ACCEPTANCE OF THE AGENDA

Transcription

1 Page 1 of 15 STATE OF GEORGIA COUNTY OF HENRY The Henry County Board of Commissioners held a Called Public Meeting regarding Henry County employee health insurance plan and an onsite health clinic for County-insured employees and dependents at 2:00 p.m. on Tuesday, in Conference Room B, County Administration Building, 140 Henry Parkway, McDonough, Georgia. Notice of this meeting was posted in the entrance foyer of the County Administration Building. The Daily Herald was notified of this meeting. Those present were: Tommy N. Smith, Chairman Bruce Holmes, District V Commissioner Brian Preston, District II Commissioner Gary Barham, District III Commissioner Bo Moss, District I Commissioner Blake Prince, District IV Commissioner Also attending was: Patrick Jaugstetter, County Attorney; Jim Walker, County Manager; Cheri Hobson-Matthews, Assistant County Manager; Nedra Swift, Human Resource Director; and Stephanie Braun, County Clerk. Also attending: Mike Gasses with The Michael Gasses Agency, and Bill Houze with Houze and Associates. CALL TO ORDER The Chairman called the Special Called Meeting of the Henry County Board of Commissioners for 2:00 p.m., Tuesday, to order. ACCEPTANCE OF THE AGENDA The meeting being called to order, Commissioner Barham made a motion to approve the Agenda; Commissioner Moss seconded the motion. The motion to accept the Agenda was carried unanimously (6-0-0). Henry County Health Employee Insurance Plan: Chairman Smith stated we have a resolution to rescind Resolution and to approve and adopt the Henry County health employee insurance plan and asked the presenters to step forward. Nedra Swift, Human Resource Director, presented the resolution which read as follows:

2 Page 2 of 15 WHEREAS, the Henry County health insurance plans for its employees and their families are up for annual renewal; and WHEREAS, a recommendation has been made to renew the CIGNA contract and to add an additional option of Kaiser to employees; and WHEREAS, the CIGNA plan will offer four plan options for employee selection; and WHEREAS, the CIGNA plan will continue to include the following services, Flexible Spending Account (FSA), Employee Assistance Program (EAP), Family and Medical Leave Act (FMLA) and COBRA Administration, at no cost to the county; and WHEREAS, the Kaiser plan will offer a one plan option for employee selection; and WHEREAS, there will be a tobacco surcharge of fifty dollars ($50.00) per month, per family for tobacco users; and WHEREAS, there will be a spousal surcharge of fifty dollars ($50.00) per month for those employees whose spouses are eligible for health insurance with their employer, yet they choose to enroll in the Henry County Medical Insurance Plan; and WHEREAS, the CIGNA plan will provide a 32-hour per week on-site health coach, as well as on-line health assessments; and WHEREAS, the medical insurance will increase by 10.5% aggregate and there will be no increase to the dental insurance; and WHEREAS, the CIGNA plan will provide Dental Insurance at no increase to employees, with a broker fee of 5.7%; and WHEREAS, the commission for the Broker of Record for Health Insurance shall not exceed 2%. NOW, THEREFORE, BE IT RESOLVED that the Henry County Board of Commissioners hereby rescinds Resolution No dated May 6, BE IT FURTHER RESOLVED, that the Henry County Board of Commissioners will incur one hundred percent of the medical premium increase for this annual renewal; and BE IT FURTHER RESOLVED, that the Henry County Board of Commissioners approves the recommendations as shown above and authorizes the Chairman to sign all required documents.

