Alliant study: Dawson County employee primary-care clinic could reduce claims costs over time

Alliant Insurance Services senior vice president Tammy Starkey presented a feasibility study for an employee primary care clinic to the Dawson County Board of Commissioners on Nov. 6, saying the model could improve employee access to primary care and reduce the county's health-plan claims costs over time.

"One of the proven strategies that we have implemented over the last decade, specifically with cities and counties, is advanced primary care or on-site near site primary care solutions," Starkey said during the presentation. She told commissioners the firm evaluated Dawson County's claims data, demographics, shift schedules and availability of local primary-care capacity to estimate potential savings and utilization.

Starkey described three models the consulting team analyzed: a full-time clinic (40 hours per week), a part-time clinic (about 20 hours per week) and a shared clinic with another employer. The firm's summary projected that a full-time model could yield an ongoing return near parity (about 1.1:1 ROI by year five in the presentation), a part-time model could produce a larger near-term ROI (presented as about 1.5:1), and a shared model with other local employers could produce greater savings (presented as roughly a 2.3:1 ROI). Starkey said those projections account for avoided higher-cost claims (emergency and some outpatient procedures), lab and pharmacy navigation, and productivity gains from reduced absenteeism.

Starkey said the business case presented to the board did not include facility space costs. "It doesn't include the facility space," she told commissioners when asked. The cost estimates the consultant provided include management, staffing, and supplies but not rent or construction for a clinic site; the team said it can assist with procurement and vendor evaluation if the county decides to pursue implementation.

On staffing, the business case modeled a clinical team without a full-time on-site MD: a nurse practitioner, a physician assistant, a lab technician and an office manager. Starkey cautioned that, under Georgia rules, on-site dispensing of drugs requires additional provider arrangements; mail-order options were described as an alternative to on-site dispensing.

The study assumed offering services to employees and spouses (but not children) for the ROI calculations. When asked whether children were included, Starkey replied that the ROI accounted for employee and spouse claims and specifically excluded children.

Commissioners asked for more comparative data from jurisdictions that operate clinics and discussed the typical time horizon for results. Starkey and county staff said engagement and measurable impact generally require a multiyear commitment; the consultant noted some programs see breakeven earlier (staff presentation said breakeven commonly appears by year two in similar analyses) but that sustained trend reductions are realized over several years.

The presentation materials included case examples and surveys the consultant has compiled for other government clients; commissioners requested follow-up benchmarking that shows the budgets and sizes of comparable counties and clarification on shared-service options.

No formal decision to pursue a clinic was recorded during the work session. Staff said Alliant would assist with next steps if the board directs procurement and implementation work.