Hello everyone, can you begin taking your seats please? That would be great, thanks so much. All right. I'll call the special meeting of the council to order and ask the clerk if she will please call the roll. Thank you, Madam Clerk. Yes, sir. Mr. McCord? Here. Mr. Myers? Mr. Stennett? Mr. Beard? Mr. Blues? Ms. Crosby? Mr. Ellinger? Mr. Farmer? Mr. Ford? Ms. Gorton? Here. Ms. Henson? Here. Mr. Kay? Here. Mr. Lane? Here. Ms. Lawless? And Mr. Martin? Here. Thank you. Thank you, Madam Clerk. I believe. So we do have two Council Members who are present, I think. We're not here for the roll call. I'll correct it when they come back. We'll duly note that when they arrive. Yes, sir. Thank you, ma'am. All right. Welcome. And on our agenda today is the presentation associated with the employee health insurance system that is being proposed. And for context, I think it's worthwhile to mention again, especially for those who are viewing, that we are in this project, in this initiative that's been underway now. The planning for this initiative has been underway for many months, beginning, in a sense, with the awareness that emerged in the middle of November of last year to the extent to which our employee health insurance plan is losing money. Some would say hemorrhaging. So the work that has been done is classic in terms of project management, effective project management beginning with effective due diligence and fact-finding, including the recruiting of specialists in the field, consultants in the field of this work. A big part of this has also included benchmarking. And a signature example of a system that is effectively working is Chattanooga, Tennessee. So we're pleased today that our colleagues and friends in Chattanooga have joined us. we've made a fact-finding trip to Chattanooga to see their wellness center there. And today we are able to welcome Madeline Green, who will be sharing with us the Chattanooga system. Benefits Insurance Marketing, our consultant, is also with us today. and they recommended Chattanooga to us some while back. Now, Madeline is Chattanooga's Director of Risk Management and Insurance, so she will be sharing with us the experience of their wellness center and prescription service. Importantly, their model has been, their mission has been to provide quality health care and to contain spiraling costs. So we're certainly interested in hearing more about that. Now, together with Madeline Green is Susan DeBose. Susan, there you are. Hold up your hand. Thank you so much. Susan is Chattanooga's Deputy Administrator for Personnel, works very closely with Mayor Ron Littlefield, who has been a big advocate for this system. In addition, we also have with us today Jerry Ford, who is the Chief Executive Officer of Marathon Health, whose contract it is we are recommending today. Dave Demers is also here with Marathon. He is Director of Strategic Planning and is the project manager or the account manager that has been designated for our account. Also, while I'm making introductions, I want to welcome Steve Rowland from Louisville, where Steve is Mayor Fisher's Chief Financial Officer. Mayor Fisher asked me if Steve could come over today to hear this presentation, and despite Saturday night's game, Steve, we still welcome you here. Okay. Our consultants from Benefits Insurance Marketing, Briggs Cochran, Benji Mars, and Ellie Burnside are also with us. Welcome to all of you. We appreciate this significant contingent of folks, this delegation that is here to share with us this important information and data. So, Madeline, the floor is yours. Thank you so much. It's a pleasure to be here. Thank you for inviting us, because we love to talk about our wellness program. We've been in the same situation that it sounds like you are in currently, where, of course, we've had some challenges with the rising cost of our health care premiums. And, indeed, our mission is, it sounds like yours is the same, to provide quality health care to our employees along with cost containment. And over the past few years, with implementing several different components to our wellness program, we have a pretty good grasp on that. So that's what I'm here to tell you about is our entire wellness program. Oops. Okay, technical things here. First of all, we like to look at our wellness program as an umbrella. Our wellness program is called the Well-Advantaged, and there are several components to that. First of all, we do have the health centers. We also refer to those as the wellness centers or the on-site clinics. We have a fitness program. We have an on-site pharmacy I'll be telling you about, lifestyle management programs, as well as a really interesting incentive program to kind of tie it all together. Our health centers were the first component of the wellness program to be introduced in Chattanooga. Are the lights going down or is it just me? They're going down just a little bit. They don't need to go down fully. You won't be able to read. Okay, yeah, I've got to be able to read. Okay, can I move this a little bit? I feel like I'm leaning into it. Yes. I can? Whatever is good for you. That whole thing. Okay. Okay, I'm good. Okay, the first component to be opened up was actually in the year 2006, and we opened up our health centers. They were a big move for us, and it's a move that I would say is probably one of the best things that the city ever did for our employees. And, in fact, our employees consider it to be their absolute best benefit. In May of this year, we changed our on-site vendor to a company called Marathon Health. And I believe it's because we feel like Marathon Health has that same vision that it sounds like we all do, to provide quality health care, to contain cost, and to actually make our employees, I guess, the healthiest they can possibly be, and to give them the providers to help them do that and the health coaches to actually help them do that. In our primary care clinics, we are able, as employees, to get the same type of quality health care that you can get with a primary care physician. We have acute care. We have strains, sprains, sinusitis. We can do well-men visits, well-woman visits, and most importantly, preventive screenings and some help with those chronic problems. And if your city is like ours, that's where we're seeing our largest health care dollars being spent for chronic problems. The median age for our employee, most of them are men. These are our employees, and they're from 46 years to 55 years old. And I think I'm in that age range, and that's about the time you start falling apart. So that is the age where chronic problems start to set in, and you really see those premiums skyrocketing because of those health care costs skyrocketing. There are no co-pays for employees who use our on-site clinics, and that's a huge plus. There are no claims that are adjudicated to our health plan either, and that's Blue Cross Blue Shield of Tennessee. We also offer about 50 generic medications, and this is a big plus because it certainly helps with the compliance of these medications. Like I say, we do offer the preventive screenings, and a really important aspect to the health centers is the fact that when employees take off time to go to see their primary care physician or to see a specialist, it takes a long time. As you know, you have to drive, you have to pay to park, you've got to find a parking space, and you're going to wait about an hour to see a primary care physician. Then you're going to be called back in, and then usually you're taken to another waiting room, and you're going to wait a long time. And by the time you finally see your physician, you're going to be seeing that physician, you're going to see him or her for six to eight minutes. And usually you've taken about three hours out of your day. With our on-site clinics, our employees see physicians and health care providers for 30 minutes at a time. And during this time, it gives them time to talk about their family history, to talk about their health risks, to talk about the things that really matter, and to try to achieve some obtainable goals with those. We have free comprehensive health screenings, or people also call them HRAs, and these are quite important. It's probably the most important preventive screening that we do because it identifies risk. It's a perfect snapshot for the health of an employee. It identifies things like high cholesterol, diabetes, high blood pressure. It looks at a CBC. It looks at huge chemistry profiles. It looks at liver enzymes. It looks at those types of problems that lead to chronic diseases, and it identifies areas where our employees can work on and try to become healthier individuals. Not only do they have the benefit of becoming healthier individuals, but there is a lot of costs that can be saved by identifying diagnoses early. During the year of 2010, there were 26 diabetics that were newly diagnosed, and they were diagnosed within our health centers. By diagnosing these early, the National Institutes of Health predict that there is about a $10,000 savings per incidence of early diagnosis. The same for hypertension. We identified three cases of hypertension in our health centers with a savings of over $7,500. And this is a really big one. We were able to detect during that year one early prostate cancer. And by doing that, according to some research, You can save about $42,000 for an early detection of that type of diagnosis that's obtained through the HRA. What's next for us? Well, we're looking at a patient-centered medical home, and a medical home means a lot of things these days. But for us, it means that our employees will have personal physician. They're focusing on the whole person. We're incorporating care coordination. And as you know, the health care continuum is quite scary. There's a lot going on out there. There are a lot of different avenues people can take with their health care. We have employees that are going to specialists, and they don't even know why they're going to these specialists. With the help of Marathon and with the help of their providers, what we'll be able to do and what we are doing now is to help those people try to navigate through that very, very scary health care system. and in doing so to try to reduce some redundancies in their care. We also have a physician-directed medical care, and we have a team of physicians, and they work with mid-levels, which are nurse practitioners and physician assistants. Another thing we would like to do, and the thing that we are doing, especially with Marathon, is we have enhanced the access of care. With Marathon, we have an on-site scheduling, and you can also schedule via phone. A lot of our employees don't like to do things online. They like the old-fashioned way of calling people up and making appointments, and they're able to do that. Also with Marathon, you have a lot of health coaching and on-site online material on their website. It's an extremely invaluable source for medical information. Like I say, Marathon Health is our new vendor, And I'd also like to say that our account manager is here today. His name is Dave Demurs, and he is here to answer any questions that you may have later on. The second component of our wellness center I'd like to talk about is our fitness center. And we opened it in 2007, also very popular. It's free to our employees whether or not they have the health insurance. And I think I forgot to add, but our health centers are open only to those who have the city's health insurance. It's also available to, of course, their dependents and spouses. We also have it available to any retirees, so anybody on our health care plan can use the clinic. But our fitness center is open to all active employees, and then if you do have our city's health insurance, any dependent over the age of 18 and also to their spouses. But it's open for set hours during the day, and it's very easy to get to. It's right next to City Hall. It's in the same center where we have one of our health centers along with our on-site pharmacy. You do have to have a medical clearance, of course. What we have is cardio machines. We have treadmills. We have ellipticals. We have bikes. We have all the normal stuff. We have classes. We have a couple of classes that are available before work time. It's 7.15. Those are pretty widely attended. We have some really great, hugely attended classes during lunchtime, and then we have some classes in the afternoon. Some of those classes are