3 Page 3 of 15 Ms. Swift further advised that if the Board had any questions, that there are a plethora of staff members present who have all of the information and numbers available to answer those questions. Commissioner Prince asked how we would go about finding out if employee s spouses have other insurance available to them. Ms. Swift stated generally speaking when someone signs up their spouse, the enrollers ask the pertinent questions at that time. Mike Gasses added that they also sign an affidavit at enrollment. Commissioner Moss asked that if they have insurance, then is it going to be an additional $50? Ms. Swift confirmed that yes, if they choose to come over and use our insurance in addition to what they have available from their employer, or if they do not use their employer s insurance, then it will be an additional $50 a month. Chairman Smith inquired if we knew of any other agencies or companies that charge this surcharge? Mike Gasses stated that the State charges a surcharge. Bill Houze said that the $50 surcharge is low compared to what other agencies charge. Commissioner Preston commented that the school system charges it as well. He stated he thought it was around $125 when he was on the School Board. Commissioner Preston gave an example -- if you have a stay at home spouse (or you have a spouse that owned a small business that doesn t offer insurance) then there would be no surcharge, but if you work at the County and the spouse works at the school system and they forgo their insurance plan at the school system because it costs more and came to ours, it s kind of crazy. At that point, the County would be subsidizing the school system. Chairman Smith asked if anyone had any further questions. He asked about the Kaiser Plan and how that would work. Ms. Swift stated it parallels Cigna. Chairman Smith stated that the reason he asked the question was because several years ago this came up spur of the moment when we had Blue Cross Blue Shield. He stated Kaiser came in and we tried to give the employees an option, but Kaiser stated you have to have a minimum number of enrollees to do it and then Blue Cross Blue Shield came back with numbers. Chairman Smith stated he just wanted to make sure there were not going to be any penalties and asked Mike Gasses to explain. Mike Gasses explained that every insurance contract, when you do a group insurance, has a long list of what you have to abide by. He stated all of them put in there that when they give you a rate, if the enrollment changes (plus or minus 10%) then they can go back and review the rates. So, not just because of Kaiser, but even if you didn t offer Kaiser and your enrollment changes, they can go in and review the rates. If 200 people were added or dropped for any reason, then they can go back and review the rates. Chairman Smith wanted to make sure that the employees would know this and Mike Gasses confirmed that they would. Mr. Gasses stated further that on the Kaiser plan, we picked the plan because the people will have to use the Kaiser plan and that will be explained when we

4 Page 4 of 15 talk to the 1400 employees. He stated if you choose Kaiser, you use their clinics and their pharmacy. The County did a richer benefit with Kaiser that will cost the employees a few dollars less. He explained the employees will get more benefits and pay a little less because they are giving up the option of being able to go anywhere they want to go. Chairman Smith commented that basically we are in the same scenario that we were in before. For example, if the breakoff is that we have 100 employees select Kaiser, then Cigna will keep their rates. If we have 300 employees select Kaiser, then Cigna enrollees premiums will be increased. Mike Gasses explained that they can go back and take a look at it at that time. He explained it is not the number. He gave the example that if all of them happened to be young people and have no claims last year, then they will raise the rates because they know the people with claims are staying on Cigna. If it is a blend, and it matches anything else, they will not raise the rates. Chairman Smith added that no matter what it is, he wants to make sure the employees that pick Cigna know that their rates may or may not go up and that he just wanted it to be a heads up. He wanted it explained that if something happened with Kaiser and something went astray and all of them dropped out, then that would be good for Cigna. If Kaiser had a good track record and all of them saw the benefits and then 300 went over to Kaiser, then the Cigna premiums could be increased. Mike Gasses stated it would be explained. Chairman Moss asked if the 10.5% was based on everyone being in Cigna? Mike Gasses explained that that was based on Cigna and the enrollment they had at the time and the claims for the last year. Chairman Smith commented that we talked about the tobacco issue last year or the year before and at that time we wanted to do some further studies. He asked based on the report, is $50 enough or not enough. He inquired how they came up with that amount to be charged. Mike Gasses stated that they ve seen it around $40 - $50 at a lot of places and said we have talked about doing it here before. People who smoke cost the employers $5,800 a year more. These are studies that have been done and he stated $50.00 is enough. Mike Gasses stated that if enrollees state they want help to quit smoking, it is the law now and Cigna and Kaiser are there to help for free. In addition, the County also has a hands-on health coach with Cigna that can give hands on coaching if someone requests it. Chairman Smith read from the resolution where it states the Cigna plan will provide dental insurance with no increase to the employee, with a broker fee of 5.7%. Commission for the broker of record for the health insurance shall be 2%. Chairman Smith wanted to know what happened to Delta Dental? Mike Gasses stated that in those percentages the fees did not go up. He stated Cigna did two things. 1) They are going to do the dental for a fraction less than Delta so we will no longer have Delta Dental; and 2) Cigna gave us a 2% credit on medical if you take the dental also which is over a $300,000 savings. Insurance companies like to package it they like cash flow. We save over $300,000 up front by letting Cigna do the dental in addition to the health insurance. We called dental offices and looked at the people that are in the networks, and

