1. Health Insurance Team Members  Human Resources  Finance  Contracts  Purchasing  Utility  Fire  Medical Director  Insurance Broker  YFCM With support from the Employee Committee

2. GROUP HEALTH INSURANCE PROGRAM OVERHAUL Contract Insurance Broker on Flat Fee Basis Contract Insurance Broker on Flat Fee Basis Evaluate fully-insured vs. self-insured Evaluate fully-insured vs. self-insured Evaluate Employee Clinic Concept Evaluate Employee Clinic Concept Analyze Plan Design Analyze Plan Design  Promote healthy workforce through enhanced wellness programs

3. Employee Clinic Concept Employee Clinic Concept  Complements current Health Insurance Program  Desired facility to provide primary medical care services to employees & dependents at no cost to employee AND at lower cost to City  Wanted dedicated space and hours of availability for staff to minimize wait times  Sought flexibility in scheduling and services to be provided

4. EMPLOYEE CLINIC CONCEPT  RFP December 2009  Considered variety of providers –Clinic Management Company –Health Insurance Program with Insurer-Owned Clinic –Family Practitioner(s)* –Walk-In Care Center(s)* Presentation FinalistsPresentation Finalists Entered into Negotiations with these two (2) providersEntered into Negotiations with these two (2) providers

5. Employee Clinic Concept Recommendation  Annual Physicals  Treat chronic illness  Treat acute conditions  Minor Surgical Procedures  X-Rays, including over reads  EKGs  Lab Testing –CBC, Basic Chemistry, Lipid & Liver Profile  Additional Testing –Strep, Mono, Urinalysis, Pregnancy, Glucose, etc. Enter into Fixed-Cost Contract with MediQuick Enter into Fixed-Cost Contract with MediQuick Dedicated Space at Pinnacles Location Dedicated Space at Pinnacles Location Agreement to provide primary medical care plus the following enhanced services: Agreement to provide primary medical care plus the following enhanced services:

6. Employee Clinic Concept Recommendation  Cost will be fixed-fee per month –Initial commitment eight (8) service hours per week –Patient visit times will vary based upon scope of service provided –Ability to expand hours based upon use/need –Ability to add services based upon utilization

7. Employee Clinic Concept Recommendation  MediQuick vs. Clinic Management Company –Community Partner by selecting a known Local Provider –No long-term contract –No upfront capital investment, minimizes financial risk to City –Existing dedicated space provides flexibility to adapt to the City’s changing needs

8. Employee Clinic Concept Count the Beans  Average of four (4) visits per hour results in 1,664 visits per year.  $92,400 annual cost provides for an estimated per visit fixed cost of $55.00, no additional charges for additional services.

9. Pat Goes to the Doctor for a Chronic Cough Service Provided Cost to City using Clinic Cost to City using Med. Plan Visits Doctor $55.00 $61.00 (+ member co-pay) Needs Labs $0.00$16.00 Chest X-ray $0.00$72.00 Stress Test $0.00$157.00 TOTALS$55.00$306.00 Note: Figures provided by AetnaNavigator Cost of Care Estimator

10. Terry has High Cholesterol and High Blood Pressure Service Provided Cost to City using Clinic Cost to City using Med. Plan Visits Doctor $55.00 $27.00 (+ member co-pay) Cholesterol Profile $0.00$40.00 Totals:$55.00$67.00 Note: Figures provided by AetnaNavigator Cost of Care Estimator

11. Analyze Plan Design Options Health Savings Account with High Deductible Health Plan

12. Plan Design Options  Changing the way the City does business.  Higher Co-Pays on current plans increases cost- sharing with employees.  High Deductible plans create more informed and cost-conscious users.  Encourages Use of Clinic which lowers overall plan costs.  Over time, informed users make better medical choices, thus controlling costs for both the City and the employee.

13. Health Savings Account/High Deductible Plan  Adding a Health Savings Account (HSA) with High Deductible Healthcare Plan (HDHP) Option. –City Short-Term Cost Savings  Elimination of City’s Contribution to the Current Flex-Card and Health Reimbursement Account Program ($540,000 approximate annual cost). –City Long-Term Cost Savings by encouraging use of HSA/HDHP plan option.  Contribute $1,500 to HSA Account (Actuaries estimate first year enrollment to be thirty (30) employees, at a projected cost of $45,000 to City.)  Promotes long-term savings for when care is actually needed.  Account rolls over from year-to-year  Employee “owns” the account  Triple Tax-free employee contributions  Interest-bearing account

14. WHERE WE ARE & WHERE ARE WE GOING? Implement Self-Insured Group Health Insurance Program Implement Self-Insured Group Health Insurance Program Negotiate with clinic providers Negotiate with clinic providers Evaluate plan designs Evaluate plan designs Adding high deductible plan option Adding high deductible plan option Increased Co-Pays on Existing Plans Increased Co-Pays on Existing Plans  City Council Approve Contract with MediQuick for Employee Clinic Services  Healthcare Empowerment Training for Employees and Families  Develop Wellness Programs

15. Health Insurance Team Recommendation  We recommend the adoption of the MediQuick contract to become effective January 1, 2011.