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June 14, 2011 MinutesCITY OF DENTON CITY COUNCIL MINUTES June 14, 2011 After determining that a quorum was present, the City Council convened in a Work Session on Tuesday, June 14, 2011 at 3:00 p.m. at Denton Regional Professional Office Building, 3537 S. I- 35E, Suite 310B (3rd floor), Denton, Texas. 1. Receive a report, hold a discussion and give staff direction regarding the proposed City of Denton Health and Wellness Center. City Manger Campbell stated that this was an important project that was introduced to Council about two years ago as a concept for better health coverage for employees. Staff would be presenting an update on the project. Caleb O'Rear, CEO-Denton Regional Medical Center, presented introductory remarks concerning DRMC. One of their focuses was to partner with agencies in the community to provide health services. Scott Payne, Risk Manager, provided an update on the project. He reviewed the cost of health benefits, strategies to combat increases in health care costs, and why a clinic would be beneficial to city employees. A clinic would be beneficial in terms of service versus benefits, better disease management, active wellness partner, influence medicine prescribing patterns, and influence physician and facility referrals. Other areas to consider for a clinic were accessibility, reduction in absenteeism and presenteeism, a resource for other medical related services, establish a medical home and provide a cost effective new benefit for employees. Clinic RFSP Process - Staff first looked for partners within the community to establish a clinic. The DISD and County indicated that they were not ready at this point in time to commit to such a project. Twelve responses were received in response to the request for sealed proposal with that number narrowed down to four for the Selection Committee to interview. The Selection Committee chose two final companies and did site visits for their current facilities. The Committee selected Care Here as the finalist. Clinic Model - the clinic would be staffed with one physician and two medical assistants. Care Here would interview and hire the employees. Employees would be able to schedule appointments on line with clinic hours being 40 hours per week. Exact days and times had not been established yet. Care Here would provide the medical supplies, medical equipment, and electronic medical records. Disease Management - disease management involved actively working with employees to better manage their health. A No/Low Risk employee might receive letters, emails or health information. Moderate Risk employees could receive letters, emails, health information and possible outreach calls. High Risk employees might receive outreach calls and be placed in structured programs to help manage their health issues. Case Management would involve identification, assessment, the physician, patient goals and evidence-based protocols. Clinic interaction with United Health Care would involve merging clinic data with UHC data while still maintaining HIPPA protection. Clinic Location - the proposed location for the clinic would be at the Denton Regional Professional Office Building. It would include 2,529 usable square feet of space, five examination rooms and three offices. The lease cost would be $1 per year. Benefits to this City of Denton City Council Minutes June 14, 2011 Page 2 location included proximity to city facilities, ample parking, existing medical facility, access to other medical specialists and services, and occupational medicine and emergency room. Estimated Costs - Start-up costs were estimated at $20,000; salaries were estimated at $360,000; administrative fee was estimated at $319,662; and insurance was estimated at $3,510. Mayor Burroughs asked about the possibility of having partners in the future and possible expansion of services based on the current proposed contract. Payne stated that the contract could be written to include possible partners in the future. Mayor Burroughs asked about the length of the lease. Payne stated it was for three years. Mayor Burroughs asked about remodeling of the proposed space. Payne stated that an allowance was provided for by DRMC for minor renovations. Mayor Burroughs suggested tracking the savings associated with the use of the clinic so it could be reviewed at the end of the contract period. He asked if the medical staff at the clinic was just for the clinic or shared with another facility. Payne stated that the clinic would have the first claim to the staff's time but they would be allowed to work elsewhere on the weekends. Mayor Burroughs stated that more would be known about employees due to the aggressive wellness program and asked about that affect. Payne stated that there would be a bump in the first year or so in the preventative area. The minor preventative care bump would eventually hold off major care later. Council Member Gregory stated that 64% of the employees participated in the wellness survey in order to get a reduction in their premium. He questioned why the remaining percentage of employees did not participate. Payne stated that there were various reasons such as it was just not worth it to the employee. Council Member Gregory asked about the definition of a "medical assistant". Payne stated that was an individual who was not a registered nurse but a LVN who had gone through medical training. Council Member Roden asked who the employees would interact with in terms of disease management. Payne stated they would work with the clinic and Care Here would provide outreach calls. City of Denton City Council Minutes June 14, 2011 Page 3 Council Member King asked about the dispensing of medications at the clinic. Payne stated that it would depend on the model used. There would be no samples provided. Employees would receive a prescription to take to a pharmacy. Mayor Pro Tem Kamp asked about the formulary. Payne stated that it would be the formulary from United Health Care. Mayor Pro Tem Kamp stated that with only one doctor, what would happen if that person were not available to come to the clinic such as an illness or vacation. Payne stated that Care Here would provide a fill-in during the doctor's absence. City Manager Campbell asked about estimated employee participation. Payne stated staff was looking at other proposals and that usually by the third year participation had reached a peak. Council Member Watts questioned what criteria would be used in the future to know if the clinic was providing savings to the city - better care for employees, employee costs down, city costs down. Payne stated that hard costs diverted from the medical community should be seen. Staff would be looking at overall trends and hard costs. Council Member Watts asked if the insurance amount was sufficient to cover the city should something happen in the clinic. City Attorney Burgess stated that the doctor would have malpractice insurance in the clinic and Care Here would provide insurance through the contract. Council Member King asked how short time appointments would be accommodated. Payne stated that part of the scheduling would still have to be worked out but there would be time provided for walk-ins. Council Member Gregory asked if Care Here was affiliated with United Health Care. Payne stated that Care Here was not a part of United Health Care. Council Member Engelbrecht suggested working with TWU to look at research for positive feedback for incentives for employees who make strides in health care. Payne stated staff could look into that strategy. City of Denton City Council Minutes June 14, 2011 Page 4 Council Member Roden asked about underutilized needs in the community partnering with the clinic. Payne stated that he was not sure about the use of public funds for a private use. Staff would have to research partnering with another organization to help with underutilization. Consensus of the Council was to proceed with the staff recommendation and move forward with the clinic proposal. 2. The Council participated in a tour of the proposed City of Denton Health and Wellness Center. With no further business, the meeting was adjourned at 4:40 p.m. MARK A. BURROUGHS MAYOR CITY OF DENTON, TEXAS JENNIFER WALTERS CITY SECRETARY CITY OF DENTON, TEXAS