5 Page 5 of 15 they are all the same (MetLife, Delta, and Cigna). You don t have to go to a certain dentist -- you can go to any. Chairman Smith stated that we are going to have several options. He stated he believes the 10.5% is a given. Having said that, he stated someone passed out brochures which show how much the County is going to continue funding and how much the employee will fund out of this 10.5%. Chairman Smith stated that in 2013 the County absorbed 100% and last year the County absorbed 25% and the employees picked up 75%. As far as throwing numbers out, Chairman Smith feels that 50% would be in the middle over the past three years -- the County paying 50% and the employees paying 50%. Mike Gasses stated at the bottom of the sheet it shows you what it would cost the County to absorb it all and all the way down the line. Chairman Smith said the one he is looking at is $799,942. Would that be the 50% one? Mike Gasses confirmed that is the 50% one, but he added that you will be surprised how the tobacco and spousal surcharges will reduce that amount. The amount reduced could be around $350,000 depending on if the employees are honest about it. He stated you have about 85-90% that have family coverage and that it is an honor system. Chairman Preston added that it has teeth in it if we structure it right. Whereas if you get caught, you lose insurance for a year. Mike Gasses said it can be decided that you have to pay back premiums of what you should have paid all the way to termination if you are caught. Chairman Smith commented that we don t have any teeth in this resolution. He added we would need to state that fact it in the resolution for it to be enforced. Chairman Smith stated he doesn t have a problem being a part of it because if you are not going to have an enforcement then you have done nothing really. He stated you are penalizing the ones that are being honest. Bill Houze explained what we normally do with plans like this is we have the employee sign an affidavit during the enrollment. When they sign up for this benefit they acknowledge that it does have teeth and could be punished by going back to get their insurance, collecting more premium, as well as up to their termination. Commissioner Holmes asked if it would be enforced by the insurance company and credited back to the County if they lied about it? Mike Gasses stated if they lied, we could make them pay back premiums directly to you because you paid the premium. He further stated that if you have employees paying it and the people working beside them are not, you will have some people tattling on others because it is not fair. Commissioner Prince asked if we could do a test for the tobacco to see who smokes and does not smoke. He stated that there are companies that you go work for that you cannot use tobacco and they have tests for that. Mike Gasses stated it would be up to the Commissioners if you wanted to test 1400 people. Commissioner Holmes added that the insurance company would know that if the employers went to the doctor, their results are reported to the MIB. If they did any kind of due

6 Page 6 of 15 diligence they would know who smoked and if they lied on their application. Mike Gasses stated he does not know the legal aspects and if you can do random testing. Nedra Swift stated you could not. Commissioner Barham asked if we knew how many employees would be affected by this. Nedra Swift said quite a few. Jim Walker, County Manager, added that you have to remember that there are also family members that have dependents that are dippers or smokers and they would have to pay the $50. Commissioner Barham asked Mr. Walker what kind of reaction the department heads had regarding the surcharges. Mr. Walker stated that we have several department heads here and that they have been pretty supportive. Chairman Smith asked how many policemen we have that use dip? Chief Nichols, HCPD, stated that a rough estimate would be about 25-30%. Chief Nichols stated that he has been telling them that this was eventually going to happen and stated his policemen have been waiting for it and that there are no surprises and they know that other companies have been doing it already. Jim Walker stated that it is more an issue of wellness. He stated having a good wellness program is going to drive down premiums in the future and our claims. He said it is the tobacco use that is driving up our claims to the tune of about an extra $5,800 a person. Mike Gasses added that the claims on the dependents are a lot higher on the employees and that is obvious and it is a pretty high percentage. That is where the claims are coming from so that is the case when a spouse can get insurance elsewhere but does not. They are using your plan because it is better or cheaper or both, and they are causing the claims. You cannot argue the point that the studies show that the tobacco is causing the health problems. Chairman Smith asked if there were any more questions. He stated that he thinks the only thing this resolution is missing is that it needs to include the pass thru. He asked the County Attorney if we put the pass thru in there, would that make it solid? Patrick Jaugstetter, County Attorney, stated he thought it was included. Jim Walker added that it does mention it at the bottom of the resolution that the Henry County Board of Commissioners will incur one hundred percent of the medical premium increase for this annual renewal. That means that zero column. There is going to be no pass thru to employees and we will incur the entire premium increase this year. Chairman Smith asked if we were going to be prepared to do that and Mr. Walker confirmed that we are. Commissioner Moss stated that he still had a question about the insurance and the spouse. If the spouse chooses not to take their insurance, we are still going to charge the employee $125 for them to use our insurance? Chairman Smith corrected the amount to be $50 per month. Mike Gasses asked why people would choose our insurance over the insurance they could get through their employer? He followed up to say it is either because it s cheaper or better -- or both. He said they saw a lot of that at the school system by doing insurance over there. He said