ones you've heard of, such as kettlebells, core blast. I happen to tell you that one is painful. The spinning is our latest thing. We were able to obtain about eight spinning cycles, and you can't get in there. It's like you're going to have to get a lottery. It's so popular we're going to have to be buying some more bicycles, I'm sure, for spinning. But we're able to do all kinds of free fitness testing. We did have a massage therapist. Oops, sorry, I keep forgetting to do that. I'm going to make Susan do that, actually. Okay, she has a job now. Yeah. Anyway, one thing about the fitness center, it's actually run by City of Chattanooga employees. And that's part of the whole success story, I think, to our wellness program is because there is a collaboration between our vendors and the City of Chattanooga employees. There is a success story I would like to tell you about, though, where we have a 40-year-old female who was diagnosed early on with diabetes there at the health clinic. And not only was she diagnosed with diabetes, but she was new, I guess, that she was morbidly obese. So she started working with the WellAdvantage program in August of 2009. and at that time her fitness test was considered to be in the poor category. She started working with our trainer, and she started also working with a dietician for about six months. She started working out two times a week in our fitness classes, and then she was also, excuse me, I'm sorry, she worked for, yeah, two times a week. Anyway, she did a lot of hard work, and in 10 months she lost 82 pounds. She is the greatest thing, I think, about this is not only did she lose 82 pounds, but she is totally off her diabetic medications, and that's quite a feat. Her fitness testing score now is she is fit, and she's still working out on her own. Now, as I told you, Marathon is our new fender. And a couple of, well, actually it was last week I was at a user seminar with them, and they have some great success stories of their own. And one of them I felt was pretty interesting was one that we're going to show you right now. Right now? These are a pair of pants I had for years, 48 inches. Today I'm down to a 34 How does that make you feel? Good Good I mean I look at these and I can't believe I was ever this big You see yourself But you don't see yourself When I started I just woke up one day I want to help I said I want to start doing this and I went out, got away, brought it home, and it sat. It sat. And I finally said, well, we're going to try it till then he went out. And I found a park that's got a half-mile path. I couldn't make it halfway the first time. And the next day I went out a little bit further, a little bit further, and right now I can make 50 miles a day. I'm depressed, not happy, I mean, didn't go anywhere, I didn't do anything. I sat around. I basically just more or less woke up one day and I said, today's the day. And I started. And people ask me why I did it. The only thing I can say is, who wants to be fat? That's all I can say. You want to be fat? I sure don't. I hope I fall this marathon, you know, totally where I'm at today. It's just, I mean, I just, the energy, I just feel totally different. My goal was to lose 100 pounds. I achieved that. It took me two years. But I did that, I think, in March. My ultimate goal is to get down to 185. 205 right now. Actually, it was easier because I get on my bike. That's all I got to do. I ride that bike. I know how long it takes. I know how many times I'm around, and I'm done. I mean, and then I change the way you eat. No fast food. I know if I stop, if I gain a few pounds, I can take it off. It's not going to be a problem. I just get back on my bike. Doctors are more in person. Just hurry up, check you out, get you through. I mean, when I went in last year, and I was down 80 pounds, the doctor didn't believe I was riding bike and exercising. He worked a whole bunch of blood tests and all this other stuff. He said, you know, there's got to be something else wrong. But here, they support you. They don't make it at you. They don't say, why aren't you doing this? They just guide you out. Just go out and do it. That's all. I mean, you gotta start. You gotta start somewhere. Like I tell some of the people around here, a little bit at a time and build up. That's all I can say is thanks, because if it wasn't for Marathon Hill, I'd still be 300-some pounds. And I said, yeah, I got a life. I mean, I'm going to live longer than I thought I would, I guess. Thank you. It's coming. Is it? It's coming. Okay. Wait for it. Wait for it. Oh, that's okay. We'll get there. Really, this is what it's all about for us. Yes, it's about saving costs, but what it's really about is making our employees healthier and giving them the tools to become that way. And that's what our wellness center allows us to do. The next component I want to talk to you about is our pharmacy. We have an on-site pharmacy, and it's not just any pharmacy. It's a pharmacy that really allows us to save some costs. The pharmacy actually started in December of 2008 and is available to, of course, all of those people that I've talked about who are on the health plan. It is a full-service pharmacy. It's not just a pharmacy with some pharmaceuticals. We have generics. We have preferred, non-preferred. We even have some specialty, and we have over-the-counter medications. How we're able to save all this money, though, is because we are able to actually buy those drugs at acquisition cost or at wholesale cost, and the claims actually do go through the Blue Cross system, and they do go through the PBM. So there are co-pays that our employees pay for these drugs, but they're really able to be reduced. And it's kind of a, I hate the term win-win, but it really is kind of a win-win because the city wins and the employees win by using this method. If you look at the co-pays structures, you'll see on the left the well-advantaged costs or prices. These are actually co-pays compared to the co-pays that you would pay if you were to go to a retail pharmacy. Once again, it is a full-service pharmacy. If we do not have the drug or if they don't have the drug at this pharmacy, then they can get the drug, they can order it, and it can be there in 24 hours. The over-the-counter medications that are available to employees are also offered. They're available at acquisition costs, so they're pretty inexpensive. Back up to the copay where you see the $2 generics. If a drug is actually obtained by us at a lower rate, then that is the price that the employees pay. So the cheapest thing I've heard so far is $0.32 for a 30-day prescription, and that's pretty good. Usually when employees go in to get a generic prescription, they leave there paying less than $2 for that prescription. We have a lot of scripts that are filled at our pharmacy. The average RX is filled per day is about 231. We filled over 5,000 in the month of March, and I was told yesterday that in the month of August we actually broke that record too, so we filled quite a few. Our on-site pharmacy vendor is a company called On-Site RX. The savings have been huge, and they're still growing. As you can tell, the graph in the middle are our drug savings, and this is since the inception, and this is a little bit old, but it was as of March 2011. But the overall savings, and this is shared savings with the city and the employees, has been close to $2 million. We do have some costs that are involved with that, but even after the costs that are on the left, the net profit is really huge. This is the second best benefit I think that the employees say that they have. And some of them say it's even better than the health centers, but the health centers are still beaten out by just a little bit. Back to the health centers, our lifestyle management program is another aspect of the well-advantaged, and it's one that we do as city employees in collaboration with Marathon Health. This is where we have, it's either registered nurses, In the past, we've had dietitians, health coaches. They work one-on-one with the employees to identify the risk and to work with them on obtainable goals in order to get them to be healthier employees. The programs that we have currently are tobacco cessation, weight management, diabetes management, and we have a strange one, but it's a reflux management program, and we actually have some pretty good results with that. But in the future, along with Marathon, we'll be having programs to work with our employees who have hypertension, cardiac disease, and I think pulmonary disease, probably COPD or chronic pulmonary disease is high on our list. We may also add our biggest dollars or the most dollars that we have got on musculoskeletal claims, and so we may have some programs to go on with that diagnosis or those diagnoses also. We also have teaching classes. We have Teaching Tuesdays. We have Lunch and Learns. Coming up next month, this October, we'll have a pink party where I say it's just for girls, but it's really not. But we have a radiologist comes from one of our outpatient clinics, and he does a program on breast cancer awareness, breast cancer, and it's excellent. So that's highly attended. With the lifestyle management program data, it's next. And in the year 2010, we had 327 employees who enrolled in those programs, and 54% of those completed the protocol. And the protocol is pretty extensive. So Marathon Health has been with us for three months now. And during that time, one-third of the population, one-third of those employees being seen by Marathon Health have some sort of an engagement where they have found a risk factor and they're looking at those goals. By the end of the year, Marathon's goal, and our goal, of course, is for 70% of that population to be engaged in some sort of activity where their behaviors are changed and those behaviors will result in a healthier lifestyle. Let's see. Oh, the Lunch and Learns are highly attended to, and the average is about 66. We did have one where we had 92 in attendance, and I will tell you that the fire marshal was not one of those. We have a health fair every year, and it's attended by a lot of people as well. It's quite informative. With the Take Control of Diabetes program that we had last year in 2010, there were 78 people enrolled in this. At the beginning of the course, the average A1C or the hemoglobin A1C was 7.8. And at the end of that class, when everyone finished their protocol, although you never really finish, of course these things go on and on, but the average A1C was 6.8, and that's a huge drop. And the American Medical Association guideline is actually 7, so that average is below that. This is major success for all of these people who are involved in that program. So how do we bring it all together? We have a lot of components. We've got a lot going on. We've got employees who are engaged. How do we keep them engaged? How do we, like I say, pull it all together? There's a huge incentive for our employees to go to our wellness centers, a lot of reasons why they have to go there, a lot of reasons why they go to the pharmacy, A lot of reasons why they go to the fitness center, but what kind of keeps it all together? About two years ago, we wanted to look around and try to find a real innovative incentive program, and we think we found one in a company called Ship Rewards. Ship Rewards is an online-based incentive program where we, as city employees, pick the areas that we want to incentivize. What do we want them to do? What kind of behaviors do we want to change? And the behaviors that we really want to change, we put the most incentive there. What our employees do is they get what's called chips, and chips are like points. And every time they do something good, every time they do something healthy, whether they know it or not, and I'll explain that in a minute, then they get some chips. You can earn more than 30,000 chips a year, and that equates to about $300. So how do employees earn chips? Well, they can get a comprehensive health review, and that's 5,000 chips, and that equates to $50 worth of chips, and I'll tell you what you can do with your chips too. They can have their waist measurement, their fitness test done. You can read these are anophysical, colonoscopy if indicated, mammogram if indicated. We want them to have their, saves us money when they have their prescriptions at the well advantage, so that's an incentive for them to do so. We also give bonus chips if these behaviors