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Commissioners weigh shifting county employee clinic from lump‑sum to per‑visit model to save costs
Summary
County commissioners discussed moving from a $500,000 annual lump‑sum agreement with IU Health Clinic to an a‑la‑carte per‑visit payment and eliminating onsite medication management to capture pharmacy rebates; staff estimate a potential ~$300,000 annual savings based on 2024 usage but requested a formal contract for the alternative model.
Delaware County commissioners on July 7 discussed changes to the county's master agreement with the IU Health clinic that provides no‑cost primary care to county employees and their covered dependents.
The discussion matters because the county currently pays roughly a half‑million dollars per year for the clinic contract while reported utilization is low; staff presented a per‑visit alternative that could reduce county costs if the commissioners approve a contract change.
Commissioner Brand summarized 2024 use data from IU Clinic: "If we look at 2024 data, 81% of the visits were employees. That means 19% were dependents or, spouses. And of that 399 total visits, it brings the cost per visit ... is $627 per employee per visit." He said the a‑la‑carte option proposed by IU would charge $56.65 per visit for actual utilization rather than a lump‑sum guarantee.
County staff said the clinic currently also provides medication management and fills prescriptions onsite; the county does not participate in pharmacy rebates for prescriptions dispensed through the clinic. Staff estimated eliminating the clinic medication‑management and instead letting prescriptions be filled through the county's pharmacy benefit manager would allow the county to participate in rebates and could save an estimated $102,364 based on 2024 numbers. Combined with the per‑visit change, staff estimated roughly $300,000 in annual savings if 2024 utilization repeats.
Pam (staff member) said she understood employees value the clinic and named clinical staff, but added operational and budget concerns: "I need to take the work you've done on that this morning ... I know a lot of people love the clinic. They love doctor Hogan, but it is costing us a lot of money."
Commissioners asked staff to request a formal contract addendum from IU Clinic that would include the a‑la‑carte pricing, detailed utilization terms, expanded urgent‑care and virtual‑care access, sleep services and other enhanced access items, and to clarify which services would be excluded from the county payment (including pharmacy management). Staff also said they will evaluate another clinic option (described in the meeting as a "Marathon" clinic) and asked IU Clinic to produce a draft contract with the per‑visit terms for review at the next meeting.
No final contract change was approved at the July 7 meeting; commissioners directed staff to obtain a written proposal and bring that contract language back for formal consideration.
