Created on 05/09/2014

MINUTES
COUNCIL OF COLUMBUS, GEORGIA
SPECIAL CALLED MEETING
MARCH 18, 2014

The meeting of the Council of Columbus, Georgia was called to order at 9:06 A.M., Tuesday, March 18, 2014, on the 2^nd Floor of the Citizens Service Center, located at 3111 Citizens Way, Columbus, Georgia. Honorable Teresa Pike Tomlinson, Mayor, presiding.

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PRESENT: Present other than Mayor Tomlinson and Mayor Pro Tem Evelyn Turner Pugh were Councilors Mike Baker, Jerry Barnes, Glenn Davis, Judy W. Thomas, and Evelyn Woodson. City Manager Isaiah Hugley, City Attorney Clifton Fay and Clerk of Council Tiny B. Washington were also present.

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ABSENT: Councilors R. Gary Allen, Bruce Huff and Deputy Clerk Sandra Davis were absent.

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Mayor Tomlinson made the following announcement to Council and Public:

On behalf of the City of Columbus and Council she expressed her deepest sympathies to the family of Bo Callaway on his passing.

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INVOCATION: Reverend Charles “Chuck” Hasty, Pastor of First Presbyterian Church.

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PLEDGE: Led by children with the Ridgon Road Elementary School’s Student
Council.

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CITY ATTORNEY'S AGENDA:

THE FOLLOWING ORDINANCES WAS SUBMITTED AND EXPLAINED BY CITY ATTORNEY FAY AND ADOPTED BY THE COUNCIL ON SECOND READING:___________ _______________________

An Ordinance ( 14-8 ) - Rezoning the property located at 1030 Illges Road and 1044 Rigdon Road from NC (Neighborhood Commercial) to RO (Residential Office) zoning district. The purpose of this rezoning is for multifamily apartments and offices.

Councilor Barnes moved the adoption of the ordinance. Seconded by Councilor Woodson and carried unanimously by those eight members of Council present at the time, with Councilors Allen and Huff being absent for the meeting.

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An Ordinance ( 14-9 ) - Rezoning the property located at 3071 Williams Road from RO (Residential Office) to PUD (Planned Unit Development) Zoning District. The purpose of this rezoning is for multi-family dwellings (individual rentals units).

Councilor Davis moved the adoption of the ordinance. Seconded by Mayor Pro Tem Turner Pugh and carried unanimously by those eight members of Council present at the time, with Councilors Allen and Huff being absent for this meeting.

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An Ordinance ( 14-10 ) - Rezoning the property located at 2020 Fort Benning Road from NC (Neighborhood Commercial) to GC (General Commercial) Zoning District. The purpose of this rezoning is for pet grooming daycare and boarding/barber shop.

Councilor Woodson moved the adoption of the ordinance. Seconded by Mayor Pro Tem Turner Pugh and carried unanimously by those eight members of Council present at the time, with Councilors Allen and Huff being absent for this meeting.

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An Ordinance ( 14-11 ) - Rezoning the property located at 2728 and 2739 Manchester Expressway; 4400 and 4408 Armour Road from NC (Neighborhood Commercial) to GC (General Commercial) Zoning District. The purpose of this rezoning is for general restaurants with drive-thru(s).

Councilor Henderson moved the adoption of the ordinance. Seconded by Mayor Pro-Tem Turner-Pugh and carried unanimously by those eight members present at the time, with Councilors Allen and Huff being absent for this meeting.

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CITY MANAGER'S AGENDA:

THE FOLLOWING TWO RESOLUTIONS WERE SUBMITTED AND EXPLAINED BY CITY MANAGER HUGLEY AND ADOPTED BY THE COUNCIL:________________________________________________________

A Resolution ( 101-14 ) - Authorizing the support of Uptown Columbus, Inc., application to renew designation for Uptown Columbus as a Main Street Program by the Georgia Department of Community Affairs’ Office of Downtown Development.

