Indian River County

Administration Complex

1801 27th Street, Building

Indian River County Florida

Vero Beach, Florida,

32960-3388

Meeting Minutes - Final

www.ircgov.com

Board of County Commissioners

Chairman, Joseph E. Flescher, District 2

Vice Chairman, Peter D. O'Bryan, District 4

Commissioner Susan Adams, District 1

Commissioner Joseph H. Earman, District 3

Commissioner Laura Moss, District 5

Jason E. Brown, County Administrator

Dylan Reingold, County Attorney

Jeffrey R. Smith, Clerk of the Circuit Court and Comptroller

Thursday, February 18, 2021

9:00 AM

Commission Chambers

Employee Health Clinic Workshop

1. CALL TO ORDER

2. ROLL CALL

5 -

Present:

Chairman Joseph Flescher

Vice Chairman Peter O'Bryan

Commissioner Susan Adams

Commissioner Joe Earman

Commissioner Laura Moss

2.A. A MOMENT OF SILENT REFLECTION FOR FIRST RESPONDERS AND MEMBERS OF

THE ARMED FORCES

2.B. INVOCATION

Mr. Stan Boling, Gracespring Covenant Church

3. PLEDGE OF ALLEGIANCE

Commissioner Laura Moss

4. ADDITIONS/DELETIONS TO THE AGENDA / EMERGENCY ITEMS

A motion was made by Vice Chairman O'Bryan, seconded by Commissioner

Moss, to approve the Agenda as presented. The motion carried by the following

vote:

5 -

Aye:

Chairman Flescher, Vice Chairman O'Bryan, Commissioner Adams, Commissioner

Earman, and Commissioner Moss

5. DEPARTMENTAL MATTERS

21-0258

5.A.1.

Health Plan and Employee Clinic Workshop

Attachments: Staff Report

Cocoa

IRC Schools

Martin County BoCC

Martin County Sheriff Office

Human Resources Director Suzanne Boyll recalled the Board's request for staff to

bring back information on an employee health clinic. In a PowerPoint Presentation,

Director Boyll gave an overview of the County's current health plan design, the total

members enrolled, and the payroll deductions for the Gold and Silver Health Plans.

Chairman Flescher along with Commissioner Earman sought and received clarification

from Director Boyll on the number of members and retirees including their dependents

enrolled in the County's health plan.

Director Boyll discussed the County's health plan costs pointing out that 70% of the

medical claims and 20% of pharmacy claims less the rebates accounted for those

costs. She reviewed the County's implementation of cost-savings measures for the

health plan: an additional prescription savings program, an option for a lower premium

health plan known as the Silver Plan, increased emergency room copays, and the

Telemedicine benefit.

Vice Chairman O'Bryan sought and received information from Director Boyll in

regard to the high dollar prescription claims review process and his concern on how it

could impact an employee's health if a different medication was prescribed than what

had been recommended by the doctor due to cost.

Mike Meredith, Executive Vice President with Lockton, the County's Insurance

Broker, stated that Lockton employs pharmacologists to determine what drugs give

the same health outcome or better to keep the costs down.

Ms. Boyll responded to Commissioner Moss that the increase in the expenditures for

the pharmaceuticals could be related to the higher cost medication or a chronic

condition.

County Administrator Jason Brown pointed out the rising cost of prescription drugs

were a problem; however, the implementation of the prescription savings program

over the years had resulted in a savings.

Director Boyll reviewed other health savings options the County had explored and

stated the County was currently undertaking an analysis of savings on a supplemental

benefit for non-emergent surgeries called SurgeryPlus and Marketing of Pharmacy.

Director Boyll and Mr. Meredith detailed the SurgeryPlus supplemental benefit and

provided information to the Board on the access to the network of Surgeons of

Excellence nationwide where they bundle the pricing for procedures. She indicated if

it was something the County wanted to pursue, it would be voluntary participation for

the member and under this service incentives could be built in such as member

deductibles and copays waived.

Director Boyll outlined the primary cost drivers of the health plan and pointed out the

cost drivers would always be there regardless of whether there was an employee

health clinic. She turned the Board's attention to the employee health clinic and stated

that out of the fourteen (14) employers that had responded to the clinic survey, only

eight (8) employers had employee clinics. She reviewed the results of the survey and

emphasized that the employee clinics were unique to its employer. The Board sought

information on the reason the City of Palm Bay closed their employee clinic, two

employee clinics in a location versus one employee health clinic, and the number of

retirees that reside in the County. Director Boyll replied there was no reason given

on why the City of Palm Bay had closed their employee clinic and emphasized the

importance of utilizing consultants to guide the clinic evaluation and vendor selection

process. She did not have a breakdown of the number of retirees, but pointed out

that 54% of enrollees live within a ten mile radius of 32960. A discussion followed on

the survey in regard to the retirees with Commissioner Earman stating some of the

surveys indicated limiting the employee clinic to the age of 65 and under because of

Medicare.

