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Indian River County seen skeptical on idea of employee health clinic BY MARY BETH MCDONALD - COLUMNIST (Week of May 21, 2009)

Efforts by consultants to persuade the City of Vero Beach to establish an employee health clinic have now spread faster than a virus to the Indian River County government, but the resistance of County Commissioners appears considerably higher than that of City Council members.

The attempt to get the county to either join with the city, or set up an employee health clinic on its own, is being pushed by the Crowne Consulting Group – which not only is the county’s compensated advisor on health insurance but now wants to double- dip by being hired to administer a new employee clinic.

Interestingly, the Crowne Group is also the consulting firm in line to administer a City of Vero Beach employee health clinic under a proposal put forward by the Gehring Group, the Vero Beach health insurance consultant.

While the Gehring Group insists that it has no financial stake in Vero Beach’s decision on whether to proceed with the clinic, the Crowne Group stands to earn an additional $300,000+ per year if both the City of Vero Beach and Indian River County move forward and sign separate contracts.

The Vero Beach City Council has now scheduled a special June 1 public meeting to weigh the merits of the employee health clinic proposals after which it is expected to vote on a contract, the Indian River County Commission does not seem as eager to see the county get into the health care business.

In advance of a presentation this past Tuesday, at least three County Commissioners went on record as not favoring a county move into the health care business based on their current understanding of how this would operate.

Commissioners Bob Solari, Joe Flescher and Gary Wheeler all raised concerns about the health clinic for reasons ranging from not being supplied enough financial information to make a reasoned judgment to wanting to keep any costsavings or profits a clinic might generate within Indian River County.

Commissioner Solari has been a critic of the city health clinic proposal, and is not inclined to want to get the county into the health care business.

Solari said one of the main reasons he has opposed the clinic is the failure of the city thus far to develop the independent financial analysis and justification for the proposed venture that would enable anyone to make a sound judgment.

“I am getting the numbers together to see whether or not this is a fiscally responsible move for the county,” Solari said. “They are talking about millions in savings, but that hasn’t been the case with other similar clinics in the country.”

Solari made a public records request from the city several weeks ago asking for any cost-benefit analysis done in relation to the clinic, any pro-formas (expected financial performance), copies of all backup material provided the City Council, copies of all the proposals to run the clinic provided by vendors and any estimates of capital and start-up costs.

“In the papers, I could not find any independent financial analysis,” Solari said. “I could not find the city generated pro formas, nor could I find any detailed information on the start-up costs.”

Commissioner Flescher says he also wants to take a hard look at the assumptions and ramifications involved before the county gets involved with running a health clinic.

“There is no possible way that this clinic could possibly save the city or the county any money,” he said. “This whole idea is being rushed through. City and county employees should have a choice of their own doctor. It is a very personal choice. I don’t agree that the city or the county should get involved with this.

“Many factors come into play regarding health care. There are elements of trust and the manner in which health care is delivered. If a city or county employee is not happy with the clinic or the physician in the clinic or the quality of health care, word will travel fast.”

Commissioner Wheeler is against any potential profits from an employee health clinic being paid to out-of-county operators such as Crowne Consulting or Care- Here, the Tennessee-based firm that is the nominee to provide medical staff for the clinic.

“I like to keep business local. I think we should investigate alternatives and do business with physicians here in Indian River County,” he said.

What also troubles some is the idea of the county’s insurance advisor, Crowne Consulting, recommending a scheme through which it stands to profit.

Under the plan put before the county, Crowne Consulting would serve as administrator of a clinic for county employees and bill the county separately for its costs. If the county chose to establish a clinic jointly with the City of Vero Beach, Crowne Consulting would charge both an administration fee.

“There is no conflict of interest,” said Crown Consulting CEO Ray Tomlinson. “If I’m recommending a company that can save the county $5 million a year and it costs $1.5 million to do that and they are paying Crowne Consulting for that, I don’t see a problem with that.”

County budget director Jason Brown said he also did not see any conflict of interest in Crowne Consulting – as compensated advisor to the County — making a separate profit for running a clinic that it recommended be established. “It is the same company, but two separate divisions which act independently of one another,”

he said. The clinic under consideration by the city would have estimated startup and first-year costs of more than half a million dollars which would be paid by taxpayers. The proposal currently on the table calls for it to be open 24 hours a week and be available to current and retired employees along with their families. At present the city has 503 employees on its payroll.

However, should the county get involved with its potential 2,000 employees and family members, the clinic is expected to be open 40 hours per week. Exactly how the city and county would split the costs has yet to be determined.

“These particular things will have to be ironed if we get approval from the Commission to move forward,” County Human Resource Director Jim Sexton said.

“The clinic will be able to treat colds, flu, and other problems,” said Sexton. “The real savings comes from the prescription drugs with the clinics. We dispense three million dollars on prescription drugs through Blue Cross Blue Shield each year.”

The most common drug dispensed to county employees, said Sexton, is Nexium used to treat heartburn and gastroesophageal reflux disease. “This drug costs $188 for a prescription. We’re told by Crowne Consulting that the clinic will be able to dispense the same drug for around $20 without a co-pay.”

Sexton did not explain how Nexium could be obtained for $20, which is far less than its wholesale price. No generic version of Nexium is available.

Regardless of what the county decides to do, the city appears determined to go forward and City Manager Jim Gabbard is in negotiations with Crowne Consulting to administer the clinic and CareHere to run the operation.

Council member, Debra Fromang, however, appears to be against setting up the clinic unless other groups join in. The City Council still has the option of voting against the clinic once contract negotiations have been completed.

“This is just too expensive for our city to do this alone,” she has said. “This group should not only approach the county, but the school board too.”

Gerard Koziel, the Director of Risk Management and Employee Benefits for the Indian River County School District, said he had met with Crowne consultants regarding the possibility of the School District partnering with the city, but is not convinced that this is the right time or the right thing to do, or that Crowne Consulting is the right choice.

“We need to do some more homework on our own first,” he said. “This takes a lot of careful consideration. Crowne is not the only vendor out there and we need to do some more investigation on other vendors first to make certain of the cost savings.”

Fromang also requested that the city make a presentation to the Indian River County Medical Society. “We need to know how our local physicians feel about this and get their input,” she said. “I hear a lot of negative comments about it from our local doctors.”

Society president Dr. Michael Wein said he had spoken with the city, but the board of the Medical Society has taken no official position on the health clinic.

As for his own view, Dr. Wein said, “The members of the Indian River Medical Society offer a wide-range of excellent medical qualifications and I hope that everyone in the community including the employees of the city and county will continue to have access to the full-range of specialty care which is available from the members of our society and the staff at the Indian River Medical Center.”

Dr. Michael Weiss, who is on the Board of the Hospital District, agreed with Dr. Wein’s assessment.

“My own opinion is that the city and county should take care that their employees are receiving the highest quality medical care available,” he said. “The clinics may appear to save money initially, but it may compromise the health care of employees in the long run. There is truly no way that this will save money. It is no doubt a big money maker for the clinic’s investors, but a big loser for the taxpayers of Indian River County.”