Councilor Woodson moved the adoption of the Resolution. Seconded by Councilor Barnes and carried unanimously by those eight members of Councilor present at the time, with Councilor Allen and Huff being absent for the meeting.

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WORK SESSION AGENDA:

HEALTH CARE DISCUSSION
Pamela Hodge, Finance Director presented a PowerPoint presentation on the current financial standings of the CCG Healthcare Fund. The following information was presented to Mayor and Council:

FY14 Health Insurance Fund

Year to Date

Actuals

(thru March 14, 2014)

Budget YTD $ 16,291,667

Expenditures YTD $ 19,430,531

Fund Deficit ($ 3,138,864)

In addition to our negative balance Year To Date for FY2014, we have

$3.8 million

negative net position for our FY2013 Health Insurance Fund due to Incurred But Not Reported Health Cost

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FY15 HEALTH PLAN PROJECTIONS

(excludes Muscogee Manor)

Total Estimated Costs* $ 26,586,633

(including Active & Retirees)

Current EE Premiums $ 7,317,419

(based on current enrollment and 6/1/14 rates)

Current ER Contributions

$ 14,695,650

(at $5,650 per employee)

Projected Deficit ($ 4,573,564)

*Medical and RX Claims, Admin and ACA fees

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Councilor Davis asked Director Hodge if these figures are before or after the Healthcare changes that were recently made by Council. Director Hodge responds by saying, these figures are after. These are based on the rates were adopted for June 1^st and also the plans changes that were made when Northwestern did the calculation for the claims, that was all taken into consideration.

Mayor Tomlinson clarified the difference between the estimated deficit and the actual deficit.

Councilor Baker asked if this is a calendar year deficit or a fiscal year deficit. Director Hodge responds, this information is based on the fiscal year.

Councilor Thomas asked Director Hodge to explain how the $3.1 million and $3.8 million deficits work together. The $3.8 million would’ve been at the end of fiscal year 2013. These projections are of those claims that would have been incurred but had not been reported to Blue Cross Blue Shield. There is a timing issue when you visit your physician typically. It can be weeks or months until the claim is submitted and processed through Finance. This is what that $3.8 million represents at the end of FY13. Which would have been claims associated with FY13, but at this point had not been funded at the end of that fiscal year. This resulted in a negative net position for that fund. You would expect any claims associated with a particular fiscal year to be funded out of that fiscal year. When CCG started off in FY14 we already knew that there were claims that had no been processed for the prior fiscal year. At this point, CCG will adjust that incurred but not reported number. Part of those claims in FY14 would have been those $3.8 million in claims from FY13. It is expected to have incurred but not reported claims at the end of FY14 as well.

Councilor Thomas asked if it would be correct to say that CCG started FY14 $4 million in the hole. Director Hodge said that is an accurate statement. Councilor Thomas then asked if this is typical. Director Hodges said no, it is not typical that the incurred but not reported claims are not funded within that particular fiscal year. Typically the fund is at a zero balance. This particular year we did not have funding available in all the departments’ budgets in order to balance that internal service fund which left it in that net negative $3.8 million.

Mayor Tomlinson said typically there is excess in department budgets, those funds are then taken to reconcile for these type of administrative and personnel costs. This deficit could have been offset by a transfer from the General Fund Reserve if we had the funds available.

Councilor Woodson asked if the $5,650 dollars allocated for each employee in the Healthcare Fund was not enough due to the amount of claims being more than usual. Director Hodge said the claims for FY13 were higher than what was budgeted for $5,650 per budgeted position. That allocation was increased from the prior year where it was $5,400. It was increased to $5,650. There were also items presented to Council such as, changes in deductibles, copays and premiums that were not approved so this is why claims were higher than what was anticipated.

Councilor Davis asked if the employees that are paid out of the OLOST, could their overages on healthcare be covered from the OLOST fund. Director Hodge said all personnel costs for those particular positions do come from the OLOST fund and any overages for those particular employees could be paid from that fund also.

