Northwoods businesses take advantage of new area healthcare options
By Lori Adler
Patients are not the only ones who are concerned with the rising costs of healthcare; business owners are greatly affected by the significant increases seen over the last decade. In 2017, Kaiser Family Foundation reported that 156 million people in the U.S. were covered by employer-based insurance plans, and between 2008 and 2018, employee premiums increased by 55%, almost double that of worker wage increases in the same time period. One answer, however, may be for employers to take advantage of some of what are called value-based care options for their employees.
Oneida County is doing just that. Since last year, county employees could use a “near-site clinic” for their health care needs. That clinic is Priority Medical Partners, run by Drs. Brian and Kim Erdmann. Oneida County is part of the Wisconsin County Association Group Health Trust, a self-funded health insurance program for Wisconsin counties and school districts. Being self funded made the creation of the near-site clinic simpler than it would have been for a business operating within the umbrella of corporate insurance. Rules and regulations may prevent the utilization of direct-pay healthcare services with certain insurers.
Lisa Charbarneau, human resources director for Oneida County, said that she has “always wanted employees to be better consumers of healthcare.” The new near-site clinic is making that possible. While no employee is required to use the clinic, those who do pay nothing for the services. The county’s insurance fund absorbs all the costs, which would normally include employee copays and deductibles. Oneida County can do this because it directly pays Priority Medical Partners for services rendered, eliminating insurance filing for everyone involved. Services offered by the clinic include annual physicals, care for chronic conditions like diabetes and hypertension and general urgent care needs such as stitches, strep cultures and treatment of pink eye, among others. Utilizing the new clinic, many employees are seeing significant advantages to the system. Charbarneau noted that employees appreciate what the clinic has to offer, including same day or next day appointments, seeing a doctor rather than a physician’s assistant or nurse practitioner; all at no cost to them.
These services are provided to Oneida County at a cost reduction of 40-65% Charbarneau said. Since so many employees are helping the county save money on their insurance costs by utilizing the near-site clinic, there was no increase to employee insurance premiums in 2019. In the past, insurance premiums for county employees increased an average of 8-12% annually. Charbarneau added that the county is on track for no premium increases for 2020 as well.
Other businesses in the area are taking advantage of the clinic services of Drs. Erdmann at Priority Medical Partners. Though regulations may prevent businesses that are not self-insured from participating, changes in the rules are taking place as more and more direct primary care providers open for business. According to the Commonwealth Fund, the Affordable Care Act does recognize direct care providers but does not allow a direct primary care agreement to be considered essential coverage. However, if the direct care agreement is in tandem with an exisiting health insurance program, it is presently allowed. Due to the complexities of current insurance programs and how direct primary care can fit into those programs, as well as the newness of this type of healthcare to the Northwoods, Dr. Brian Erdmann invests a great deal of time visiting local businesses and community groups to explain direct care and discuss available options. Erdmann said he feels it is a valuable idea for Wisconsin and the country overall, and that clinics like his will be the catalyst for effective change and significant improvement in America’s healthcare system.