Hamilton County, Indiana Creates Better Employee Health and Economic Outcomes

County Leadership Leverages Association with Riverview Health and Forward-thinking Compensation and Benefits Practices

Hamilton County, Indiana enjoys the status as a popular and prosperous County located north of Indianapolis. The Hamilton County suburbs of Carmel, Fishers, Noblesville and Westfield are routinely featured in “Best Places to Live” lists of major publications like Money magazine or Town & Country. The County employs more than 1,300 people for its government center and public services such as judicial services and public safety.

County leadership long recognized the need to equip employees with health benefits that help them live healthy and productive lives while contributing to the efficient operation of the County’s public assets. If this recognition was always felt, it became more deeply so in the early 90s as a number of new factors, including more intense competition for employees, came to bear upon County government and employee population.

The Tipping Point(s)

In the early 90s, Hamilton County, Indiana utilized a conventional approach to fully insuring its employee population. Like many insurance programs in the US at the time, the County’s annual renewals came with significant premium hikes for the County budget and raised deductibles for covered employees enrolled in the benefit programs. As Hamilton County Human Resources Director, Sheena Randall put it, “Each year our insurance renewal projections brought increased costs for both the County and our employees.”

Randall, the Hamilton County Board of Commissioners and others searched for a better way. Free-standing, dedicated employee health clinics became more common around this time, especially for large corporations and organizations. They were just beginning to come into the realm of possibility for mid-sized organizations like Hamilton County. These clinics had an at-times spotty reputation in the general population for cold, impersonal service and lacking the professional feel expected of a primary healthcare facility. Hamilton County decided to begin a partnership with Riverview Health, located just blocks away from the Courthouse in the County seat of Noblesville to form an amazing Health Center.

Commissioner Steve Dillinger and HR Director Sheena Randall believed that the creation of a Health Center associated with Riverview Health could work for Hamilton County to provide excellent services and a method to achieve cost containment of the programs. Working with Pat Fox, former Riverview Health president/CEO, the Hamilton County team took an analytical approach to determining if that gut feeling was right. They toured neighboring facilities, gathered information, and conducted interviews with staff, doctors and other stakeholders. Riverview Health had a strong reputation in the community and a respected network of physicians from which to recruit to a new center. With a center or clinic, “we could move to a more successful self-insured platform, engage with our employees on a more meaningful level and manage costs,” said Randall. To illustrate her point, Randall noted that employees were spending an average of just 7.5 minutes with their primary care doctors in the conventional system. “We felt there were a lot of things that could be missed in that scenario,” said Randall.

Building a Competitive Compensation Plan with Healthcare

Scott McKinney, a captain for the Hamilton County Sheriff’s Department, has used the healthcare benefits provided by his employer for the 30 years of his employment, but sparingly. He noted, “I was one of the guys that rarely went to the doctor…I would end up at the ER at times.” With the ease and convenience of the Health Center, it has streamlined the process. “My whole family uses it for our primary care. They know us by name. I trust them, and I don’t think my health would be what it is now if not for the Hamilton County Health Center.”

That kind of engagement was one of the chief objectives for Hamilton County and Riverview Health leadership. Nurse Practitioner Hilary Herendeen saw the opportunity at the Health Center as “primary care the way it should be done” when she interviewed to be part of the team. Riverview Health had a pharmacy and, over time, added elements that rounded out of the employee offering including a refined disability program, mental health support and more preventative health and wellness programs. As Herendeen noted, “the approach here is very holistic, we look at the whole patient. It’s a model I believe in from an ideological standpoint.”

“We made the decision to make our medical benefits program something really special and not even call it a benefit – it’s part of our employment package,” said Dillinger. “It’s part of compensation…total rewards before there was Total Rewards.” Hamilton County saw a positive impact on multiple fronts including cost containment, savings for employees, improved health outcomes and greater employee retention in a highly competitive job market. “One thing First Person has really helped us with is navigating the pharmacy costs on ultra-expensive or specialty meds,” said Dillinger.

Challenges, Anticipated and Unanticipated

The Hamilton County team knew self-funding and setting up their own health center would not come without challenges. Gaining the confidence of employees would be a huge factor in finding success. As Commissioner Dillinger said, “Probably the key to the health center is the quality of the facility and the personalities within it – the doctors, NPs, nurses and staff are all top-notch. That’s intentional – finding the fit. When our employees talk about Dr. Guzman (now retired) or Dr. Sharpe, it’s with admiration and enthusiasm. One focus for us was to allow our doctors to be doctors again. A 7.5-minute average visit would not cut it.”

Hillary Herendeen noted, “First and foremost this model removes the financial barrier or burden for people. People would delay care because they were worried about a co-pay or high deductible. This changes the mindset.” In this way, the health center becomes a place where there is a continuity of care, and the staff gets to know an employee. It is a safe space for Hamilton County employees. Employees agree. 2020 usage of the health center hovered at or near 75%.

The year of 2020 brought a worldwide pandemic which put a spotlight on the importance of overall health and well-being. For Hamilton County, it accelerated the attention given in recent years to mental health as part of a holistic and comprehensive care equation. Having extra time with patients allows for those conversations, referrals or prescriptions to take place more naturally and in a context that both doctors and patients feel comfortable with. “We believe that our employees truly feel that we are looking out for them,” said Dillinger. For First Person Advisors, it just underscored the need for a continued drive to find the best strategies for employee health and well-being and organizational performance. We’re inspired by the efforts of Hamilton County and we thank their leadership, health center staff and employees for working with us and for reflecting on their experiences here.

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Image source: Hamilton County

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