Mayor Pro Tem Turner Pugh made a referral to Director Hodge requesting the cost to CCG for Health Insurance Coverage for active employees and Pre-65 retirees.

City Manager Isaiah Hugley comments, on how tight Department Budgets are and in the past they have ended the fiscal years with excess funds in their budgets to cover overages such as this. Because over the past few fiscal years City Departments have been required to reduce their budgets, they are extremely tight and there are no overages at the end of the year. An example of the seriousness of the Department Budgets, something as simple as dealing with the wild hogs, coyotes and chickens that were lose in the city, he asked departments to engage someone to do this work, he had Department Heads asking where this money was coming from because they do not have it in their budgets. Then they have to go to contingences for $2,500.

City Manager Hugley also spoke on the past convenience CCG had on relying on Fund Balance when it was over the 90 days, even at times at 131 days. This is no longer an option to cover overages because that budget is so tight. Between that and no change in premiums, copays and deductibles, we are left where we are. This information is a good segue into what our Human Resources Director will be covering during the meeting. She will be sharing ideas that staff has on how to deal with this deficit.

Human Resources Director Reather Hollowell takes the podium and recognizes three employees from the Benefit Committee, Consultant Phil Goldstein and Consultant April Halstead both from Northwestern.

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Healthcare Options Summary

Muscogee Manor- Eliminate Liability; Long Term Savings

Spousal Exclusion

Cost Sharing Plan- 25/75% Employee/ Employer

Pre-65 Retirees pay 50% of coverage, spouse and dependants 40%-0% over 5 years

Increase deductibles and copays

Increase Rx copays

***All Options are valued independently***

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Councilor Thomas asked what kind of liability is CCG responsible for when it comes to Muscogee Manor. Director Hollowell explains, Muscogee Manor pays their full insurance premium every year however, at the end of the year that does not always cover the full cost of their medical claims. Whatever cost is incurred after the premiums, CCG is liable for that expense.

Councilor Thomas asked if this can be avoided by requiring Muscogee Manor to carry some sort of risk insurance to help eliminate the liability to the city and so they are still able to participate in our plan but at no cost to the city. Director Hollowell responded by saying, the administration of Muscogee Manor contacted the City Manager a week ago wondering what they were able to do to cover that liability. The administration offered to pay what ever the cost is that is not covered by their premiums.

Councilor Henderson said he would not be comfortable with Muscogee Manor being in agreement with CCG to write a check for the difference of premium costs to claim costs. Reason being, the unexpected cost of healthcare in general and catastrophic illness costs. He expressed the only way he would feel comfortable with an agreement like this is if Muscogee Manor had a stop-loss plan to cover the overages up to a certain amount.

City Manager Isaiah Hugley spoke to the discussions between him and Mr. Frank Morast, President of Muscogee Manor Administration. There was a conference call meeting, during this call Mr. Morast explains that he understands the financial situation that CCG is in. He also spoke on the stop-loss during this conversation and how they would have to acquire this type of insurance.

Councilor Mike Baker asked Director Hollowell if Muscogee Manor has developed anymore facilities. She responds by saying, that in 2013 they did acquire two additional facilities. Councilor Baker said that if Muscogee Manor is acquiring additional healthcare facilities, he is not sure that this is part of the basis mission of the city. He is not sure that CCG covers programs that are expanding beyond the basis function of the city, whether they are going to pay for it or not. He said he would like to look at the situation from the standpoint of, are they expanding beyond the basis functions of the city government. This was accepted as a referral to look in the mission and scope of Muscogee Manor.

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Councilor McDaniel said that CCG would be creating a lot of problems with excluding employees’ spouses from the health insurance. Mayor Tomlinson explained that the only time a spouse will be refused insurance, is if they are eligible and have access to healthcare benefits through their current employer.

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Councilor Thomas clarifies her earlier comments regarding Muscogee Manor to Council.