Melissa Anchia, Lockton Health Risk Solutions Expert, via Zoom, used the

PowerPoint Presentation to discuss the challenges and opportunities with the different

types of clinic services and staffing options. Vice Chairman O'Bryan sought and

received information from Ms. Anchia regarding when an employee would utilize the

clinic and also received clarification from Commissioner Earman on a Nurse

Practitioner and Physician Assistant's scope of work. Ms. Anchia spoke on the

opportunities and challenges with on-site, near-site, virtual, retail/community based,

direct primary care locations, and how the estimated value and return on investments

on an employee health clinic were measured noting the employer may not see results

for several years. She presented an example of a recently implemented clinic with

their goal to provide a competitive benefit to members combined with a three year

goal for risk reduction and medical plan savings. She pointed out some of the key

performance indicators that clients were looking for was the number of clinic users,

the estimated value in clinic services provided, the savings and the top visit types. She

concluded that Lockton looked at several key metrics from the Indian River County

Health plan data to demonstrate the plan savings through the diversion of community

visits to the clinic, risk reduction, and how it could translate into a clinic strategy.

Director Boyll stated that the survey respondents with a clinic indicated a savings and

overall value; however, she was unable to get tangible numbers to support their

savings. She proposed implementing a wellness strategy into the clinic that could

result in a positive impact to individuals on the health plan and potentially impact future

claims, but noted it would be an additional service to be administered and managed.

Director Boyll concluded that staff was unable to provide any assurances that overall

plan costs would be reduced by the implementation of a clinic; however, there would

be perceived value from the members who utilized the clinic. She indicated that if the

Board determined it was in the best interest of the plan and its covered members, staff

would bring back an agenda item to recommend the Board engage the services of

Lockton Companies Clinic Consulting Services in the amount of $75,000.

The Chairman called a recess at 11:00 a.m., and reconvened the meeting at

11:10 a.m., with all members present.

Commissioner Moss referred to the percentage of plan members that lived within the

10 mile radius of the 32960 zip code and she inquired on the number of

walk-in-clinics within that 10 miles radius. She questioned the origin of the employee

health clinic and asked if it was something the employees had requested. Director

Boyll did not have information on the number of walk-in-clinics within the 10 mile

radius and confirmed that some employees had come forward and made reference to

other employers with health clinics. She indicated that the employee group had not

been surveyed as a whole in regard to an employee health clinic. Commissioner Moss

felt it was important to survey the employees and mentioned incorporating a wellness

program apart from establishing a clinic.

Vice Chairman O'Bryan sought and received clarification from Director Boyll and Mr.

Meredith on the StopLoss Premiums and the analysis that Lockton used to predict the

number of high cost claimants. He was open to further exploration of an employee

health clinic, but expressed concern with under-utilization.

County Administrator Brown further discussed that everyone under the plan had

access to a once-a-year wellness visit at no cost.

Chairman Flescher was very interested in an employee health clinic for patient care,

and he emphasized that the County needed to consider the reduction of costs through

other options or plans. He felt it was critical to survey the employees for their interest

in an employee health clinic.

Commissioner Earman was interested in looking at options to keep the Employee

Health Plan costs down and agreed that the County needed to take a further look into

an employee health clinic. He added that an employee health clinic could be more

than a health advocate for the employees, such as the first step in the Worker's

Compensation process, and could be utilized for drug testing or physicals if required

by the County. He also wanted to look at partnering with other agencies within the

County.

Commissioner Adams had the same questions and observations as Commissioner

Earman and felt there were opportunities to partner with other entities to help offset

costs. She thought it was important that the respondents with clinics indicated that

they received a perceived savings, and that their employees looked at it as a positive

value. She also felt the County needed to address the unnecessary Emergency Room

visits. She opined there was not enough information in the presentation to make a

decision and was in favor in obtaining additional information in order to move

forward.

The Chairman opened the discussion to public comment.

John O'Connor, President of the Indian River County Firefighters Association Local

2201, referred to the presentation and felt the insurance was not affordable or

competitive. He urged the Board to look at other venues or opportunities for health

savings in order to be competitive in the marketplace and retain the best employees.

County Administrator Jason Brown summarized the Board's desire to further look

into an employee health clinic and recommended bringing back an agreement with

Lockton at a future Board meeting. He suggested looking into partnering with other

entities and preferred not to build a stand alone clinic, but contract with other clinics,

and he addressed the need to drive down the number of emergency room visits.

County Administrator Brown agreed with Commissioner Moss that it was important

to survey the employees to determine their overall interest because that would drive

the success or lack of success of an employee health clinic. In response,

Commissioner Adams cautioned that there was not enough information on an

employee health clinic for an employee survey and the importance of marketing the

clinic to the employees. Chairman Flescher was for an employee survey and felt it was

important to know the hours the clinic would be available to the employees.

Commissioner Earman referred to Director Boyll and County Administrator Brown

on whether the employee's health plan and the employee health clinic were considered

as two separate items. County Administrator Brown replied that the employee health

clinic would become part of the County's health plan. A discussion followed on the

process once the County decided to move forward. Ms. Anchia and Mr. Meredith

detailed the different phases of the process indicating the total process would take up

to 12 months.

The Chairman asked if there was anyone who wish to speak; there was none. He

indicated that there was a consensus among the Board on the County Administrator's

pathway to move forward with an employee health clinic and thanked everyone for

their input.

It was the consensus of the Board to: 1) determine through an employee survey,

the overall interest of an employee clinic; 2) return to the Board at a future

meeting with an agreement for a consultant to further look into Employee Clinics;