stay their behaviors, and otherwise they don't go back to smoking after they've quit smoking. But we also give chips for not only becoming healthy, but we give chips for those people who were healthy in the first place. We want them to stay healthy. You can report your exercise three times a week. We have Weight Watchers. We have an on-site Weight Watchers program that we offer for half price. Of course, enrolling in any of our lifestyle management programs, stay injury free for a year, attend a lunch and learn. Well, how does this company get this information? Well, it gets this information in a variety of ways. We give them the information from our fitness program or our on-site City of Chattanooga wellness program. Marathon Health gives them some information and lets them know who's had their annual physical, who's had the health risk appraisal. And then they get information from Blue Cross Blue Shield as well. They give information and the CPT codes are collected, and so they're able to identify who's had their colonoscopy and who's had this. And people are really, our employees are really, really weird about this. They'll call up and they'll say, I had my test two hours ago, and it's not on my chips yet. I don't know. I don't see these chips. I don't see these points. They really keep it up, really keep up with those numbers. So what do those chips do for our employees? Well, they allow them to get stuff, and everybody likes stuff. But it's basically, once again, an online program. It's kind of like Amazon.com. It's very close to that. So our employees can turn their chips in for items on, like I say, kind of like an Amazon.com. They can get iPods. They can get plane tickets. Our wellness manager is a big St. Louis Cardinals fan. She's gotten, I think for the last two years, she's received some baseball tickets. You can save your chips from year to year. You can compile them for, I think it's four years. If you left the city, you can take those chips with you as long as you utilize those within four years. The things that are mailed to your house, let's say you've got something really big for those chips, it's mailed to your house and there's no postage or handling. Also, by getting the $300 worth of chips, they don't have to pay taxes on this. So this is a huge benefit as well. Our employees love this program. They absolutely do. And does it change behavior? I think it does. Like I say, it's all of the components of the well-advantaged system that makes them change the behavior. So what are the numbers with engagement by behaviors? And this is with information not just on the on-site clinics but everywhere. Not only are we able to kind of look around and see what kind of behaviors are being changed, but we can kind of keep an eye on what areas we may want to work on in the future. Let's say we don't have a lot of change in what area. What can we do? Let's have some more incentives for that certain area. Annual physicals, 46% of the total population are getting those. You can read all of these. Nicotine tests, about 12% are getting those. That needs to increase. Regular exercise and activity, 12.5%. I would say that needs to increase too. But those are areas that we were able to identify now in kind of a bigger picture because of this. It combines all of the programs with the well-advantaging. It gives us an idea of where we are and where we need to go. This information was in the first six months of implementing this program, too, and so it could be updated just a little bit, and I bet the numbers will be better. The next one are just the numbers that we got through CHIPS from our on-site engagement. And the second column here was within the six months after starting the CHIPS program. And so the prior year is in the column below that. The annual physicals rose 5%. HRAs, remember we were given $50 worth of CHIPS for that. It rose 14%. Women's exams were 19%. That's a pretty huge increase. The blood pressure testing, 48%. That's huge. but the biggest one that we saw was actually with men getting their PSA or their prostate-specific antigen test. We had an increase of over 400% for men getting that, and that's fabulous. We want to see that with every one of these, actually. And the next slide is just sort of the whole picture of the cost analysis. This was done by our internal audit department, so you know they have to put everything in a graph. And so this was the graph that they chose for us. But this, if you look at fiscal year 2006, is when we started the health centers. And you remember that's the first thing that we started in our program. And this was the amount of money of premium that we brought in. And this is the starting place. The dotted line is trend. It's like a 10% trend of where those premiums should have been had we not done anything, had we not created our well-advantaged program or made any kind of changes. And so if you see the arrows there, it's where we implemented the certain components. First one with the health centers. And, yes, our premiums started raising a little bit, but around the time, actually, we became self-funded in there. But somewhere between fiscal year 2008 and 2009, we kind of had a little leveling out, and we're hoping to keep that level. Actually, the pharmacy guys would like to tell you that it started leveling out when their error comes here. So I don't know that that's true, but they like to tell you that. Anyway, we are due for our fiscal year 11 results, and those are down in finance right now, and so we'll be adding those to this graph here pretty soon. Once again, the number below is the premium minus the cost of running the clinics. And so we do take out that money when we look at these numbers. And that is it. So I appreciate the opportunity to tell you about our program. We like to talk about our program. We think we've had some really good results. And we like to see when other municipalities do the same sort of thing. And we hope that you have the same kind of results, too. We have an excellent partner in Marathon Health. They are our vendor for our on-site clinics. And we've got a lot of great things coming up. coming up so who knows what we'll have in the future but hopefully i can come back again sometime and tell you what we've added because i hope it's going to be really good and once again the bottom line is we want our employees to be healthier and we want to give them the tools to become that way thank you so much and i'll answer any questions okay madeline thanks thanks so much sure okay we have some we have some uh council members signed up for uh comments or questions and uh first is is Council Member Jay McCord. Council Member McCord. Thank you, Mayor. And I want to thank you for coming because so often we get presentations all the time that leave us saying, boy, I wish we could compare apples to apples. Well, guess what? We've got an apple-to-apple comparison, and it's here, and you all made the trip. So again, thank you very, very much for taking the time to share. And I think you hit the nail on the head, and I just want to confirm and affirm some of the things you said for our employees as we kind of face this new season that we're going to get into. So often what happens is that someone individually will go to the doctor and they'll hear a bad report. And the doctor will basically tell them that if you don't change your behavior, then you're not going to live very long or have the kind of quality of life that you like, not see your kids or your grandkids. And generally that type of a statement or that type of an encounter changes behavior. Basically, we've had the same type of thing here as it relates to the cost of where we are health-wise. And we've had that kind of moment at the doctor's office as a government. But what I really like you saying, and I want to reiterate it, is it's not about cost savings. That's kind of just what woke us up. Cost savings is actually just the result of living a healthier lifestyle. And I think Lexington and Kentucky and our population here has to realize that we are not a very healthy population. And it's one of those things where nobody likes to hear that and nobody necessarily likes to change behavior because of personal responsibility. And it's my life and I can do what I want. But at the end of the day, it is about your life and it is about our community's life and so forth. So what I would challenge our employees to think about after hearing your comments is that we need to radically change the way we look at things because what we're looking at right now is the cost of sick care. What's our health insurance premiums? That's the cost of sick care. Once you're sick, then that's what we're going to pay. And we get very hung up on what's my premiums, how much more are my premiums going up. The only way your premiums go down is if you're healthier and we have a lower risk. That's it. There is no other way. There's no silver bullet. There's no magic formula. And so at the end of the day, if you want your health premiums to go down, you have to be healthier. That's it. And so I would say that we have to start to fundamentally start changing the way we think about sick care to the cost of what it means to be well. And there's a lot of folks that can give a lot of excuses as to why they can't be well. But at the end of the day, when you get to a moment of crisis like we are right now as a government, but as individuals, it's time to change that behavior. And so I would say that we just need to start focusing on that cost of wellness. So I have a question as it relates to that. I asked this question the other day, I guess, to Leslie Jarvis, but anyone in the administration I can ask this to. The wellness center, which I am obviously sold out for this, and I'm so glad to hear what you report. Have we decided where this is going to be? I'm going to end. Council Member, that decision has not been made. Okay. It is under review. Okay. It will not be made precipitously. It will be made thoughtfully. and we can talk to Mr. Maloney about that, but I don't think we're prepared today to identify any locations. Okay. Well, and the reason I bring that up, Mayor, is I know that this is something, I mean, this is critical, obviously. This is the piece that saves us the longest, saves us the most going forward, and I firmly support having this. The question is, when you ask where, is it a facility that we own, a space that we own, or are we going to lease because there is a cost for Marathon, and I think that we can recoup, obviously, many, many times more than that cost is going to be in wellness. But if we're leasing a space versus owning the space, then that's an additional cost, and this council just needs to understand what that cost is. We started out very simply. We started out with a double-wide trailer in the police parking lot, and then we went to another facility, an unused building near one of the senior centers that was not affiliated with us. We're hoping our next thing is to build a new center that we've got on the drawing board. But, you know, you can start out small. It doesn't, you know, like I said, the double-wide trailer was a success, too. Well, that's my point, is that as we go, this thing is obviously going to be a lifestyle change for our government, and we just need to know as a council that we have that cost of the consultant or that group, but we also may have other costs, and we just need to know what those are so that we can demonstrate how we are turning this thing. So as we go, I'd appreciate that. Thank you, Mayor. And thank you, guys. Council Member McCord, that's a worthwhile question because in my view in conversations regarding this has been to encourage a responsible decision, one that will create a space and environment that encourages the usage of it. And I think we share that, and I would encourage anyone that has thoughts and a point of view on it to please share them with Mr. Maloney. Thank you, sir. If one thing we found out over the last couple of months, we own a heck of a lot of property, and we've got a lot of opportunity for space utilization. So I appreciate that, Mayor. Thanks. Thank you, Council Member McCord. Vice Mayor Gordon. Thank you, Mayor. Thank you, Ms. Green. for your presentation. I wanted to get back to some of the things you said and ask you just a few technical questions so I can understand more about how you operate. You did say that you have an on-site clinic. What does that mean in terms