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Director Hollowell continues her presentation by explaining that another Healthcare cost saving option is spousal exclusion. This is for those employees who have spouses that have access to insurance through their own private employer. This would apply to about 284 active CCG employees and 22 pre-65 retirees. This is a typical cost saving option that many organizations are putting in place. Northwest calculated the savings for this particular exclusion to be about $1.1 million.

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Councilor Henderson informed Director Hollowell that he has an appointment today and that he has to leave the meeting early, but made a referral on the Health and Wellness Center. He made a request for a matrix or an actuarial formula for the savings CCG would incur for every 100 employees that migrate to the health and Wellness Clinic option. There was discussion between Councilor Henderson and Director Hollowell on the Health and Wellness Center is the cheaper option for both the employee and CCG.

Councilor Henderson said the bottom line is sustainability of not only our health insurance program but also the pothole fund and other areas that money has to be pulled from to cover the health insurance fund. All signs are showing that healthcare is going to continue to get more expensive. There was further discussion on the functions of the clinic.

Mayor Tomlinson gives an example of the magnitude of savings for employees to elect the Health and Wellness Center option, if CCG was to do away with the current HMO plan and require those employees to enroll in the clinic, the savings would be around $600,000.

Councilor Davis said, in theory the cost of a healthcare plan is shared amongst the participants. He asked if the number of participants goes down, can the remaining participants expect their premium rates or copays to increase. Consultant Phil Goldstein from Northwestern says no, they should expect their premiums to go down if that should happen.

Councilor Henderson then left the Council Meeting, time being 10:00 a.m.

City Manager Hugley asked for clarification from Mr. Goldstein, that the premiums are not going to decrease considering the cost of healthcare is steadily rising about 10% each year. Mayor Tomlinson said the way she understood the statement was, in isolation, if the only issue CCG had was a $1.1 million deficit then this would satisfy the whole issue. But CCG is not at an isolated issue. We are at a $4 million deficit and saving $1.1 million only reduces the $4 million deficit. Therefore, you will not see a reduction in premiums, deductibles or copays because that additional deficit is still there. It will also not increase because of the $1.1 million savings. The spousal exclusion is just a way to help reduce the deficit.

Mayor Pro Tem Turner Pugh made a referral that she would like a written analysis on the claim cost of employees verses spouses verses dependants. So that Council will have the numbers to look at when there is a further discussion on the claim cost of dependants.

Director Hollowell adds that out of all the tiers within CCG’s healthcare plans, that the employee plus spouse is the most expensive.

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Director Hollowell continued her presentation by going over the other Healthcare Options, with Finance Director Pam Hodge explaining the shared contributions.

During which Director Hodge explained how in the past the HMO plan was cheaper and the PPO/POS plan was the more expensive plan. With the deductibles and copays changed, the HMO plan is now the more expensive option. If the city was to abide to the 25/75 percent contribution split for all three plans, the savings would be $1.6 million. Director Hodge suggests, depending on what is presented in the budget, Council adopted a different cost sharing strategy then what was presented before. An example was given, 25 percent of the Health and Wellness Center plan used as the base, CCG would contribute $319 per month for employee only. The employee would contribute $106 a month. Since the Health and Wellness Center would be the base plan, CCG would contribute $319 a month for each employees plan per month, the difference of cost for their plan, the employee would then be responsible for paying the difference in cost.

Mayor Tomlinson made a referral and asked Director Hodge to get a copy of the more detailed information to Council.

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Mayor Tomlinson asked the Representatives from Northwestern, is it typical or rare for an organization to provide and contribute to health insurance for pre-65 retirees. Mr. Goldstein said that in their marketplace that it is very rare to cover retirees. He said according to the Mercer Survey on Employers Sponsored Health Plans it is the most comprehensive employer benefits survey in the country. They surveyed more that 2,600 employers every year. The most recent data that Northwestern has available states that out of all large employers, which is defined by having more that 500 eligible employees, 4% offer subsidized benefits to their pre-Medicare eligible retirees, and 13% of government employers offer medical benefits to pre-65 retirees.

