab Tests (included in total fees) $ Rx
$ ,000.00
Supplies (included in total fees)
Monthly Management Fee
$ ,000.00
Total Monthly Costs
$ 14,825.00
Health Plan Expenses (had visits run through plan, not the on-site clinic)
Office Visit ($225 average charge x 76)
$ 17,100.00
ER/Specialty Visits ($500 average charge x 4)
$ ,000.00
Vaccines ($30 average charge) $
Labs ($25 average charge) $ Rx
PTO Expense (75% of visits x 3 hours x avg PTO rate)
$ ,000.00
Total Monthly Costs
$ 30,910.00 .
Savings Summary
Monthly Health Plan Expenses
Monthly On-Site Clinic Expense
$ 14,825.00
Total Monthly Savings
$ 16,085.00
Return on Investment Estimate
Margin over Expenses per month
Margin over Expenses per year
$ 193,020.00
*Illustration only

17. Excise Tax On-site clinics subject to Cadillac Tax?
Cost of clinic may count toward excise tax
IRS delayed effective date from 2018 to 2020
No one knows for sure how thresholds or tax will be calculated
Nominal care provided at on-site clinics may not be included
“Employers continue to launch worksite clinics despite ACA uncertainties- Mercer survey dated September 8, 2015”
Clinic sponsors say savings will outweigh the cost
Still positive net value

18. Current Wauwatosa Waiting Area

19. Current Health Department Storage
Future Clinic Exam Room

20. Current Health Department Storage
Future Consultation Room

21. City of Milwaukee Workplace Clinic (Froedtert)

22. City of Milwaukee Workplace Clinic Exam Room

23. City of Milwaukee Workplace Clinic Exam Room

24. Proposed Hours:
Twenty hours per week with option to increase. Froedtert advised that the most critical hours for the success of an on-site clinic are Monday mornings.

25. Proposed Hours: Monday, 8am-3:30pm Tuesdays, 7am-12pm
Thursday, 10am-5:30pm

26. Proposed Services: All services are free to employees and dependents, including select medications, and lab services.
Diagnosis and treatment of minor illnesses and injuries such as sore throats, ear aches, sinus infections, flu or cold symptoms, urinary tract infections, skin conditions/rashes, and sprains/strains
Preventive/wellness visits including physical exams and health coaching for lifestyle related concerns (i.e. nutrition, weight, exercise, smoking)
Management of chronic disease conditions (i.e. diabetes, cholesterol, blood pressure)
First aid/triage of work related injuries
Proactive outreach for prevention an early detection (i.e. immunizations, wellness screenings)
Additional services may be added in later phases, such as occupational health services (e.g. drug screening, pre- employment physicals, specialized physicals for protective service, physical therapy).
If requested by Customer’s employee, assistance in providing continuation of care with the individual’s physician regardless of health system affiliation
Provision of basic onsite lab tests, including glucose, lipid panel, urinalysis and screening for strep throat, and pregnancy.
Administration of designated vaccinations
Provision of educational resources addressing health and wellness topics
Dispensing of select medications (excluding controlled substances).

27. Timeline to Opening Council approval early March
Construction of build-out March-April
Communication and Promotion March-April
Opening mid-May

28. Future Opportunities Eligibility for part-time employees
Expand hours depending on utilization
Community partners
More robust occupational health care
NFPA physicals for fire department
Drug screening
Pre-employment physicals
Physical therapy