of closeness to your government building? It means one block from City Hall. It means it's a building that's literally in the next block. Okay. And so our employees can, if they have an appointment there, they can leave, and usually they're back in about 40 minutes because there's really not a lot of waiting. Do they have to use sick time, or can they just go during work hours? Well, Susan and I just talked about that before we started, and I think the consensus is that they're supposed to use personal time. It's not going to be the time they would be taking, of course, if they were to go to a primary care physician or a specialist. They're just not taking that time. But I think a lot of the departments have some sort of a comp system worked out to where if you go to the wellness center that you may work a few minutes later, or not a few, but 30 minutes later, a lot of people are able to take lunches whenever they please, and so therefore they can take a late lunch, they can take an early lunch. A lot of those visits are done during their lunchtime. We have some hours before and after work, too. Okay. And also, I'm sorry, the clinics are open on Saturday mornings. Not both of them, but the one that's located closest to the fire and police centers, they're open on Saturday mornings. There are also some walk-in visits at that same clinic on Tuesdays and Thursday evening. It's supposed to be open for sick care when you're actually sick rather than an appointment where you come in for a prescription refill. But those hours are 5 to 8, so we do have a lot of times that people can go. Okay. And you mentioned screenings, mammograms, colonoscopies, bone density, all those kind of things. Do you simply refer out and the employee's insurance pays for that? Yes, they do. Is that how that works? Right. Of course, a lot of those services now, after last year, are at no cost to the employee. We don't perform, of course, mammograms on site or colonoscopies, thank goodness. Okay. That involves a lot of expensive equipment. But that's one of the things that the health care providers can help our employees with is finding, telling, letting them know what screenings are needed and to help them find a good provider to get those services and to let them know when they are needed. Did I understand you to say that Marathon, I may have misunderstood this, Marathon reports who uses the fitness center? No, no, no. What did you say? The city employees report who uses the fitness center. The city employees report who uses the fitness center to whom? To anybody that needs to know, which is really it's chip rewards. We want to know who is exercising at the fitness center, and it's chip rewards. And I also wanted to point out that the city of Chattanooga, actually, we don't get any information from Marathon, chip rewards, on-site RX. We don't know who these people are. We get aggregate information. All of the health care information is totally 100% private. I don't know who is seen on the primary site. I don't need to know. But I need to know that aggregate information. How many people do we have are in these programs? I don't want to know who they are. What's your potential pool of users and what percentage use your facilities? At one time, I'm thinking, is it over 50% now? I know that for the pharmacy, 73% of active employees use the pharmacy and about 30% of our retirees use the city's pharmacy. With the clinics now, Dave may actually be... Dave, where are you? Similar numbers. Is that right? Okay. Yes. Similar numbers. I would say more. It's just such a huge benefit. Everybody is using the health clinics. So 73% of employees use the pharmacy. How many use the clinic? Yes, active employees. And those are just some recent numbers I'm aware of. But the clinic is widely used, and I would say it's about 70, maybe even more percentage used, the health centers. And employees don't have to use it for all of their care. I mean, it's to enhance any other kind of provider they're using within our health plan, but it's there for them. Some employees use it for primary care. They say that their primary health physician is that physician that's located on site. Okay, thank you very much. Thank you, Vice Mayor. Council Member Beard, then Council Member Blues. Thank you, Mayor. While you're at the podium, how many employees does the City of Chattanooga have? We have actually 2,770 employees, but that includes part-time temporary. We have about 2,300 employees that are active employees that are eligible to use the health care plan. Okay. Second question involves staffing, and I know that that's not your bailiwick necessarily. Oh, yeah, it is. It would be Marathon would be contracting with these people. How do they handle a situation where you have a physician, you aren't going to have him eight hours a day exactly, for five days a week, for 52 weeks out of a year? Where do they get their pool of replacement folks, I guess? Well, actually, we do have a full-time physician, and we're about to have two full-time physicians, and they will be there 52 weeks a year. They don't get a vacation. No. They're very different than the doctors up here. Absolutely no vacation. No, we do have some per diem doctors who fill in. Okay. We also have, I think I mentioned this, but two mid-levels that are full-time on the primary side. And Marathon, I didn't mention this because it's kind of outside of the wellness program, but they provide a lot of occupational health for us, too, And so there are a lot of providers on that side as well. Okay. One other question, and this really doesn't involve you as much as it involves us, and that is if we have a $3.5 million dent facing us, how are we going to cure that in six months? And I'm looking to my right. yeah and i'm going to look to my forward um you know uh julian i think uh councilmember beard um the numbers yeah and jane why don't you come on up and help me some but you know i think we've We've all learned in business models where we are adjusting and undertaking a new approach that we do our best to project, to budget, and to estimate. And we do have some good folks who have worked on this, and those numbers have been confirmed and verified. But is anything perfect? No. Are these numbers going to be within a range of predictability? We hope so. I'll let Ryan speak to that. Well, if I may, I'd like to separate it in two different questions from two different perspectives. In terms of the urban county government, if I may, handle that first in terms of cost savings. The three and a half was more on the breaking of the trend. I'd take that in the second part. As I've said many times at the podium before, we're going to implement cost of service January. So you can infer from that and from the numbers that were distributed from the mayor's office earlier. I guess it was yesterday. that we have a current subsidy. We do not charge cost-of-service rates. We have not implemented any of these new plans. We intend and have always intended through the budget to implement those in January. So from the urban county government side, through the first six months of the year, as projected, we're going to have about an $8.3 million subsidy into the health care plan. Last year, it was $13 million, and we project through the first six months to be about $8.3 million. Health care is getting more expensive. So that's why that subsidy amount went up. So in terms of the urban county government, I would say the number we're going to save January through the end of the year is going to be $8.3 million. So that's government-wide. It's not just one particular fund. So from the government perspective, again, to reiterate, it's roughly an $8.3 million. Now that comes from two instances in terms of savings and cost of service rates. We're going to save those as of January. Now, the $3.5 million that was kind of breaking of the trend, we've had midpoint to midpoint last year to 2011, the year before to 2011, we had a 16% increase. Now, the numbers that were distributed don't show our top-line health care spend going up $16 million. What is not articulated there that did happen is we had some satellites leave. So actually our health care expenses are outpacing even the national trend. So it is substantial. So when we talk about that $3.5 million savings, again, I'm now focusing on the second part of the question in terms of the employee side. These initiatives, the CHIP rewards, if that is so who we choose to administer the benefits, the on-site clinic, the on-site pharmacy, that $3.5 million is going to be made up of a couple of things, mostly on the consumption side that goes directly into the employee's pocket, that $3.5 million. For instance, Marathon Health. I'm parsing the numbers. That's where I focus on. Just the primary care visit, Marathon can treat somebody in-house for about $80. Whereas if I go to the doctor and I spend three hours of my time to get six minutes of a doctor's time, That, out of our health plan, costs $110. So the primary care visit is going to be cheaper. The referrals will be cheaper because we can refer out to the lowest cost, best service. So that $3.5 million is going to be that consumption of health care where it's a block away or a mile away from the government center where we do it in-house and save time to the employee, as well as the in-house pharmacy and the new express scripts. Our consultants have estimated, and it's in the literature, we send out about $1.5 million just by migrated from Caremark into Express Scripts. So, again, to reiterate the two separate parts, it's about an $8.3 million savings to the urban county government. Annualized. Well, yes, it's over the entire fiscal year, but we're capturing that starting in January because our benefit plans don't run concurrent with the fiscal year. And then the second part, that $3.5 million that's always been quoted as more from the employee side, from a lot of the health initiatives that we've articulated and our consultants have articulated. Since you directed a little bit of that to me, I think it's real important that we recognize that this is the equivalent of a startup. We are starting. We know that there are benchmark good examples of this model. But we are still in a place where we are estimating. So that is an estimate. Good case, best case at this point in time. The sooner we get at it, though, in my view at least, with a good model, the better off we are. And I would agree that I think we have a good model. I guess what I don't see is on January 1st, everybody turning their TV off and running to the wellness center in great numbers. I see a ramp up over time that we won't do that well in the first six months. We might do that well in month 18. Yeah, that's a good question. Maybe with that, you all can share the double wide experience for us again. Maybe Dave, do you want to address that? Oh, sure. Absolutely. Dave, why don't you introduce yourself again for us? Okay. My name is David Demers, and I work with Marathon Health, and I would function as the account manager for the program here and kind of be the day-to-day go-to person that your team would work with, making sure the program is on track. So you're very perceptive, Counselor Beard. Basically, it doesn't happen all at once. There is a ramp-up period. It takes some time to get people in the saddle. And the best thing that happens is word of mouth. The first people to try it out, the so-called innovators, will have a good experience, whether it's with simple acute care or whether it's meeting with a clinician and making some simple changes and finding out that they're listened to, they get great support, and that good things have happened to them. That will spread. We typically see 50% participation in the initial year, and then that grows rapidly up to the 75%, 80% that you heard Madeline talk about. And the other key thing is the way you effectuate changes all at once. We're recruiting medical staff that have, at a minimum, great clinical skill sets, but that's just the beginning. What we're looking for are people who are going to be real people folks who can function as great health coaches. And what they do is they find out where people are in their readiness to change, and the interaction with that individual is based on where they are in their readiness to change. Some people are just starting to think about it. Some are very actively exploring ideas. And then the goal is to get each person to pick one thing that they're