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Healthcare Options Valued

Options

Savings

Muscogee Manor N/A

Spousal Exclusion $ 1,180,341

EE Pays 25% Across All Plans $ 1,669,722

Pre-65 Retiree 50%; Dependents 40% $ 257,000

HMO Deductible to $1000/ $2000 $ 715,547

POS Deductible to $1000/ $2000 $ 173,116

HWC Deductible to $500/ $1000 $ 140,142

Rx Copays to $20/ $40/ $60 $ 119,499

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Director Hollowell continued her presentation. She said that the difference in the amounts of these savings is based on the number of participants in each plan. About 60% of employees are enrolled in the HMO plan, 20% in the POS/PPO plan and 17% at the Health and Wellness Center.

Director Hodge added that if you increase the deductible, the premium equivalent for that particular plan would be adjusted and therefore the savings that you would have by applying the 25/75% rule would change slightly and the savings would actually be less. Because you are increasing the deductible, your premium cost would decrease. That is why it was said all of these savings are valued independently. Mayor Tomlinson pointed out that if all Healthcare Options were adopted by Council, the net savings would be around $3.6 to $3.8 million. These types of suggestions, if adopted by Council, would restructure the plan such that it would come very near eliminating the chronic deficit.

Councilor Thomas made a referral requesting when Director Hodge presents this information again to Council, that the contribution percentages for the pre-65 retirees be compared to what the current rate is to the suggested change.

Councilor Davis said that over the years of going over the Healthcare cost to the city, the figure that keeps coming to mind is $22/$22.5 million. He said that the number he asked Director Hodge earlier as to what the deficit was being based on, she said $23 million. He asked what the ideal sustainable number that the city can afford to cover the cost for healthcare for the employees. Director Hodge responds by saying that at this time, without reducing departmental budgets, the contribution from the city at this point is around $14.7 million. Any increase in the city’s contribution, would require departments to make adjustments within their budgets to absorb any additional contribution, which could result in loss of employees. Departments at this point have reduced their operating budgets as much as they possibly can without changing the level of service they provide. She says that her estimate that without the loss of employees would be the $14.7 million contribution.

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HMO Deductibles

Deductible

Savings

$600/ $1200 $ 255,552

$1000/ $2000 $ 715,547

$1500/ $3000 $ 1,124,431

$2000/ $4000 $ 1,431,093

$2500/ $5000 $ 1,635,535

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Director Reather Hollowell continued the presentation on the deductibles. She said that the current rate for the HMO plan is $400 for the individual and $800 for family.

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POS/ PPO Deductibles

Deductible

Savings

$1000/ $2000 $ 173,116

$1500/ $3000 $ 346,232

$2000/ $4000 $ 432,790

$2500/ $5000 $ 484,725

$3000/ $6000 $ 571,283

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The current POS/PPO deductible is $500 for the individual and $1000 for family.

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HWC Deductibles

Deductible

Savings

$300/ $600 $ 98,009

$500/ $1000 $ 140,142

$1000/ $2000 $ 294,297

$1500/ $3000 $ 392,397

$2000/ $4000 $ 490,496

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The current deductible for the Health and Wellness Center is $100 for an individual and $200 for family.

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Employee Contributions

Contribution Strategies

Savings

EE Pays 30% of HWC Plan $ 2,687,529

EE Pays 25% of HWC Plan $ 1,669,722

EE Pays 22% of HWC Plan $ 1,059,039

Other options for Contribution Strategies may also be considered

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As Director Hollowell concluded her presentation, Mayor Pro Tem Turner Pugh asked if Northwestern’s administrative fees are paid through CCG or Blue Cross Blue Shield. Director Hollowell responds by saying that Northwestern receives commissions from whomever CCG’s carriers are. Mr. Goldstein of Northwestern explains that the administrative fee that CCG pays to Blue Cross Blue Shield has Northwestern’s commission built in. It is not impacted by whether or not the city’s claims go up or down. It is a flat fee that is built into the administrative fee for all the services that Northwestern provides.

