Benefits committee weighs replacing full-time health coach with additional clinic provider, pilots Omada and FoodSmart programs

On June 2, 2021, the City of Clearwater Benefits Committee discussed a proposal to eliminate the city’s full-time health coach position (paid through Cigna’s administrative fees) and use that funding to convert a per‑diem clinic provider to salaried status to increase access to clinical appointments.

The chair handed the floor to Sean Fleming, a consultant with the Garing Group, who opened the item and described the staff recommendation. "On the coaching program, as you all know, we have the clinic," Fleming said, and explained the current arrangement: the wellness coordinator and health coach are funded through the administrative portion of the city’s Cigna contract while clinical staff costs are billed separately to the city. Fleming said the health coach was added in February 2019 and is well liked but is being underutilized compared with original expectations.

Why it matters: Committee members said improving access to primary and urgent care at the on‑site clinic is the top priority. Committee discussion framed the proposed change as a reallocation rather than a personnel discipline: use part of the administrative funding that now pays a full‑time health coach to fund more consistent clinical hours from a provider currently paid per diem, identified in the discussion as Yolanda (about 30 hours per week, with flexibility to cover providers’ vacations). Fleming and staff said the move would likely be roughly cost neutral or a modest savings but would increase clinic access for employees.

Details of the proposal and alternatives - History and utilization: Fleming said the health coach role began in February 2019. Early on the coach helped many employees; usage fell over time (Fleming said the coach was seeing "maybe 3 people a day" in recent months versus higher volumes historically). Committee members described the coach as "extremely well liked" but acknowledged low overall utilization. - The alternative: convert Yolanda (a per‑diem nurse practitioner or physician assistant) to a salaried, scheduled clinic provider (about 30 hours/week on the schedule, with potential for more during vacations) to provide more consistent clinical access. Staff emphasized the provider’s hourly rate is higher than the coach’s, so cost savings would be modest. - Continuity and retention: staff said converting the per‑diem provider to salaried status would reduce the risk that the provider takes another job and clinic coverage drops.

Digital and third‑party wellness programs discussed - FoodSmart: Committee members described an existing FoodSmart program that includes a virtual dietitian and an app offering recipes, grocery plans and telehealth consultations. Staff said FoodSmart is available to employees at no cost through the plan and that FoodSmart includes a dietitian option at no charge. - Omada: Fleming described Omada as a digital program the committee is considering. He said Omada began as a diabetes‑prevention program for people meeting certain risk criteria (for example, BMI over 25 or other metabolic risk factors) and that it provides a cellular‑connected digital scale and a dedicated Omada coach. Fleming said the program is free to participating employees and that Cigna will pay Omada only when a participant achieves weight‑loss outcomes (the consultant described the vendor pricing model roughly as a one‑time preventative claim and suggested an illustrative figure of about $13 per percentage point of weight loss in year one). Fleming said the initial rollout under consideration would target prediabetic employees; a later phase may include programs for people already diagnosed with type 2 diabetes with connected glucometers and blood‑pressure monitoring. - Virtual physical therapy and other pilots: Fleming noted Cigna had acquired a company (referred to in the meeting as Fisera) that offers virtual physical therapy and said that option might be considered as another digital care pathway to increase access and convenience for shift workers.

Employee communications and confidentiality Staff and committee members said they are actively promoting the FoodSmart and clinic services through wellness emails and scheduled "Wellness Wednesday" sessions (one was scheduled the same day at 11 a.m.). Fleming asked committee members to keep the staffing discussion confidential while staff completes analysis and outreach to the clinic and Cigna.

What was not decided There was no formal vote at the June meeting. Staff said they will return to the July meeting with additional information on Omada (and any integration with incentives) and with further analysis of cost and clinic scheduling implications. Staff confirmed that, if the committee moves forward, the change would be presented as an administrative reallocation of Cigna‑funded services rather than a disciplinary action against any individual.

Ending Staff will provide additional detail about Omada and reserves of clinic capacity at the committee’s July meeting, and will continue to promote FoodSmart and existing clinic services in the interim. The committee asked staff to bring concrete cost comparisons and an implementation timeline in July so members can consider formal direction.