comfortable working on and to set a small goal and to create a success and then to build on that so that over time you hear about the success story that Madeline talked about or the profile of Ken, of which there are many, many cases. And when you add up 10, 20, 100, 500 Kens, that's when you start to see real benefits flow. And that's how it's done, one step at a time, and it grows by word of mouth. Well, we're quite lucky to have a model come visit us from Jattanooga to help us get started. Obviously, we've had Briggs and his folks have been helping, and you all have been helping. We met last week, and did you all stay, or did you go back to Vermont and then come back down? We went back to Vermont, but we came back down this morning. Okay, well, that's amazing. Anyway, I appreciate what you just told me because it makes me feel a little bit easier about this $3.5 million is something we just don't have is the problem. And where we're going to get it, hopefully we're going to probably be running around dragging people into the Wellness Center by sometime in April or May. Thank you, Mayor. Yes, sir. I would like to add that the wellness program, getting people to come in and exercise, that's the slower piece, I would say. But getting people to go to the clinic, I mean, as soon as you have, it's flu and cold season, that's a great place to go because you can go online. I did that once. I went online. I woke up with a fever. I said I need an appointment. I set my appointment, went back to bed, came out with medicine. you know, that morning. So you have things like that that gets people in there fast, and the pharmacy especially ramped up very fast. I mean, we thought it would be slow because we thought our employees would be hesitant to jump into this because they do have health problems and they're not young people for the most part, but it ramped up very quickly. Dr. Blues. Thank you, Mayor. I do have one question, I think, for Ms. Green, and thank you for being here and helping us through this. And that's between the relationship between the clinic and specialist referrals. Does the individual employee choose the specialist? Absolutely. Yes, our employees need some help. We actually, with the stats that we get from our insurance plan, our numbers of employees, the numbers of specialists that we see are very high. I truly believe that a lot of our employees just are not educated in the health care system enough to know which types of specialists to go to. We have employees that are going to two and three specialists they probably don't need. But the health coaches and the health providers can help them to find a specialist that maybe someone has told them about them. It's like, do I need an endocrinologist? And what is an endocrinologist? And who's a good one in town? And who have other people seen? And what kind of results can I get? It just kind of helps them maneuver through that system. But, yes, the employee absolutely can decide. As long as they're in the Blue Cross network, I mean, they can go out of the network, but it wouldn't behoove them. But they can get whomever they would like as long as, like I say, it probably needs to be in the network. But, yes. But, once again, the provider just kind of helps them along with that. I see. And how about in making the transition, some employees might already have a specialist whom they see. That's absolutely fine. Like I say, our employees don't have to see these providers at all. The health clinics are just an enhancement to our health plan. It's a great enhancement, but it is. We have a lot of people who utilize certain aspects of the wellness program, but they may never go to the health clinic. They may be very happy with their primary care physician, and that's a great thing. They may be getting the care that they need. But that's not to say that the health clinics aren't there or the health centers aren't there if they decide that they, say, get sick and they need to go see somebody. That doesn't mean they have to give up their primary care physician that they're happy with. It's just an additional source of health care. Thank you very much. And one other question. How did you manage the transition period from or to your own pharmacy service? You started in 2006, and the pharmacy came online, I gather, sometime. Right. The health clinics started first, the health centers. We're trying to call them wellness centers, but I'm not doing a good job. Sorry. We started talking about putting the on-site pharmacy into place a long time before it actually started. As you know, this takes a long time. Once we gave the employees all of the information that they needed, that the pharmacy was a real pharmacy, it had the same services, quality medications, and to give them the information of the choices actually theirs, They do not have to go to the employee's on-site pharmacy, but it's at a cost savings for them, too. If our pharmacy closes at 5 and it's not open on the weekends, if drugs are needed after hours or on the weekends, which they often are, they can't utilize that service. There's nothing that says that they have to. A lot of our retirees choose not to use the on-site pharmacy because of the location, and it's just not convenient for them. They would love to be able to reap those benefits of the discounts, but they just can't get there. In the future, one of our goals is to have a mail order. When we get to our new facility and we have more space, that's one of our goals. And that way, our employees could get those deep discounts with the co-pays, and they could get them and not have to drive anywhere. I see. Thank you very much. That's helpful. Thank you, Mayor. Thank you, Sir. Council Member Lawless, then Council Member Kay. Thank you. I have several questions. One, in Kentucky, physician's assistants and nurse practitioners can write certain prescriptions, and I don't know if that's the law in Tennessee because it's different state to state. Do you all utilize? Yes, we do. We probably have similar laws. Dave may want to address this question even more. You are correct. And has there been any attempt, and this is to look at partnering with UK and their medical school and physician's assistants and nursing and PAs and et cetera? Well, unfortunately, we don't have a medical school right in Chattanooga because it's either Memphis or up in UT. Right, and we have some. But we do partner with Memorial, one of our large hospitals, to do the mammogram. They provide a van that comes to our centers for mammograms. But we are certainly looking at more ways. Well, for us, we have the University of Kentucky Medical Center. Yeah, that would be a wonderful advantage. And certainly they do internships and et cetera, so that might be. The other thing, it seems to me that especially, depending on where it's located, if it's in the downtown area, this might be a great benefit to some of our local employers who may, small businesses or larger, who may not have the financial ability for the infrastructure of this that may want to partner with us for a price to help with their health care costs for their employees. And it would be a win-win and certainly an economic development incentive for our employers in the area. Well, we have a, you know, because we want our employees to have access to the centers, and that's one of the issues you get into when you're trying to share. We have our electric power board is very lightly connected with us. They have used the same provider. And, you know, once we got our center in and we have a separate county government, like they have a pharmacy that they've opened with the same provider we have, So it does sort of snowball once you start it. I mean, not starting off the bat, but it seems to me that that would be a great economic development incentive and a healthier thing. Marathon does have some companies that have shared services. I'll let Dave answer that. As well as the state. No, Councilor Wallace, it's a great observation on your part. It's a great idea. It is happening. It's what we call a shared services model. there is there's two companies that just started this that we're working with in nebraska two small companies neither of which were large enough to do this on their own so they we opened one wellness health center and they're sharing it so it is possible to build on the program as it goes and i think we're starting to see a lot more interest in that because many people are kind of understanding the potential here, but unless you're of size, it's hard to do it. So bringing smaller groups together is a good way to do that. And these are things that have been implemented. I know many of the businesses, large employers around the town and in the region like Toyota, et cetera, have their own pharmacies, et cetera. So I think while this might not fix our budget deficit for this year, we keep looking at woulda, coulda, shoulda. We also need to be thinking long range, not just about what's going to fix things today. It did take a little while. It does take a little while, but you've got to start somewhere, and it's a great place to start. So to me, I think this is extraordinary, and I really appreciate your all's time and energy and whoever on the administration pulled this together. So thank you, and thank you, Mayor. Thank you. Council Member K. Thank you, Mayor. I have a question also, Ms. Green. I'm right here. Get my exercise in. The sound system makes it hard to identify who's talking to you, but. It does. That's fine. Okay. I got you. And this may be a question that you don't have the data with you, but the last slide showed a trend line. Yes. And it started in 2006. It did. It's hard to know where that line was coming from. That line is coming from the amount of dollars that we were paying for. It's the premium that comes in, meaning the amount of money we were paying for a health care plan. And that's minus the cost of running the clinic. Okay. So it's the, yeah. Okay. So my question is, using that same data, if you were to take that trend line back, say, let's say 2000, 2002, 2004, was it all the same? This is a Susan question. Okay. You know, we were arcing up. We did some premium changes, some of those sort of changes because we went from being a premium to a self-funded system. We kept doing these things that people are always doing to cut costs, but we were really arcing up. When did you go to self-funded? 2007. Yeah. 2007. We had a contract in place prior to that time that was based on the premiums. But when we were getting like 20 percent increases, that's when we realized we've got to do something else. Actually, one year there was a 32 percent increase. Yeah, I think so. And that's when our administration decided to really take a look at what was going on and what we could do to prevent that from continuing. Because, like, you know, you have a contract you start that goes for a couple years. The first year you've kind of worked out maybe some good deals or something, but then as whoever you've contracted with, you know, if they're seeing bad numbers, then when you go next to bid, you see huge increases. And when we presented this model, it tremendously helped the bids that we got. We started all of a sudden getting bids with no increases, which was just unheard of when increases were 10% easily. Okay, that's helpful. Thank you, and thank you for coming up from Chattanooga. I also wanted to express my appreciation to the Marathon team for coming back on very short notice. That makes me feel good about the kind of service we might be able to anticipate should we make a positive decision this afternoon. And I want to add my own perspective on this. It seems to me that this piece of the approach to health care is really crucial. has been demonstrated as something that can save money and provide better service for our employees. So it may not answer all the questions about how we're going to save $3.5 million in half a year, but I think it moves us in the right direction. So I will be urging my fellow council members to consider this favorably. Thank you. Thank you, Council Member Kaye. Council Member Martin, next up. Thank you, Mayor. Ms. Green, I appreciate you being here. Council Member Kay was sort of following the line of a question I was interested in. Do you actually know what expenditures that Marathon makes on behalf of Chattanooga? What our claims are for them? I mean, what we pay them? No, what they spend for the program. We pay them a set fee, so that