Mayor Pro Tem Turner Pugh asked what the cost of the administrative fee is. Director Hollowell says it is $37.83 per employee each month. She says there are 2,600 employees enrolled with healthcare through CCG. Mayor Pro-Tem asks Mr. Goldstein if Blue Cross Blue Shield is the only carrier that they work with. Mr. Goldstein says that they have 580 clients in the state of Georgia. That is every carrier that provides healthcare in the state of Georgia.

Councilor McDaniel then left the Council Meeting, time being 10:50 a.m.

Director Hodges explained that Northwestern handles the RFP process of CCG choosing their third-party administrator, which is Blue Cross Blue Shield. Northwestern analyzes the needs of the employer and employees. From there they look for the best provider to accommodate those needs for the best price.

Mayor Pro Tem Turner Pugh made a referral for a list of services that Northwestern has provided.

Mayor Tomlinson and City Manager Hugley explained to Council that all of the figures and information that is provided during these updates are provided through Northwestern’s analysis.

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Internal Auditor John Redmond took the podium to give information in regard to a referral made by Council at a past meeting. The referral was related to the comparatives of what other communities, cities and providers are doing to deal with the increase in healthcare costs. The Georgia Government Finance Office’s Association has done a healthcare cost management strategy study for 3 years.

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CCG Healthcare Cost

Over past 10 years, CCG annual healthcare costs have risen from:

$10M to $25M

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This is the total cost of healthcare for the employees, not right the city’s contribution. That is about 10% each year, which is consistent with what the national average has been for the past ten years.

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Why Have Healthcare Costs Risen?

Expensive medical technology

Rising compensation for medical professionals

New and expensive drug therapies

Construction costs of new health care facilities

Community demographics

Mandated benefits

Affordable Care Act/Administrative fees

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The mandated benefits began in the late 1970s and continued on into the early 1980s. The Affordable Care Act has brought on some additional mandated benefits as well as more administrative fees that employers are required to share in.

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Cost Control Strategies

2013 GGFOA Study

32% Negotiated lower cost with current carrier

30% Increased employee share of monthly premium

25% Increased deductibles

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The information that is being shared by Auditor Redmond came from the 2013 GGFOA Study. The 32% of employers have tried or attempted to negotiate lower cost with their current carriers has generally worked well if it is a fully insured plan. In CCG’s case the only thing that can be negotiated is administrative costs and possibly changing the benefit structure.

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Cost Control Strategies

18% Explored market & change carrier/health plan/TPA

18% Increased office visit co-pays

15% Other (including Wellness Strategies)

12% Introduced 4-tier co-pays system drug formulary

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Since it was mentioned earlier, the $50,000 Wellness Grant that Blue Cross Blue Shield has provided as a result of Northwestern negotiations for 3 years. Wellness Dollars are spent on Wellness Programs. They generally have a return of $6 in savings on your healthcare cost on each dollar that is expended.

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Cost Control Strategies

12% Increased Rx drug co-pays or coinsurance

12% Increased employee share of coinsurance

11% Performed a dependant audit

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Wellness Strategies

2013 GGFOA Study

49% Blood pressure screenings

47% Employee assistance programs

43% Flu shots

43% Wellness newsletters

41% Cholesterol screening

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Wellness Strategies

21% On-site exercise facilities

15% Telephonic health coaching

12% E-mail/internet health coaching

12% In-person health coaching

12% Weight management program discount/reimbursement

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Shifting Healthcare Costs

2013 GGFOA Study

Healthcare costs continue to shift from employers to employees- much is due to the economic downturn

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Who Pays for Healthcare

2013 GGFOA Study

59% Employer Contribution

25% Employee Contribution

16% Employee Out-of-Pocket

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Portions of premiums have been talked about and how we want to divide it up. The percentages that are being shown work out to be 70% contribution from the employers and 30% contribution from the employee. Given the suggestions that Director Hodge and Director Hollowell have presented are still rather generous compared to what other cities and counties are doing.