7 Page 7 of 15 people would jump back and forth according to which one was better. Mr. Gasses stated that he and Nedra even had a discussion wherein if the spouse could get insurance at their employment, that it would not be an option to get insurance through the County. It is an option though, and if they choose to get insurance through the County even though they can get it through their employment, then they have to pay the $50. He added that if they cannot get insurance through their employer, then they do not pay the surcharge. Chairman Smith called for any further comment; there were none. There being no further questions or comments from the Board, Chairman Smith stated we have a resolution for the Henry County Board of Commissioners to Rescind Resolution # and approve and adopt the Henry County Employee Health Insurance. Commissioner Holmes made a motion to approve; Commissioner Prince seconded the motion. The motion to approve Resolution was carried with Commissioner Moss being in opposition. Henry County Creation of On-Site Health Clinic Jim Walker addressed the Board and read the resolution regarding the On-Site Health Clinic. The On-Site Health Clinic is for County insured employees and their family members in other words you have to be enrolled in our county health insurance plan to use the clinic. Whereas, Henry County is interested in the health and well-being of their employees; and Whereas, the County Manager proposed doing a study on the benefits of an On-Site Health Clinic; and Whereas, the County Manager and staff reviewed the structure of several On-Site Health Clinics in the public sector and government organizations; and Whereas, seven (7) proposals were received and reviewed; and Whereas, after inspection of several On-Site Health Clinics a determination was made to solicit proposal for professional services; and Whereas, after reviewing the proposals, it is the recommendation of the staff that an On- Site Health Clinic is a benefit to the employees; and Whereas, the recommendation of the staff is that CIGNA be the operator of the Henry County On-Site Health Clinic; and Whereas, there is a CIGNA one-time setup fee and service fees; and Whereas, the Health Clinic will be for the use of all County-Insured Employees and Dependents under the Henry County Health Insurance Plan.

