Montana’s state-employee health clinics not only are saving the state money, but also providing better access to primary care for thousands of people, clinic operators say.
“When I first arrived here, one of the biggest things that hit me is how many patients hadn’t seen a primary-care physician in five or 10 years,” says Nate Buffington, the lead physician at the clinic in Helena.
State health officials and the private operator of the clinics also note that costs for the state-employee health plan are declining this year – and say the clinics may be playing a role.
“Having (the clinics) as a gatekeeper of primary care, we’ve been able to get members the care they need and maybe not drive them to specialties or additional tests they don’t need,” says Marilyn Bartlett, head of the state Health Care and Benefits Division, which manages the plan.
Bartlett and executives with CareHere, the Tennessee-based company that operates the clinics, spoke to MTN News this week, responding to a recent audit that said the state couldn’t document any widespread savings from the clinics.
Both said the state and the company began addressing problems outlined by the legislative audit as long as a year ago. The audit was released in June.
“I was disappointed (with the audit) because I felt that the recommendations the audit provided had been put into play by the state (health) plan six months to a year in advance,” said Ernie Clevenger, CEO of CareHere.
They also said they could document direct savings, such as lab costs that were $1.7 million less than comparable costs in the private sector over two years, and lower-cost office visits.
Clevenger said an actuary hired by the state determined that the average private-sector office visit for a physician cost about $125, while the cost to the employee health plan for visits to the clinics has been about $93 per visit.
The first employee clinic opened in Helena in 2012, offering free primary care to anyone covered by the state employee health plan.
Additional clinics, operated by CareHere and authorized by the state, have since opened in Billings, Missoula, Butte, Anaconda and Miles City. Some cities and school districts also have started using the clinics as part of their employee health plans.
The state health plan covers nearly 31,000 people.
Bartlett said for the first six months of this year, the trend of costs for the state’s health-care plan has dropped 3.1 percent, while the national trend for similar plans has been a slight increase. No increased premium payments for employees or the state, to support the plan, are planned for 2018, she added.
She attributed the downward cost trend to several things: A new pricing plan for services at hospitals, a new pharmacy contract put into place this year, and the health clinics, which Bartlett believes have helped many members get primary care in a timely fashion, preventing more costly health problems down the road.
CareHere’s contract to operate the clinics ends this year.
The state, its consultants, employees and other employer groups have been meeting to determine the future role of the clinics, she said, and whether the contract should be changed or extended.
She also noted that the state cut CareHere’s administrative fees in 2015 by 18 percent and recovered $97,000 for pre-2016 items that weren’t in compliance with the contract.
“Our division is really actively managing those taxpayer dollars,” Bartlett said.