After years of off-and-on discussion, plans to open an Ector County ISD wellness clinic in January 2022 are moving forward.
The clinic comes along with a switch from Blue Cross/Blue Shield to AETNA.
“… This time around, Dr. Muri is on our medical plan committee. He was ready to move forward in that commitment … And so with his help on our medical plan committee, we were able to come into an agreement and vote upon this clinic. So that’s how it became not just a goal, but now we’re moving forward with that,” Director of Benefits and Risk Management Yolanda Gordon said.
The district’s insurance plan is self-funded.
“… Our goal is to allow this clinic to become a comprehensive primary care wellness center. What we mean by that is that we’ll allow the staff and their families to participate before their medical condition becomes an actual medical condition. We’re trying to cover preventive medical conditions. There are some things we won’t be able to do such as long-term … or terminal type medical conditions, which we hope are rare, but they do occur,” Gordon said.
The clinic will be able to help with blood pressure, diabetes and preventable diseases.
Mental health services also will be available as they currently are.
Gordon said they hope they can use the wellness clinic to reduce inpatient stays at the hospital and costs.
She added that it could also help reduce outpatient and prescription costs.
“We’re also seeing it as a type of recruitment tool, because we know that medical cost is one of the main reasons teachers are willing to relocate from different areas,” Gordon said. “We have some teachers that come to us from our past. We have teachers that come to us from the Lubbock area, surrounding areas, even as far as South Texas and the first question they ask us is, what about your medical plan?”
They go into specifics of the self-funded plan.
“We provide a competitive package … When I started with the district, we did not have co-pays, so they basically had to meet their deductible, or pay that reduced cost that insurance allows. But they still had a high expense, so the one thing that we did utilize my first year here was adding that copay, which has been a big plus. You go see a doctor, if you’re a participant in your option one plan, you pay $50 to see a doctor. And if you’re a participant about three, or option three HSA (Health Savings Account), you have to meet your deductible first,” Gordon said.
Younger employees say they don’t have to see a doctor as often, so they take the lower cost plan and pay $60 a month instead of the $125 they normally pay, Gordon said.
She and her team, which includes Maria Melendez and Risk Manager Estela Vejil are doing outreach to other district departments to encourage them to participate in the plans.
Gordon said they hope to bring on a coordinator soon.
“Our custodial, our food service, departments that haven’t taken an interest in our medical plan, we’re outreaching, sending notifications in Spanish, English, working with their department heads to promote wellness … We understand that teachers are hard to come by, but so is food service, so is custodial, so is transportation so we’re outreaching to our entire district and trying to keep us as healthy as possible,” Gordon said.
Asked if she had any idea why custodians and food service employees, for example, don’t sign up for the plan, she said cost is a factor.
“… If we can encourage them … to make that investment and then to be able to utilize our clinic and not have to pay anything out of pocket, that would be a big step for them. It’s just encouraging them to understand that they can be really proactive in taking care of themselves physically (and) emotionally. We’re hoping that (by) providing that information, we can encourage them to do it. We have visited with those particular departments on a one-on-one basis, because I, too, wanted to see why they had such a low participation. Some of them say that they’re covered by their spouses, and some of them really don’t like to address the question at all. But what I was promoting to them was then at least let me give you information that might encourage you to see things differently. We hope that they’re healthy and that they don’t have a problem down the line medically, but if they do, here’s what’s available to you. This year, of course, we’re going from Blue Cross/Blue Shield to AETNA. We’ve had Zoom meetings to promote medical plan changes and information. We are sending out correspondence via email. We’re allowing departments to invite us to go in and speak to the departments about the changes and why we’re incorporating these particular changes and it’s all for the financial well being of our health plan, being self-funded, and to promote wellness. If there’s some way we could have cost reduction on administration fees, which are usually what (cost) the plan so much, then that’s what we want to do,” Gordon said.
AETNA owns CVS pharmacy and they have health hubs that can be used, which Gordon said is another benefit of the medical plan.
The clinic location has not yet been determined, but it will be staffed with a doctor, a nurse practitioner and four medical assistants.
“It will be open for 40 hours per week …,” Gordon said.
The hours have not been set yet, but there may be some days where it will be open later. Her goal is to have reviews on a quarterly basis to make sure they are open during hours that make sense for employees.
“All services provided will be at no cost to employees on the health plan. That means the visits, the labs and shots. … We have a teacher who has some athletes that need physicals, they can get them there as well at no cost, which right now, usually they had to pay $25 in their schools to get that done. But this would cover those costs. … We will have a mental health counselor. We’re making sure that that person is going to be available Monday through Friday, 40 hours a week,” she said.
She noted that it’s hard for a teacher to schedule an appointment.
“… Right now as it stands if you need to see a doctor, you pretty much have to wait a week to two weeks, if not longer. So our goal is to kind of defeat that right off the bat with this clinic. When we did visit with the medical plan committee, they were really interested in that as well,” she added.
The district’s medical plans run from Jan. 1 through Dec. 31.
Currently, option one is $125 for an employee only. It goes up if you add a child, several children or a family unit. They also have the option of covering an employee and spouse.
Option three is a lower premium, but a much higher deductible.
“… We started open enrollment on November the first and we’ve started really strong,” Gordon said.
On-site enrollers have been sent to Permian and Odessa high schools.
“… We received some very positive feedback from both campuses. And we … send reminders to the principals and we send notifications to them on a regular basis,” she said.
She added that she sends updates to them on participation and options they have for the rest of the open enrollment period. Because we are going from November the first to December the third and on December the first, second and third, we have what we call makeup days. So they’ll be here in our administration building, not just for the administration staff, but for anybody in the district that did not have the opportunity to meet with one …,” Gordon said.
They will also be available if someone signs up for something and has second thoughts.
Any selections or elections do not go into effect until Jan. 1, 2022, she said.