may be a few questions. But you don't really see the specific expenditures? That they're doing, not with this contract. I know what we pay Marathon, and we work closely with them on the services that are provided to make sure there are enough services and the types of services that we want. But how they spend their money within that, no, I don't know. Well, perhaps the gentleman from Marathon might address this. Good afternoon. And the model that we have in place is what we call a flat fee pricing model, Councilman. And what that does is that gives you a set fee for every single cost that could possibly be incurred so you can actually plan so there's no overrun. Versus traditionally in the health care system, it's based off a fee-for-service model where engagement utilization can actually cause more cost to happen. So what we do is we take a very in-depth look at all of your data historically and plug it into a model that says here's the expected utilization and engagement that we're going to achieve. So we base everything, all supply costs, all equipment costs, all furnishings, everything that you could possibly imagine into that cost. So you know right now what the fee will be for next year, and you'll know at the end of the year what the fee was. And ultimately the benefit that the city of Lexington or city of Chattanooga receives is reduced costs. Is that fair? Correct. One thing I was curious about, because when I was looking at their changes, they instituted some changes in their premiums and their deductibles, I think, around the time that they saw reduced expenditures. will the city of lexington experience reduced expenditures by reducing our i guess increasing our premiums and and deductibles would that be a natural part of that changing that fee structure and and part of that would be you know work with your consultant uh bmi and just uh if i can tangent slightly and i will answer your question what we believe in is to fix the situation that you are faced with here, the situation that the City of Chattanooga is faced with, is the need for a collaborative effort to look at all avenues available to us collectively to solve these issues. And Councilman McCord very correctly pointed out at the beginning, you need to make sure that we're placing some responsibility on the individuals themselves to join in that venture. One thing that when he was speaking at the beginning, we do believe, people have heard before that you need to get fit, you need to wash your diet, you need to stop smoking. We believe all those things, but we believe the way that's been delivered to people before hasn't been in a way that's been communicated in an educational manner in such a way that they can see their own contribution to everything working together. So working in concert with your benefit consultants, working in concert with all of the providers of services that touch on health care in any avenue, we all come together and hold summits as an example to decide, are there changes that you might want to make to the plan design that could help or benefit based on where the trend is going? Well, where I'm leading is, you know, I have to separate, and I want folks to know I'm separating out. We absolutely need a wellness plan. I mean, today this is about whether we're going to hire Marathon to do the wellness plan. And my question is, I mean, will we know what your profit margin is on this? What we can do is we can give you detailed cost analysis that can tell you where the buckets of the money is going to. So we can show you here's where the profit margin is, here's the expenditure on equipment. We have full transparency on salaries and benefit loads, and I'm more than willing to show that to you. So what range are we looking at? What you're looking at from a profit perspective is about a 9% to 11% profit margin. The concern I have is what is a customer, from an economic standpoint, willing to pay for a vendor to save them $1 million or $2 million or $3 million? On the flip side, what is a vendor able to charge a customer to save them $1, $2, or $3 million? Since our benefit is going to be this reduced cost, And since it's tied up with the amount of premiums and the amount of deductibles, how are we going to know when you're the one saving us money and not these changes to the premiums? But second of all, how are we going to, I guess, know when this is all sort of turning into our net positive? For example, if we don't receive that benefit, will you all share the cost of that with us? What you will see is on a monthly basis, first off, from the get-go of implementation, you will see detailed reports that will show you exactly where the redirection of care is happening. As Ryan mentioned, the savings of a differential by a procedure in a primary care office of $80 versus $110 will show you every single visit that's taken place in that center and what the redirection of care would be. So on a monthly basis, you'll receive reports that detail out exact savings of redirection you'll get. We also utilize a very, very rigorous algorithm for predictive modeling that will say, based on these type of visits, you will have experienced these type of savings by condition. We will show you reports of standard of care, people that, the diabetic that is having the foot exam, that is having the eye exam, we will show you those on a monthly basis. We have a very elaborate reporting package, and it's one of the things I just really wanted to commend. Your team in the city, as with the city of Chattanooga, When we went through the procurement process and responded to the request for proposal, the job that BMI did putting it together, it was very in-depth, and it really drilled down deeply. And several members of the council actually sat on the committee that evaluated, and we were very impressed with the forward thinking and the questions that we had to answer to and were responsible for as part of that process. My five minutes are up. I will yield back to the mayor. Thank you, mayor. Vice Mayor Gordon, since you've spoken on this issue, you want to let Council Member Myers go and then come back? No problem. All right. Council Member Myers. Thank you, Mayor. Ms. Green? You say you guys have about 2,260 employees? About 2,300 active employees. Okay. Do you know how many? That are eligible for the health plan. Okay. Well, it's about. That's right. But we have a lot of part-time and some other employees, but that's probably about 2,400, yes. Okay, but 2,300 are eligible. Remember, we also have our retirees under the health plan, too, and so we have to include them. That was my next question. Yes, we do. They are eligible and their dependents, as long as they're on the health plan, they are eligible to use the health centers. As well as our retirees over the age of 65 who are on our Blue Advantage plan or Medicare Advantage plan, they can use the health centers as well. So the covered lives amount is right around, it's just under 7,000 members. But that's not really true because we only take children over 6, 6, so minus dependents under the age of 6 from that. Okay. Don't ask me where that number is. Okay. Because I don't know. Okay. Thank you. But when you look at, there's two parts to this because we're not going to initially have the gym, the health club. Right. We didn't either. If you just look at the lifestyle management program part of it, what percentage of your employees do you think, I saw in here it says. I believe in 2010 it was 327 employees were involved in the lifestyle management programs. All of your employees are not going to be involved in those, but a good percentage has been for the city, and it grows every year. Okay. And some are in more than one lifestyle management program. Okay. So does this include the 327? Is that just employees, or does that include? Because it sounds like you said that. The 327 would include some spouses and dependents. Probably the majority of those, though, are active employees. Okay. Have you guys looked at, and that was in 2007, that statistic, do you know what it is now? Or you said it grows every year? I'm sorry. You said the number grows every year with the number of people that are enrolled in the lifestyle management program. Right. That was the amount for the year 2010 was 327. That does grow. I don't have the exact number, but I would say the year prior to that probably had about 250 in those programs. So it takes a little while to get those started, but once the word gets out that they're available, they can build up pretty fast. Okay. What have you guys done to try to increase that number? Because that number is out of... Well, once again, the CHIP rewards is a huge incentive to try. It's word of mouth. It's communication that these programs actually exist. And one of the things that Marathon will be doing is to actually send the health coaches out into the city. If you're like we are, we have employees all over the city, and we have them in probably literally hundreds of buildings. And so the idea is to take the health coaches out to the departments and get the word out that these exist. That's very beneficial for us. We have a lot of employees who don't have access to Internet, whether they're at home or whether they're at work. And so we have to be very creative with the way that we get the word out. for anything that goes on at the city. I would say 100% of the employees know about the health centers and they know about the pharmacy. Okay, my time's, I only have a minute 20 left. When you look at, have you done any analysis on what segments of your population have enrolled in a lifestyle management piece? Segments meaning like which departments, male, female? Like healthy as opposed to, I don't want to say unhealthy, but less healthy. Oh, I see what you're saying. Age demographics. That is one of the areas that we'll be relying on Marathon and their expertise and that part of the data analysis that we're going to get. Actually, he's right here. Good afternoon, Counselor Myers. Good afternoon, sir. The population that we're focusing on is about 960. That would be the high-risk population, chronic condition population. As of right now, about a third or 300 of those are engaged in these programs. Excellent. That's the number I'm looking for. Okay. So let me ask you this. To me, I think you were saying Thursday when I was speaking to you upstairs in the other building that the platform, the base fee that we're going to pay you, that million for, is based on 60% of our aggregate population that's eligible. So for me, it would be key that if they only have 327 out of, it's really not the 7,000 number, but whatever that number is, that's not really a high number. So for us, and I realize my time's out, if I could just ask this one question about, how are you going to work with our population to ensure that as much of that, I know you said that normally 60% come on board that first year. How are you going to work with us so that we get as many of our census possible engaged in the lifestyle piece? Because we're not going to have the gym until later on down the road. Right. Yes, sir. So remember that the number I just gave you was what percent of the high-risk population is engaged. If you look at Chattanooga, three-fourths of the total employee population is using the health center, either for acute care, primary care, wellness. So three-quarters of the population is actively using it. What we look at for lifestyle engagement is the target population that needs it the most. So there's kind of two different numbers. Three-quarters are using it overall, but in terms of engagement in these risk reduction programs, it's what percent of the target population, which typically is between 20% and 40% of any population you study. Because that's where the majority of the savings is going to be for us. Correct. is getting those folks that are in that target population healthy. Long term, that will be very important. And so we will do a whole series of things to increase that percentage over time. And you've heard some of those things mentioned. Outreach, good communications, the city leadership participating, setting an example in a tone. All of those things combined, having a good incentive structure and program, all of those things combined is really the recipe that leads to higher participation. If I could ask a real quick question, my time is up. But have you looked at, do you have an analysis of what our target population would be? How many