Cole County commissioners spent substantial time Dec. 10 reviewing the health department's budget and services, including whether to retain a nurse practitioner (NP) position included in the draft budget at about $107,810.

Health-department staff presented anonymized insurance-explanation-of-benefit examples intended to show how the county clinic can reduce costs. One example compared an ER bill of $1,075.99 to an estimated $70 clinic visit for the same issue. Staff argued that if more employees used the county NP clinic, the county and employees could save on insurer payments and out-of-pocket costs.

Commissioners and staff discussed outreach and incentives to increase clinic use: signage, business outreach, and supervisor discretion so employees can leave work for brief appointments and return quickly. Commissioners also weighed whether the county should absorb some of the cost difference for certain plan types or reimbursements.

After discussion about cost, staffing and the difficulty of proving long-term program value in year one, the commission directed staff to lower the employee copay for the clinic to $20, to keep better records of visits and to pursue additional marketing and internal outreach. Commissioners asked staff to track results so program performance can be evaluated at future budget reviews.

Next steps: staff will implement the copay change and enhanced recordkeeping and report back during the budget cycle.