8 Page 8 of 15 Now Therefore Be It Resolved, that the Henry County Board of Commissioners authorize the Chairman to sign and execute all necessary documents and to authorize any funds necessary out of fund balance for the start-up of an On-Site Health Clinic, not to exceed $700,000. Jim Walker explained that we have identified a location in the Public Safety Building. The Community Room on the far right-side has water, sewage, the appropriate amount of space, and is centrally located within the county and you have a packet in front of you that gives you a lot of different information that talks about the clinic. This is what we envisioned: it is going to take us one hundred twenty (120) or one hundred fifty (150) days to get this clinic built, seek and hire the staff, get equipment and begin operations. He said we are hoping to open by October 1 st of this year. What we envision is a clinic that will be opened thirty-two (32) hours a week. We can structure those 32 hours any way that we want. We were thinking about 8:00 a.m. to 3:00 p.m., Monday Thursday, and 8:00 a.m. noon on Saturday. We will have a nurse practitioner, a nurse and a receptionist with a waiting area. We just approved the renewal of the healthcare plan so let me sort of build a scenario for you: Our premium will be $16.5M; it will not exceed $16.5M. We will pay our claims monthly as we receive them. If at the end of next year s level of insurance service, our claims are below $16.5M, we keep the difference think about that our premium won t exceed $16.5M, and if we pay less in claims then we keep the difference. How is the claim a benefit to that? A couple of ways: If an employee goes to the doctor now it is roughly $200; they will pay a $30 co-pay and their doctor will bill Cigna $170 just for walking in the door. If an employee or family member chooses our health clinic, there is no co-pay. So for an employee, you have already saved $30, but you have not paid to walk into our clinic. Most of our experiences with doctors and medical staff are often times you go to the doctor and you do not see the doctor. You see a nurse practitioner or you see a nurse and they can take care of about eighty (80%) percent of what ails you. If you need to go see your doctor, then go see your doctor. You can pay the copay and go -- that system does not change, but for employees that come into our clinic you pay no co-pay. As a result, there is no doctor to file a claim with through our insurance. For everyone that uses our clinic as oppose to using the doctor, that is a claim that does not count against our $16.5M. There is a savings every time someone uses our clinic. For our employees under most of the plans that they are covered under, it is $15 every time they go fill a prescription. We will have a dispensary at the clinic that will carry about forty (40) or so drugs; you should have a list of the twenty (20) that are most common. Among our employees, or among a population of employees, we can add to that with drugs that we feel our employees will need or use. In this dispensary we will use generic drugs; so if an employee shows up at our health clinic or dependent they do not pay to see the nurse practitioner or the nurse and if they have a prescription for one of the 40 items we carry that is free to them also. So an employee saves $30 by seeing a medical care professional and if they are prescribed a

9 Page 9 of 15 medicine that we carry then they save another $15 per prescription. If you think about what we have done for our employees so far today; you all have saved them from any premium increase on their health benefits so in effect you are putting money back into our employees pockets. We are saving them money each time they go to a doctor by not paying a co-pay, and if there is a prescription we carry-- they don t pay for medicines. We are recommending Cigna for a number of reasons: (1) they are cheaper, (2) they are also providing our healthcare so all of our records that are electronically maintained by Cigna just carry-over -- they know who your doctors are and who your specialists are if you are under the Cigna Plan. If you go into our clinic first and you do not have a co-pay and you see the nurse practitioner and they determine that you do need to go see a doctor, then you go see your doctor or specialist. You will pay a co-pay there, but that initial visit you would not necessarily and it sort of feeds off of itself. Employees, if they choose to use our clinic... and we hope they do, they will save money by no co-pay and no fees for drugs. We, as a county, save money because if we can solve their medical issue at the clinic and they do not need to see the doctors and we do not have any medical claims filed against our insurance, and hopefully we can stay below that $16.5M threshold; all that money is money that we save. Commissioner Holmes asked provided we save over this entire year in terms of reduced claims, how will that impact our premiums next year? Jim Walker answered that we are hoping that they do not increase and remain flat; however, if they do, it will be a moderate increase. It will be determined by the number of claims that we pay. Bill Houze stated that another savings in that is that the drugs that are dispensed at the clinic is a pass through at a wholesale price. Where today our employees go out and go to CVS and paying retail price and Cigna is getting charged retail. Through the clinic, they are going to pay at wholesale price. Jim Walker explained that the truth is these generic drugs really cost pennies, but CVS and the pharmacies make money because $15 is your co-pay and they are billing a lot back to our insurance company. I do not know if you are looking at your statements every month, but drugs are expensive and they are using generic drugs but still charging for name brand drugs. That is a huge savings to us. Commissioner Barham questioned as far as the employees with Kaiser Permanente Insurance, will they be offered to go to the health clinic as well? Jim Walker acknowledged yes -- it is a Henry County Employee Healthcare Clinic. With that being said, there are other counties that we visited that have both either Cigna or BlueCross/BlueShield and Kaiser. Depending on how many of our employees choose to sign-up for Kaiser, Kaiser will put a representative in the health clinic for their family and patients, but

