Eau Claire school leaders weigh switching district clinic services to AchieveHealth; formal vote set for next meeting

Eau Claire — District staff reported on a year of changes to employee health benefits Tuesday, saying the Eau Claire Area School District’s move to partial self-insurance and the opening of a new AchieveHealth clinic have reduced some costs but left the district with higher-than-expected utilization this year. Chair Nordine recommended the board delay a final decision and hold a formal vote at its next regular meeting.

District leaders said the shift to self-insurance, combined with the in-district AchieveHealth clinic that opened in February, has allowed earlier access to care for employees while producing mixed short-term financial results. The presentation included figures staff said show “reduced expenses by over a million dollars” and an estimated annual prescription rebate of about $600,000; the district’s net position for the last 12 months was reported as negative $175,005.97.

The report matters because the board is considering ending participation in a regional direct-access clinic shared with other employers (ODAC) and routing more care through AchieveHealth. District staff recommended “option 2,” which would transition to AchieveHealth as the primary direct-access provider, begin ramping capacity on Nov. 1 and end ODAC access Dec. 31 if the board approves at the next meeting.

Dr. Ellworthy, who led the presentation, walked the board through utilization and cost details and answered members’ questions about access to specialty care, mental-health services, and physical therapy. He told the board the district’s conservative estimate of potential cost savings from the self-insurance change was $1.7 million, and that prescription rebates could add roughly $600,000 annually. “We have saved or spent I don't wanna use the word saved, but reduced expenses by over a million dollars,” Dr. Ellworthy said. On net for the mixed year of fully insured followed by self-insured coverage, he reported: “Our net our negative was, $175,005.97.”

The report also described capacity and operational details staff said are central to the recommendation. AchieveHealth’s reported appointment capacity was 318 per month; by contrast ODAC’s highest month was 780 appointments in July 2024. Staff said AchieveHealth would need to increase capacity if ODAC services were discontinued. AchieveHealth offered a transition incentive: a 60% fee reduction for November and December to help ramp operations, and staff described a 60-day notice requirement to discontinue ODAC services.

Board members asked multiple questions about quality and access. Commissioners asked how AchieveHealth handles x-rays and physical therapy (both described as off-site or virtual today, with plans for in-person PT to be added), whether telehealth PT is clinically appropriate for all cases, and how the district will handle employees with established relationships at Marshfield, Mayo or Sanford systems when those systems change services. One board member summarized employee reports that Marshfield had recently discontinued certain pediatric specialty services, creating care gaps for some families.

Dr. Ellworthy acknowledged higher utilization this year — including an increase in high-cost cases such as cancer and maternity-related complications — and said those clinical needs drove the year’s higher spend. He described ongoing coordination with the district’s third-party administrator (formerly Security Health Plan, now Insight) and with AchieveHealth on clinical navigation and referrals to higher-level services. He also said the district is pursuing occupational-health services through AchieveHealth (for fit-for-work and hearing tests) at a lower cost than current vendors.

Chair Nordine recommended the board schedule a vote at its next meeting rather than act Tuesday so staff could supply additional requested details. The chair characterized that timing as generally consistent with board practice: “my recommendation will be that we hold a vote at the next meeting so that we have time to answer any additional questions,” Nordine said. Board members agreed to place the item on the next agenda as a standalone item for action.

The board did not take a final vote on ending ODAC access or on converting fully to AchieveHealth Tuesday; staff will provide additional follow-up data and the vote will be taken at the next meeting. In the meantime, staff signaled how a delay increases the district’s outlay: presenters said each month of delay costs roughly $16,000, and the annualized extra cost if the board waits would approach $200,000.

Board members also discussed communication and implementation steps that would accompany any transition, including an employee wellness fair planned for late September where AchieveHealth and other providers will meet staff, and ongoing surveys (a short one in August and an annual survey in December) to measure employee experience.

The board recorded no formal motion to implement the AchieveHealth-only option Tuesday; instead it directed staff to provide additional information and scheduled the decision for the next meeting.