is in that population? Do you know that yet? Not yet, because we would need to have data that isn't available to us yet, biometric data, HRA data, and so forth. But with a number as large as exists here at LFUCG, I can say with confidence that it will be between 20% and 40% that will emerge as the high-risk target group. Okay. Thank you. Thank you, Mayor. Yes, sir. Council Member Farmer. Thank you, Mayor. Thank you all for your presentation today. I appreciate it. And, of course, my first question is, how many chips do we get for setting through the presentation? You get about 100. Thank you. $100 worth. I feel like we're all ahead 100 chips already. And thank you. I really appreciate your expertise. When folks go down the street to go to the health care place, is that property that you all own or that you all rent? It is. It's property that we own. It's actually an old, it was a senior neighbor's. It's the building next door. I think senior neighbors moved a block down the way, and so we purchased this and sort of renovated it. And it's where we have our fitness center. It's our downtown health center. We've thrown in the on-site pharmacy. It's kind of close quarters. but it works. And then we also have a few offices there. And, of course, with the fitness center, we have some showers and some bath facilities there. Sounds complete. It's pretty complete. It's small, but it's complete, yes. All right, thank you. Sure. Like I say, we started slowly, and it wasn't a lot of money to put this all together. You have to buy a few things, but it doesn't have to be grand. I just get the feeling we don't have the luxury of starting slowly based on our budget situation. But I guess my question, Mayor, and I'm not sure who to ask it of, is how do we contemplate the costs for the center itself in this bid or in this ask? I mean, if we're not sure where it's going to be, I'm wondering what it will call. This is the services, right? This is the, you know, we're not talking about the cost of the center itself. Right now. That's correct. So that's an add-on, then. Yeah, this is the people cost, right? And this is the docs, the nurses. Benji or Briggs, you want to speak to this? That would be. The scope of this contract. The cost-saving components, it's really a redirection of care. If you look at your current pool of health care financing, you're spending about $30 million, $33 million. We're not talking about spending $30 million plus another $1.3 million. When you put the wellness center in place because you have low-cost payers-to-care, that care will be redirected. Right. And that savings will be there. My interpretation of the question was that Councilman Farmer is asking, where have we included the cost for the clinic, the facility? The equipment costs. I mean, is that part of the consolidated? The facility is a cost that LFUCG will bear, either in one of your own buildings or leasing. All the equipment, the furnishings, the examination beds, all of that is inclusive in the Marathon health fee. and, again, that's financed right out of the gate with the redirection of care because the employees, rather than going to the retail health care sector, you know. Order of magnitude, I think that let me, I'm sorry to intervene, but just to short-circuit this, I suspect. We're talking about how many, 2,000 to 3,000 square feet gross for the 5,000? More than 5. 3,500, okay. 3,500 times, you know, let's say topside $15 a square foot, $3,500 times $10 is $35,000. So half again at $15,000. So you're looking at $45,000, $50,000 a year. So in the scheme of things, $50,000 on $32,000. So we're looking at a little over one-tenth of 1%. That is in the number for the savings, however, the net savings, right? Well done. I could have never gotten to that. But are you excited? Are you excited, Mayor? Sadly, I've done that all my life. Forgive me. Forgive me. Forgive me. It's like counting carrots on a diamond, I guess. Well, there's something to that. I guess we're in a position now where we have to make this decision this way, it looks like to me. There's no viable alternatives. And we have to turn the corner. And the point that you had made, we have to start somewhere. It's just a point of leadership for you as the mayor and for us as the council to change. This is a dynamic change. And I'll guarantee you that there's people in every office in this building watching this conversation because it's going to make a huge difference in their comfort level about their health care and how it's delivered to them. And as one of the insured folks of this government, for me too. I mean, will I change my doctor? Will I come here? Will I get drugs down here? I mean, I think there's a lot of trepidation in leadership and making these decisions, but there's also a great opportunity, too. It's just we've got to cross those lines pretty quick based on our current financial model, I think. If I may, just to respond. And that phrase, leap of faith, perhaps is a phrase that adequately describes this. However, I do believe, and I think one of the benefits of having the folks from Chattanooga here is just to, in a sense, hopefully to satisfy that level of natural anxiety that you just expressed, Council Member Farmer, That, you know, they fortunately have gone over this Rubicon. They've gone across this river, in a sense, and they have, with that experience, are able to, in a sense, you know, sort of be Sherpas and pull us along and illustrate to us that, yes, it can be done, And, yes, we can achieve better, more progressive, more effective results, and at the same time save money on costs that are rapidly, for them, got out of hand. I think we're on the same page. Yeah, but it's a very good question. And I think that's the nature of significant change like this, the anxiety that you're just expressing. Well, we all do. We enjoy the support of every one of the employees of the government when we're running for office and certainly when we're serving. And I think that, particularly to your election and to this time, there's an implied covenant that you and us are going to take the best care of our employees that we can. It's just that we can't do it the same way we've been doing it. and the way that we're going to do it from now on may not be as comfortable as it has been in terms of where we go and what we do to receive our health care and in its benefit form. But we have to do something different than what's currently going on, and that's why I think it was really good to have this discussion truly during the business day when people are here and when questions between divisions, departments, directors, employees, and us can go on because we're getting ready to roll up here and take a vote here pretty quick, strikes me. And this is a big change, and I greet it with the opportunity that it is, but I still have that leap, you're right. We're at the point where you take that breath just before you step off. But thank you, Mayor. Yes, sir. Thank you. Vice Mayor Gordon. I have just a couple more technical questions for Ms. Green, but I think, Mayor, you should challenge your friendly mayor in Louisville and the Louisville folks to come up with the square footage and cost per square foot, et cetera, and see if they can compete like you rolled that off. That was very good. Ms. Green, I just had a couple technical questions. And I know I'm very familiar with some very good internal medicine practices that offer what I kind of call full services. They do exercise stress tests, phlebotomy, EKGs, dieticians. Will all those services be done in the, are they all done in your clinic? We do a lot of the services. Yes, we have an EKG machine. We certainly do phlebotomy. or the rest of them. I think we do... Exercise stress test? We don't do a stress test. Okay, dietician services? We do not currently have a dietician. That is something from a health coach that we have had in the past, and it's been extremely successful. So we'll probably work with Marathon on trying to implement that sometime. And then for your employees... And that's not to say that the city of Chattanooga... I'm sorry, I didn't mean to butt in. And that's not to say that the city of Chattanooga can't hire a dietician, because, as you know, we collaborate staff. And so if that's what our employees need, you know, and one of us needs to hire them, then that might very well happen. I apologize. I'm sorry. That's okay. Then for your employees who choose not to use your services, how much co-pay do they have when they pay their own? They pay $30 for a primary care physician visit and $40 for a specialty visit. Of course, once again, after September 23rd of last year, their well visit, even if they go to a primary care physician, is at zero cost to them. But that's the only visit per year. Okay, I really appreciate your being here. And I have a quick question for maybe Briggs or someone from Marathon who knows, how much do you pay your physicians? and do you contract with pediatricians? I know someone said you treat over six years of age. So the first question, how much do we pay physicians? It varies by market, but in general, we like to pay physicians at the 75th percentile, so-called P75, and that is anywhere from $180,000 to $200,000 a year. And pediatricians? And pediatricians. So we are hiring family medicine physicians. So it is a family medicine model, and those types of physicians are able to treat adults and children. Okay. Do you also contract with, I know some of your services are pregnancy services. Do the clinics offer obstetricians? We are currently not employing obstetricians in these health centers, and for fundamental and basic obstetric care, we would refer those patients to an OBGYN in the community. Okay, thank you. Thank you for being here. My pleasure. Councilor Myers. Thank you, Mayor. I just have a quick question. I'm not sure who best to ask it. somebody in the administration or our consultants, but it sounds like the key to the savings for us is going to be in getting people enrolled in these lifestyle management programs. So what's the plan for that? What's the plan for doing everything we can to get as many employees engaged as we can? And then if you could speak also to the CHIPs aspect of it, when do we start designing that part of the program? Right. We started with four RFPs this year. We did the prescription benefit manager, which is going to save about a million and a half dollars. We talked about recontracting with the TPA, and we secured a number of deals on reinsurance and admin fees. Can I remember just for a second? Yeah, I'm going to hit. Okay. I understand all that, but what I'm talking about is what's the plan to engage our employees to get them to get involved in the lifestyle management programs and those things? The fourth RFP, after we get these three behind us and starting just immediately, is already out there. We've got responses to the RFP from vendor-partner relationships that do specifically that, engage employees. One of the things that we're looking for in a provider is one that would be very strategic, very customized to talk about the uniqueness of the city and talk about collaboratively what you all want to incentivize, what behaviors, what wellness activities, what health activities. And it's forward-thinking cities that recognize the dollar value tradeoff. There's going to be some low-hanging fruit. Like we might incentive people to use the on-site pharmacy and move from a brand. Cholesterol medication, it might cost $130 to one that costs $10. Those are going to be the low-hanging fruit. But somebody is thinking strategically about incentivizing employees to take a health risk assessment. meet with the wellness coach. That's the stuff that's going to be. And we've got that RFP, and we've got four real good responses, and with the selection committee, we're getting ready to score, evaluate, do finalist interviews, and put that linchpin and boost that up. Okay. Okay. The other question is, the flat fee that we're paying, Marathon, is based on our census, and then they said the other day that it's based on usually 60% of the people that are eligible participate. When we negotiated that piece of the contract, did we take into account how many of our employees don't live in Lexington, they live in surrounding counties, maybe even a couple counties away in some cases, as well as retirees, and how many retirees don't live even in the state? Correct. When we looked at what our aggregate census