10 Page 10 of 15 we do not know if we are going to meet that threshold or not. However, if they are Henry County employees, they can still come to our clinic and there is no co-pay and no cost for medicines. The nurse practitioner can write prescriptions so even if you have maintenance drugs that are not carried in our dispensary, you save them a doctor s visit just by getting your prescription refilled. Chairman Smith: Yes Sir --I yield the floor. Commissioner Moss asked if the clinic was for employees only. Mr. Walker answered, employees, spouses, and their children if they are enrolled in the plan. If just you and your wife are covered and you did not include your children, then your children would not be covered. You would have to be enrolled in the family plan for them to be eligible. Commissioner Moss reiterated that if you are enrolled in the family plan then everyone is covered and Mr. Walker confirmed that they would. Commissioner Barham asked if that included retired people as well. Jim Walker answered he was not certain that retirees were included and proceeded to explain that we do not know how successful this is going to be. This is one of those things that is a test and we do not know what we do not know. It is going to take us a year to see where we are. We are starting with thirty-two (32) hours and see if we get overwhelmed. If the response is overwhelming and we decide to keep the clinic open forty (40) hours, then we will come back to you for additional funding to ask you to keep it open an additional eight (8) hours. It has not come time for that yet, but there are other things we can do such as pre-employment physicals and drug testing to save money, but we want to see our rhythm first. Obviously, job one is to make sure that our employees are getting the healthcare they need. If we have time for physicals; if we have time for drug tests; if we have time in our schedule to accommodate our retirees, then we can move into that. Mr. Walker reiterated that he thinks the first six (6) months to a year we are just trying to move the needle and see where we fall out. We do not have all the answers just yet. Commissioner Moss recalled when we began discussing this it was going to be for employees only and then we were going to bring spouses in. Mike Gasses explained that what we found in Cobb County (which is a county we used as a comparison large county), is that they started off based on the need for employees only, but within three (3) months time they saw the need and opened it up to the families -- and now to retirees. So it is up to you to do it anyway that you want -- in stages or all one time. Commissioner Holmes stated it sounded like a win-win in that we are saving money and our employees are saving money. Mike Gasses stated that the biggest win in his opinion is not only the money savings, but the wellness aspect. He stated you cannot put a dollar amount on savings if there are people

11 Page 11 of 15 walking around now that have high blood pressure that do not want to go to the doctor, do not want to spend the money or the two (2) hours in the doctor s office, but they would come by the clinic instead and then we find out they have high blood pressure and they are able to leave with medication -- then you have saved a stroke. We may have saved about $75,000 in the prevention of a stroke. The wellness plays a big part in it and the benefit plays a big part in it. Jim Walker stated that some department heads were present which represent about fifty (50%) percent of our employee population and asked them to state whether they were in favor of the plan. Sheriff McBrayer, HCSO, stated that he would be in favor of the proposal. The biggest thing that he hears when he has employees that are sick and definitely need to go to the doctor, is that they do not really think they have the co-pay or do not want to spend the co-pay. He stated they could go the clinic to be seen and get the medication they need to get them well. He added that some of them do struggle with paying and assume they will get better in a few days so do not get medical care they need. He does not think you will know until you try it, but did believe there were some positives. Chief Bill Lacy, HCFD, stated he would definitely have to agree with what Sheriff McBrayer said. He hears the same sort of conversations and obviously the convenience and costs are big considerations. He said wellness is what gets us more than anything else. Chief Nichols, HCPD, stated the same and noted that there are families with a number of kids. He stated when you start taking all of the kids and a paying thirty ($30) dollar co-pay per child that you can go from ninety ($90) dollars to one hundred-twenty ($120) dollars a month and that can hurt these folks. Terry McMickle, DOT Director, stated his guys would really appreciate it. He said that if some of the lower income people within the County had the opportunity to go without the copay, it would be great. He agreed with Chief Nichols and reiterated that if you have a family with multiple children and they all have medications prescribed for them without a co-pay that would be very beneficial. He added that he thought employees would take that as a very positive action from the Board and the fact that they are trying to help by attacking the increase of costs to them. Jim Walker stated that the other cost or savings that we cannot capture is that employees would take sick leave to go to a doctor s appointment or take a family member to the doctor. He state in our experience, you can write off five (5) or six (6) hours. They will sit in the waiting room for two (2) or three (3) hours so you ve lost an employee for half a day or longer just to go to the doctor. If we have a clinic or we have a sick-call hour from 8:00 a.m. 9:00 a.m. in the morning and an employee does not feel well, then they stop in on their way to work to see the nurse practitioner. They can either be sent home or sent to work which can save four (4) to five (5) hours of productivity per employee by having a clinic where they can get what they need and

