State employee health clinic used much more than expected

Jul 8, 2013

Helena's government run health clinic has been open since last summer. The state recently opened a second clinic in Billings and is in the planning stages on several others.
Credit Dan Boyce

Helena’s government-run health clinic for state employees is seeing much more use than originally expected as the experiment moves closer to its one-year anniversary.

The clinic provides free primary care services to the Capital city’s 11-thousand state workers and their dependents. It was launched last year by former Democratic Governor Brian Schweitzer as way to improve overall employee health and save money for the state’s self-funded health insurance plan.

So far those objectives seem to be happening—and officials say visitation has been more than 75 percent above initial projections.

The clinic has been expanding its hours to fit in everyone making appointments. It runs from 7AM to 6PM weekdays and has recently started providing Saturday hours too.  It’s a tightly run operation, though-- staff say the average wait time is about 5 minutes.

Director of Operations and Physician Assistant Jimmie Barnwell said patients are responding this well because the format of the clinic removes a lot of the barriers people often feel in going to the doctor—like cost.

“We don’t charge out of pocket expenses when people come to see us, so no copays, deductibles, (or) coinsurances,” he said.

The state government is paying for the total cost of those visits. The state also contracts with a private company called Care Here to operate the clinic. The state pays the salaries of the physicians, nurses and other staff. The state is paying for all of these new expenses and Republicans last year faulted then-Governor Schweitzer for moving ahead with such an idea without legislative approval—although it was not needed. But current Governor Steve Bullock’s Budget Director Dan Villa said the budget set aside for employee healthcare is already saving money.

“About $1.5 million dollars over a ten month period,” Villa said. “You can see the direct savings from what the cost would have been due to prior costs outside of the clinic with the costs inside of the clinic.”

A patient’s visit to the employee health clinic costs the state a little over $100. But when an employee visits a doctor outside the clinic, out in the private sector, that visit costs the state an average of almost $190. Multiply that difference over almost 24 thousand visits to the clinic so far—that’s a big part of the savings.

And that’s short-term. Looking further ahead, Montana Healthcare and Benefits Division Administrator Russ Hill looks at improving employee health.

He said since the clinic opened more than 650 people have come in who had not seen a doctor for at least two years.

And the clinic is catching a lot. Of all the patients who have come in, Hill said 600 cases of diabetes have been discovered in people who didn’t know they had it, 1300 cases of high cholesterol, 1600 people with high blood pressure, and 2600 people have been diagnosed as obese. Physicians give all these patients the option of speaking with a dietitian and exercise physiologist the clinic’s wellness program.

“The goals are not to look like a super model or run a marathon,” Hill said. “The goals are to establish healthy eating habits.”

Hill said it is in the state of Montana’s interest as an employer to get these employees and their families healthier—to avoid expensive emergency room visits and other costs of these chronic diseases down the line. Clinic operations Director and P.A. Jimmie Barnwell said that’s all very rewarding for him.

“As frustrating as medical care can be for patients,” he said, “sometimes it’s just as frustrating for providers as well because there’s a lot of times that we identify and see things in patients that we want to work with them on but because of the barriers in the fee for service model, we’re just not able to.”

In this model, those patients might be more willing to come back and work on those conditions if they don’t have to pay for it.

Montana opened another, smaller, state employee health clinic in Billings at the beginning of June.

Other clinics are in the works for the Deer Lodge Valley and potentially Missoula and Bozeman as the state enters into negotiations to make the clinics available to Montana University System employees.