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Plans Offered

2013 GGFOA Study

58% offer 1 plan

26% offer 2 plans

11% offer 3 plans

5% offer 4 or more plans

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2013 Enrollment

CCG Active Employees

HMO PPO/POS HWC TOTAL

January 1,845 380 0 2,225

December 1,327 304 553 2,184

Change (518) (76) 553 (43)

% change -28% -20% -2%

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2013 Enrollment

CCG Pre-65 Retirees

HMO PPO/POS HWC TOTAL

January 166 82 0 248

December 167 83 22 272

Change 1 1 22 24

% change 1% 1% 10%

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The pre-65 retiree group has grown by 10% in the past year.

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2013 Enrollment

Muscogee Manor

HMO PPO/POS HWC TOTAL

January 223 62 0 295

December 247 55 52 354

Change 14 (7) 52 59

% change 6% -11% 20%

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2013 Enrollment

Total

HMO PPO/POS HWC TOTAL

January 2,244 524 0 2,768

December 1,741 462 627 2,810

Change (503) (52) 627 42

% change -22% -16% 2%

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How HWC Model Works

Patient focused health risk assessment and management

Eliminates financial barrier to needed care

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The Health and Wellness Center begins at the patient focus and health risk assessment. From there, the care is managed according to the need of the individual, so it is tailored to their needs. One of the things the center has done by taking away the deductibles and co-pays, it has eliminated the financial barrier to needed care. For families it sometimes comes down to paying for essential costs to provided for a family or going to the doctor or buying prescriptions. The center was running at higher than 100% capacity for the first 6 months of operation.

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How HWC Model Works

Controls rising healthcare cost through direct contracting for primary care; generic medications; and imagining and laboratory services at pricing below the allowable payment of BCBS.

Not an immediate fix to CCG global healthcare costs.

Plan takes several years and significant employee participation for CCG to reap full benefits.

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There was a question asked earlier, why do we use Blue Cross Blue Shield. Northwestern evaluates each carrier based on their capacity for handling various types of claims. They also look at the discounts they have negotiated for their payments.

Our Health and Wellness Center’s management company has gone out and negotiated prices on some individual services that are well below the allowable payment by BCBS. Every time patients go to the Wellness Center they receive quick service. Upon the results the providers get paid at that contracted rate. They do not have the IBR or time lag of paid claims. This is the reason that the Health and Wellness Center plan has the capacity, as more employees enroll, to level out the trend line that has been steadily increasing for the last ten to twenty years. With this plan CCG could at least flatten that upward curve out and reduce the annual increase, which would be beneficial to the city and the employees.

There will not be much savings in the first year because of sick patients. Once these patients have been seen and treated, they will frequent the doctor less often. This is when the savings will be prominent and there will be room for more enrollees. It is not an immediate fix to CCG’s global healthcare cost, but it is one that offers promise down the road.

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HWC Model Funding

The HWC plan is funded with the primary care portion of its members (employee & city contribution)

The HWC plan is not subsidized by any of the other CCG healthcare plans and is intended to be self-supporting.

Emphasis on prevention and wellness mitigates healthcare expense in the future years.

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Mayor Tomlinson asks Auditor Redmond to address the affect of the capitation rate of employees who are enrolled in other plans, such as HMO or PPO/POS, utilizing the Health and Wellness Center. Auditor Redmond says the HMO plan is probably the least compatible with the Health and Wellness Center. Reason being, a large portion of the primary care monies goes straight to their physicians from BCBS each month in the form of a capitation payment Therefore there is not any money that can be paid for these enrollees to go to the HWC.