12 Page 12 of 15 get back to work whatever the case may be. He added he does not know how we capture that savings of labor cost, but that is also a benefit to us. He said we are sending a message out to our employees that we are looking out for their welfare; that we re putting a premium on wellness, and that we are discouraging tobacco use. We are going to have a clinic onsite to treat them that will not cost them anything. For the financial well-being of the County, we hope that it drives down our premium costs or we show savings in the amount of claims we make so it is kind of a circle that completes itself. He stated they have looked at this and toured around the state. Mr. Walker recognized Mike Gasses and Bill Houze and their team, and complimented their work. He added that they are not drawing any commission on the work they have done to help us to decide to recommend a health clinic to the Board. He stated they have done a terrific job and thanked them again. Commissioner Preston asked what the wait times were in comparison to Cobb County? If you go to the doctor as an employee in Cobb County is your wait time less than an hour in the lobby or are you in and out? Do they have any metrics of measurement on that? Jim Walker answered that he will allow Mike Gasses and Bill Houze to answer the question; However, the way they had scheduled their time periods they were pretty judicious there... where appointments were scheduled every twenty (20) minutes, but for us it is going to be trial and error. If we become overwhelmed and it is that big of a success then we may have to come back to you and request to keep the clinic open forty (40) hours now because we see the amount of claims going down and the number of employees and dependents that want to use the clinic going up. This is why we are not giving you steady-state today -- we are giving you a proposal; to take some money out of the Fund Balance, set this clinic up to run it for a year and as we get into this thing we may decide this is not a good idea or it is a good idea. We grow it or keep it the same. I just do not think we have all the answers. Commissioner Preston again asked about the metrics of measurement? Mr. Walker answered no, but there was no backlog of anyone that he saw when he was there. Mike Gasses added that they try to keep it to 20 minutes, and were not allowed to double book or things like that. He stated while he was thinking about it, he wanted to add that if you want to go to your personal physician and he or she writes you 2 or 3 prescriptions that are carried at the facility here, then you can get that filled at the clinic. Not only the ones that are written at your own clinic, but when you go to your doctor and you receive 2 prescriptions instead of paying $30 you can come to the clinic and pay nothing. Mr. Walker interrupted stating that if we carry that drug, then you can get them for free. Mike Gasses acknowledged that they just found out that they can carry insulin. Commissioner Preston asked whether or not allergy shots will be available? (Laughter among attendees). He commented the clinic could be a one-stop-shop.

13 Page 13 of 15 Jim Walker commented that was the great thing about this. That this is our clinic and if we choose that is beneficial and useful and cost effective and drives down claims, we have the ability to modify this however we determine is the best way to go. Commissioner Holmes expressed that generic drugs are basically brand name drugs with an expired path. All generic drugs used to be brand names so it doesn t make a difference. Chairman Smith asked if anyone else have any questions. Jim Walker explained that with drugs you are paying for the name of it, the doctors that developed it, the trademark, but once it goes into the generic market it goes for penny on a dollar. Chairman Smith asked if anyone have any comments. Commissioner Prince commented that he has been over this for quite some time viewing several different options. This is a good measure he feels in that we are trying to do something a little different. We are trying to give back to the community and our employees. I see it as a winwin. Commissioner Prince further expressed he did have a couple of questions. He asked if the $700,000 include the construction on the site or is that just Cigna s part? Jim Walker explained that what this consists of is that we have a chart and said hopefully his numbers are pretty close; its $476,000 to run the clinic for a year, that is the labor costs and all of the costs associated with running the clinic. There is an $110,000 set-up fee which Bill Houze assures that we will not use the full amount, but that is for Cigna s hiring and establishment of the clinic. He said we are going to have to build some walls and has factored that into the $700,000 and has also given us a little room because we just don t know yet about $10,000 a month for drug costs. In other words, we buy the drugs and keep re-stocking and that is just a best guess. He stated we may find out that it is less or find out it is more. There are also certain privacy requirements for a health clinic and that is why walls have to be so thick, sound proof, and water in each examining room. There are construction costs that we must do and some of the $110,000 setup cost includes the examining tables and that sort of stuff. We should not exceed $700,000 for the first 12 months based on the 32 hour schedule. If it really looks like this thing is knocking it out of the park and we need to increase the hours; he stated he may have to come back to the Board and ask for an increase in funding and an additional 8 hours. Commissioner Prince asked who employs the clinic employees. Mr. Walker replied Cigna does. He said we started out considering the County running the healthcare program and hiring employees, but there are medical malpractice and other issues that we, as a County, do not want to be involved in. They will be Cigna s employees, but he believes they will come into this area and recruit local talent to help run it. Chairman Smith asked if anyone else have any comment.

