Clovis Unified School District has opened its own health clinic for its 12,000 employees, retirees and dependents as part of its own self-funded health insurance model.
Written by Donald A. Promnitz
Many businesses with larger employee rosters have taken to alternative methods of insuring their workers and in doing so, saving money on premiums. One such method, self-insurance, has found a strong and still growing foothold in the Valley.
In the typical insurance model for smaller companies, a business will contract with an insurance provider for the benefit of their employees. Health risks are then transferred over to the insurers by paying their premiums.
However, in a self-insured company, the employer pays for its own employees’ claims, or at least to a certain amount, while larger claims would be handled by insurance companies. Alan Thaxter, senior client consultant for Gallagher Benefit Services California in Fresno, described this model as ideal for bigger businesses.
“We would look at a company above maybe 200 lives as a candidate for partial self-insurance, or partial self-funding,” Thaxter said. “And anything that’s really above 400 or 500 really should be either extensively looking at—or involved in—the alternative funding marketplace.”
In the case of larger companies, Thaxter said it becomes more convenient to take care of their employers on smaller claims. The benefit to this is fewer premiums in insurance, as these claims are predictable and can be managed by the employer.
“So the gist of self-insurance is to transfer risk, keep the risk in house,” Thaxter said. “That is, having employer accept the risk that is predictable and manageable.”
Along with large, private companies, self-funded insurance has also found its way into the public sector. Last month, the Clovis Unified School District opened its own clinic in the former ITT Tech building on Clovis and Herndon avenues, run by health care company miCare. The center handles the routine needs for the more than 12,000 employees, retirees and dependents.
Direct primary care filling the void.
Despite being seen as pragmatic for larger employers, self-insured and partial self-insured plans would not be an effective model for smaller businesses, which would fail if it had to pay for employee claims on a smaller income and from a smaller pool of employees.
Nonetheless, it has become possible for small companies to take advantage of self-insurance programs through direct primary care. In this model, companies pay for a clinic to provide direct care for their employees, with multiple companies getting treatment through the center.
Previously unavailable in the Central Valley, Integrating Healthcare, a direct primary center, will be opening later this year in Fresno. It is managed by Wellness for Life of Terre Haute, Indiana.
“For years, we were recognizing there was a missing spot, that we could only service certain-sized employers, but with this, what happens is it’s sort of like no one left behind,” said Dr. Kayur Patel, chief medical officer for Wellness for Life. “You literally cover the largest or smallest employer.”
Dr. Tushar Patel, CEO for Integrating Healthcare, said that while small businesses and families may have health insurance, they often still decline even routine screenings due to a high deductible, something that direct primary care seeks to amend.
“So with the DPC model, it’s like having a Netflix membership, or a gym membership,” Dr. Tushar Patel said. “We’re able to package all of that within that membership cost.”
Like larger-scale self-insurance centers, direct primary care has the added benefit of allowing for quicker access and longer visits with a primary care physician. James Richardson, director of business development for Wellness for Life-West Coast, said that this leads to greater productivity and better, long-term wellness for employees, as they will receive more thorough advice and treatment, thus preventing conditions from becoming more serious. This in turn can save money for the business and avert larger claims.
“There’s more productivity. There’s an aspect of it, too, that if you think about one of our visits, the person goes to our clinic, is seen right away, gets the medications there — they don’t have to go to the pharmacy,” Richardson said. “They get their labs done — they don’t have to go to a lab, as opposed to a visit where your employee’s gone for half the day doing that.”
“If you’re on a fully-insured plan and you greatly increase the overall health of the group, who benefits?” Thaxter added. “You want to be in charge of benefitting [from] your employee’s health getting better.”
Integrating Healthcare is expected to open within the next two to three months and will be located at 5043 E. Kings Canyon Rd.