The PPO plan is a little different. There can be funds allocated for the HWC. The only problem is that the staff in the HWC is based on the employees that are enrolled in that plan. Therefore, if employees that are enrolled in other plans begin utilizing the HWC, it could cause an overload of patients.

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Councilor Davis asked if Auditor Redmond has the total cost of the primary care portion that funds the HWC. Auditor Redmond says he does not have that information at this time but is going to provide it at a later date. City Manager Hugley reminds Council that they will be conducting a one year assessment in May on the cost savings of the HWC.

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Councilor Thomas asked Mr. Goldstein, in his experience, if the insurance tiers that CCG uses, is a typical structure. Mr. Goldstein says that he primarily sees 4 tiered ranges. It is a more equitable distribution against any risk.

Councilor Thomas asked how much CCG pays for stop-loss insurance. Mr. Goldstein responds the city does not have stop-loss insurance. CCG pays an administrative fee and then funds 100% of its claims cost. Mayor Tomlinson says that CCG went out on RFP for stop-loss insurance and it was extremely cost prohibited.

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Councilor Thomas said that she was in a meeting with the Columbus Fire and EMS service, as they are dealing with the accreditation of their paramedics program. One of the topics that came up in the meeting was citizens that frequently call on EMS transportation to go to the hospital. A representative of another region sais that they have started a program where their paramedics go out to these citizens and check their blood pressure and cholesterol, it has significantly cut down on the ambulances having to transport these same citizens one to two times a week to a hospital. She asks if there are programs such as this that could be of benefit to CCG employees on a proactive basis. She would like to see if there are any programs that could be administered through our paramedics to save money. City Manager Hugley says that he will accept this as a referral for Fire and EMS. He does say that it may be a liability by going to someone’s home and checking their blood pressure, if they leave and then something happens to that particular person.

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Councilor Davis asks if having a high deductible health savings plan is an option for CCG. Mr. Goldstein responds, it is an option but it requires a great deal of employee education. The employees would need to understand that there is an overall deductible and all medical services would go through that deductible. Consumer driven healthcare is a great way to save on cost. You have to make sure that the plan is designed well and communicated well amongst the employees.

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Director Pam Hodge explains to Council that CCG is going through a review by Standard and Poor. She says that she has provided Council with a list of the questions and topics that will be discussed during the conference call. As reminder, over the last several years they have been emphasizing the importance of the General Fund Balance and Reserves. One reason being, our Bond Rating Review. The majority of the topics for the review relate around the drawdown of the General Fund Balance and the reasons for that. Director Hodge says she is confident in responding to their questions and she will update Council on the results of that review.
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Mayor Tomlinson asks City Manager Hugley and Director Hollowell to alert the employees of this meeting so that they can be informed of the discussion that Council is having regarding the health insurance.

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City Manager Hugley makes an announcement. There is one more Special Call Council Meeting on March 28^th. Mayor Tomlinson says this 9:00 a.m. meeting will be a presentation on the Mayor’s Recommended Budget.

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Mayor Tomlinson says that Mayor Pro-Tem Turner-Pugh asked for her to make a comment earlier in the meeting. The High Speed Passenger Rail Forum is to be held that night at 5:30 p.m. She wanted to add that transportation projects do not come out of the General Fund. They are separately funded and anything such as this would be a 20/30 project. It is projected to be profitable in the first year for bond financing, Tiger Grants and other grants.

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With there being no further business to come before the Council, Mayor Tomlinson then entertained a motion for adjournment. Mayor Pro-Tem Turner-Pugh so moved. Seconded by Councilor Woodson and carried unanimously by those six members of Council present, with Councilor Allen and Councilor Huff being absent for this meeting and Councilor Henderson and Councilor McDaniel being absent for the vote, with the time of adjournment being 11:52 a.m.

Tiny B. Washington, MMC
Clerk of Council
The Council of Columbus, Georgia