14 Page 14 of 15 Commissioner Barham commented that he would like to hear what Cheri Hobson- Matthews and Nedra Swift had to say. Nedra Swift, Human Resources Director, commented that initially she was a bit skeptical --particularly by the way the County Manager was describing how we were going to use the clinic. After visiting the clinic in Cobb County and Marietta and talking to the different representatives from the different companies, as well as having a very long conversation with the Human Resources Director in Hall County where they just opened a clinic where they literally had lines outside the clinic going down the block because the employees were so happy to have it, that she could see where it relates to reducing money that we are spending on medical claims and prescriptions, that this is a good way to go. In addition she stated it is also a good way to get employees to go to the doctor who do not normally go. There are some people who work and no matter how sick they are, they will not go. She stated this is a good way where they can go to a doctor that is right there where they know they do not have to wait. She liked that fact that all the companies have a 20 minute deal on their appointments and they do not double book. All of the clinics they walked into she noticed there was never anyone sitting and waiting so she could see how it will be beneficial to our employees. Cheri Hobson-Matthews, Assistant County Manager, commented that she does not doubt that it can be beneficial; however, she did not participate in any of the on-site clinic visits. The information the Board was presented is also the same information which she received. Based on that information, she stated she most certainly can see the benefits of it. Commissioner Barham thanked them for their comments. Mike Gasses remarked he would like to add a comment referencing Piedmont leasing our hospital about 2-3 years ago. Part of the agreement was to give back and keep up benefiting the county population of the people of Henry County. The Board is supposed to watch and make sure they give back. He stated if this gets approved, he will be part of it and he invited the Commissioners also, to approach first the Piedmont Henry Board to say we can use some help with this by sending a nurse practitioner for 16 hours a week. He said he has heard that Piedmont does that at other places. They are supposed to give back to the community and he thinks we should go and approach them and ask. Jim Walker commented that maybe they could run our Saturday hours. He said we want to try everything -- we just have to get the clinic going and see what the best fit for Henry County and our employees is. Chairman Smith asked if anyone else had any comments. He stated the only comments he had was that all his research was done via the internet by viewing Cobb County, Hall County and all these other places. The thing that stood out to him the most in the document provided here was that in 5 years we anticipate on saving $2,138,344. He stated what that tells him is that after

15 Page 15 of 15 calculating all the costs involved: the $700,000 setup, etcetera, that at the end of 5 years total, whether it was premiums or maintenance fees or whatever --we are going to save $2,138,344. For that reason, he votes in favor of this and that we track it and see. He said if that is, in fact, a realistic number that it would be worth a try to him. He followed up by saying if there were no additional comments, then we have a resolution for Henry County Board of Commissioners to create an On-site Health Clinic for County-insured employees and dependents. There being no further questions or comments from the Board, Commissioner Barham made the motion to approve Resolution ; Commissioner Prince seconded. The motion was carried unanimously (6-0-0). ADJOURNMENT There being no further business to come before the Henry County Board of Commissioners, Commissioner Moss made a motion to adjourn; Commissioner Barham seconded the motion. The motion to adjourn the meeting was carried unanimously (6-0-0). Stephanie Braun, County Clerk Tommy N. Smith, Chairman