is. Right. What's real interesting, I'll answer that question by talking about the demographics that you were asking about earlier. The city has about 2,300 employees. You have about another 600 retirees on top of that, police and fire. In total, you have 6,000 members, which is mom, dad, and the employee, similarly situated to the city of Chattanooga where you've got hundreds of buildings all across the county. And so strategically and with the selection committee, we've been talking about what is that quartile within the city where the vast majority of your employees work, they could have access to it, as well as the convenience for the other members, spouses, to get there as well. Part of the incentive piece that you talked about, the engagement, We will incent them, perhaps with a reward, for using the on-site clinic. The other thing that's going to drive that is the low-cost barriers to care. So a city that's spread out demographically, geographically, successful putting in the one site and driving them, As it relates to LFUCG, where is that quartile within Fayette County where the vast majority of employees work and perhaps live? We do think that employees are going to gravitate to it, regardless of where they live, because the low cost bears to care. Somebody can pay a $30 copayment and go to the retail health care sector, or they can save $30 and go and get a phenomenal health care experience. Okay. Thank you. If I can just add one thing on that. But all I can say is if you build it, they will come. Council Member Stennett hasn't spoken yet. Is that okay, Council Member Martin? Yield. All right. Council Member Stennett. Thank you, Mayor. I just want to ask one quick question of the administration. First of all, thank you everyone for coming down today. It's been a worthwhile discussion. But in this late hour, when is the deadline for finding a location for the clinic? Have we set that from the administration? Do we know where yet? Where the clinic is going to be? Have we set a deadline when we're going to come back to council to talk about set-up cost or lease cost? And where are we going to pay for that? Okay. Melissa. Currently, we're working on an RFP. What we're just going to do the first year is we're probably going to lease space this first year so we can realize savings. and then we'll also be working on constructing one of our buildings that we already own to house the facility so then we can grow it and include the fitness center in those. Can't give you an exact deadline on the RFP. We don't want to get. Drafting that, but sorry. I'm sorry to intervene here, but I think what's important is let's dial back to what the message was from Chattanooga. We started operating in a double-wide trailer in order to get the system underway. So I think at this point in time, we are examining all available options, including leasing space in order to move in quickly and get moving. Will it change? Does it have the capacity to change? Should we be flexible? I think the answer to all of that is yes. Well, and I bring this up because some of the apprehension that Council Member Farmer alluded to from the employees is exactly where the location is going to be, the parking. So I think the sooner we get that comfort level as to where I'm going to be going to see a doctor, I think people will gravitate more towards the concept. So that's the reason why I ask, because during the RFP process, we actually talked about a specific site within government. So I'm kind of trying to figure out what happened to that site. But I'll leave that to come back to council another day to let us know, because I think the employees are more anxious to know than we are up here. Yep. So thank you all. Thank you for the presentation. Good question. Thank you, Council Member Stenet. Council Member Martin. Thank you, Mayor. I really think it's a great idea that we're moving into wellness. But I've got some problems with this particular contract. The City of Lexington is sending tens of millions of dollars out of state in contracts every year. I think we should buy local. Lexington is one of the health care leaders in this part of the country. And it concerns me, and I don't understand why we have to go to Vermont to buy this kind of service. We hire the University of Kentucky, who runs this kind of thing for the state and for other cities and for other universities. But what they don't do is they don't competitively bid on this kind of stuff. That's just not what they do. I'm also concerned by the fact that we're hiring a for-profit company. You know, we hired UK to run our family care centers, so we have a for-profit rather than a not-for-profit. But I'm also concerned that we're engaging sort of a company and helping them to become a national health care leader in this sort of emerging market, rather than a local company to become a national leader in this type of emerging market. We have an immense amount of health care expertise in Lexington. We have experts and some of the best folks from around the country here. And we've got folks from John Hopkins, from Harvard. It is an incredibly high level of expertise. And I don't understand why we have to go higher out of state for this. I think we have a lot of capacity here in Lexington, and I think it would be ultimately cheaper. I think you guys have a terrific reputation. I mean, there's no question you're a top-notch company. But as far as we, the city of Lexington, should we hire a firm from Vermont to manage our health care in Lexington, I think we have folks that we should look for here in Lexington. Thank you, Mayor. Okay. Do we need to – does someone want to comment on that? Briggs, yeah. I think – go ahead and let Briggs. Well, you know, we hired a specialist in this space for a purpose, to examine just those questions. So I think it would be appropriate for Briggs to comment on it, and then if we need to, Brian, our purchasing folks can. I don't know if I'll adequately be able to give you from my perspective. First of all, the staffing is obviously all going to be local representatives. Secondly, when we put out the public RFP, we did have responses from the local community. People from the Baptist health care system came in and provided a presentation. People with the Humanis Concentra program came in and provided presentations. Council members sat and listened to the intricacies of those various delivery systems. I think of Steve Cave's words from the other night that they were head and shoulders above the rest. First of all, for somebody that is functioning, this is my perspective, functioning in the retail health care sector to get into the worksite health center tent is completely different from what they're doing currently in the retail health care sector in that we're going to save money on primary care, we're going to save money on acute care, just in terms of unit cost pricing. We can get it for $80 as opposed to $110. But we're going to use those two opportunities for employees that are coming in to really start talking about the prevention and the wellness component. And the companies that are having the most success and the most traction in the on-site, worksite space are ones that have got a phenomenal value proposition to really impact prevention, compliance, you know disease management compliance and health improvement risk factor reduction some of the local vendors that we talked to and actually presented to us had a really good story about acute and primary care and how they can deliver that and they talked about the panel of specialists that they have residing in Fayette and contiguous counties to us that they would refer out employees of LFUCG who in turn would go to that specialist and use their Humana ID card to get a fee-for-service bill. So it's a very specialized space, but the measurement of value is not who can deliver acute and primary care at the lowest unit cost pricing, but who can do that, but more importantly, get at the prevention, health improvement, wellness, disease management compliance, coaching, et cetera. And anybody that served on the committee, the selection committee, and heard the demonstrations, I think recognized that value. Did you go talk to the University of Kentucky to find out what services they provide to other universities and cities? Well, one of the things that Steve... I asked some question. Yeah. There was a public RFP put out, and they unfortunately did not respond. So you did not look to see what services are available? May I comment, please? We had several council members, and first, I think the question is certainly worthwhile, let me say that, that any time we can use local vendors, we should, and I endorse that enormously. There were several council members that served on this committee. This process was extraordinarily transparent. We engaged in a vigorous RFP effort, and in my view, it is a bona fide and responsible process. Now, as the leader of the executive branch, I'm going to say this because we need to take responsibility for our actions, and I'm certainly taking responsibility for the process that was initiated, the process that was engaged, for the viability and the credibility of the process. because it did not come out with a local vendor, certainly does not suggest that the process itself, should not suggest that the process itself or the outcome is inappropriate or irresponsible. So I do appreciate your question, however, Council Member Martin. Council member Crosby. I make a motion that we get second reading on resolution number one. There's a motion and a second for a second read on resolution number one. Is there any discussion? All right. Then hearing none, we can take the vote. All right. All in favor of the resolution. That's right. Roll call this second read. Excuse me, Madam Clerk. We need to do a roll call. Actually, what would need to happen is, I believe Ms. Crosby's motion would just be to move on to the item three on the docket. and so it would be a voice vote to handle her motion. Okay, a voice vote for the motion. Just to move forward with the docket, and then I will give second reading to the resolution, and then the council may make a motion to approve the resolution on the docket. All right, then. Okay. It's a motion to call for the question. All right, we have a motion to call for the question and a second to call for the question. All in favor, please indicate by saying aye. All opposed, no. All right. The motion carries with one no vote. All right. Mr. Martin. Okay. Now, is there a motion for the, we don't need a second read, you can just read it. All right. That is correct. Number one, resolution for second reading, a resolution authorizing the mayor on behalf of the urban county government to execute an agreement with Marathon Health Incorporated to provide employees with certain preventive wellness, disease management, health consultation, and or primary care services at a cost not to exceed $1,370,886. Thank you. Second. It's a motion by Vice Mayor Gordon and a second by Council Member Stennett. So now we can take the voice vote, I mean the roll call vote. That is correct. Oh, that's right. Thank you, Council Member Blues. Is there any further discussion on the resolution? All right. Hearing none, we can then take the roll call vote. Yes, sir. Mr. McCord? Yes. Mr. Myers? Yes. Mr. Stinnett? Yes, ma'am. Mr. Beard? Aye. Aye. Mr. Blues? Yes. Ms. Crosby? Yes. Mr. Ellinger? Yes. Mr. Farmer? Yes, ma'am. Mr. Ford? Yes. Ms. Gorton? Aye. Ms. Henson? Yes. Mr. Kay? Yes. Mr. Lane? Yes. Ms. Lawless? Yes. And Mr. Martin? No. Thank you. Read it. I just sent you a message. All right. So the vote does reflect passage of the resolution. Before we move on, I do want to thank, I believe on behalf of all the council members and our city employees, all those who are involved in this project and this initiative. Thank you all for coming up from Chattanooga so much. And thank others who are here who have not. Thank you all, Marathon folks, for coming from Vermont. Council Member Lane Yes, on behalf of the Urban County Government I'd like to invite Marathon to consider relocating its corporate headquarters to Lexington We are a great city and we're centrally located very close to Chattanooga too Thank you There we go Yes sir Motion to adjourn and a second the special council meeting and a second All in favor of the motion, please say aye. Aye. All opposed, no. Motion carries. Okay, we'll take five minutes so our clerk can reboot the Granicus system.