Lessons on Employee Health Care from Ashwaubenon School District
There’s plenty on the plate of any school district employee come August. Things just ramp up this time of year.
If you need confirmation, just try to find Jody Smits’ desk. The Ashwaubenon School District HR Coordinator’s workspace was a Jackson Pollock.
“But I know where everything is,” she said.
Following a school year without precedent, Ashwaubenon — like every other school district — again faces pandemic-inspired uncertainties. From virtual learning options to building projects to substitute teachers to covering expenditures until tax revenue and state aid is received. COVID simply makes everything more complicated.
Assistant Superintendent Keith Lucius says the district has made plans to try to get back to normal. But they are ready for the irregular as well.
“We look at every decision from every possible angle,” Lucius said.
It’s an approach the Ashwaubenon School District has used for a long time now, one that has served the district well.
That’s certainly true for employee health care.
Long before it was fashionable, Ashwaubenon became one of the first districts in the state to go self-funded for its health insurance. Self-funded employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier for a fully insured plan.
“I came here in 1999 from a fully funded district and struggled to find anyone else who was self-funded,” said Lucius. “I found four other districts in the state then that were self-funded, and I got to know and learn from my opposite numbers there.”
Now, it’s Lucius who fields calls from districts looking for advice about self-funding.
“Just this morning someone called me with a bunch of questions wanting to know how to get things going,” said Lucius.
Lucius, who has presented multiple times at the state education conferences on the topic, says many districts start by self-funding their dental insurance, finding success there and then moving on to health insurance, which he admits is a completely different animal.
The key, insists Lucius, is to ask the questions and get to the bottom of things: Why are we doing this? What does it do? How are the steps relat- ed to one another? What am I trying to accomplish? What is the end goal? By understanding the why of each step, districts can react and adjust in response to changes (rules, stop loss, TPA) that can occur.
“The first year is tough, because you’re setting up procedures,” said Lucius. “But once you figure it out, I think it works as easy or easier than being fully funded.”
The landscape has changed. Upwards of 40% of school districts state- wide are now self-funded; half of the districts in the Green Bay area have gone that route.
After two decades, Lucius clearly knows more than the average bear when it comes to self-funding. He freely shares his knowledge and continues to learn from the experiences of others from districts facing similar challenges. Lucius is part of a group of business managers of Wisconsin school districts who recently joined forces to exchange ideas and best practices.
At the first meeting, Lucius broached the subject of NOVO Health.
“We talked about direct contracting and packaging health care services, doing those things that can take it to the next level,” said Lucius.
Stacks of paper pushed to the side; Smits becomes visible, ready to talk about how Ashwaubenon connected with NOVO Health.
“As we’re self-funded, our brokers meet monthly with our insurance committee to let us know how the plan is doing, and they bring to the table different vendors, companies, and ideas that we might be receptive to,” said Smits. “That’s how we found out about NOVO Health.”
It’s apt that Smits is a strong proponent of doing your homework.
“We’re wise consumers of health care at Ashwaubenon School District,” said Smits. “We work hard to keep ourselves educated.”
Ashwaubenon School District personnel and their families have access to NOVO Health’s Bundled Payment Program for Health Care Services. The Appleton-based health care organization’s flagship program bundles 100-plus procedures, with the price of services — physician, surgery center, anesthesia, etc. — known in advance and provided to the consumer in a single, understandable bill.
The savings generated by the program at Ashwaubenon have been substantial. In the two years prior to COVID, 13 episodes of care through NOVO Health resulted in savings of $85,000. In the pandemic year of 2020 and thus far in 2021, 16 bundled procedures saved Ashwaubenon more than $170,000.
That’s a quarter of a million dollars that can be directed back into school programming, facility needs or employee cost of living increases.
“We’re a self-funded school district, so we are very cognizant of our dol- lars,” said Smits.
NOVO Health is a choice for employees, one part of the health care benefit package. As such, employees are free to select providers they are most comfortable with; it’s Smits’ job to make sure they understand what is available to them.
Smits sends out timely information (generally quarterly), via internal newsletter, posting on the district’s website, or through marketing materials created specifically for Ashwaubenon by NOVO Health (for example, fliers with testimonials from colleagues who have taken advantage of the program).
“I just try to get things in everyone’s hands, to keep reminding folks that they have options,” said Smits.
A bouquet of flowers in hand for her daughter’s prom day, Jennifer Bower headed back to her car.
Suddenly, the Ashwaubenon administrative assistant to the superintendent and school board couldn’t walk.
“Yep, tore my meniscus walking across a parking lot,” said Bower.
There was the immediate connection to her surgeon (“He had my best interest in mind and was always educating me”), his team and the people at the facility; there was easy scheduling, no delays, the cash bonus; and there was the hoped-for outcome: following her meniscus surgery, Bower walked out with the crutches she would never use again.
No pain, no need for medication, and she’s been great ever since.
“My experience was so good,” said Bower. “I literally had to do nothing.”
She did something, however.
When her friend one desk over was having trouble with her wrists, Bower told her colleague she had a suggestion.
There was numbness, and there was pain — the kind that would wake Nancy Pierce up at night. Month after month it was this way, until she had had enough.
After Bower shared her experience, Pierce decided to see if the NOVO Health process could be replicated, right down to the same surgeon. One call, then a timely appointment with the same surgeon as her work neighbor, and Pierce was on her way. Diagnosed with carpal tunnel, the surgery was performed successfully. Numbness gone; pain gone.
Well, not entirely.
“I had carpal tunnel in both wrists,” said Pierce, “so we did the one that was worse first.”
Two months later, Pierce returned for her second surgery.
At this point in the interview, Pierce holds up both wrists. There was a small scar on one; the other was unblemished.
“My doctor apologized because he couldn’t find any line on this hand to disguise the scar, but they were both done artistically,” said Pierce.
The administrative assistant to the curriculum director knows about artistic sensibilities: she’s a photographer. But it had not been easy to pursue her passion with wrist issues. Oh, and then there was the bout with trigger thumb (NOVO Health surgery number three).
But she’s back to where she wants to be, summing it up this way:
“My mom had rheumatoid arthritis and joints replaced. I took her to all of those surgeries, and my experience compared to hers was night and day,” said Pierce. “Hers weren’t bad. But mine, this was the red carpet.”
Lucius is excited about the monthly meeting of business managers for self-funded districts, with 20+ districts represented at the initial meeting this past June and growing.
“I think out of this group is where you’re going to see that innovation spread,” said Lucius. “There’s so much to learn from each other in the self-funded space.”
One such lesson sprang from the frustration any employee feels when faced with a deluge of bills following a procedure.
“NOVO Health made sense to me right away, as they group everything into one bill, which translates into one less frustration, one less stressor for a staff member,” he said.
From there, Lucius said, conversations with NOVO Health provided an understanding of the benefits of bundling beyond just the billing side, how it’s more complete and coordinated care and that with the limited warranty offered by the group, if there’s a complication it’s not going to cost the person or the plan any more money.
And when cost comparisons were shared, Lucius said it was difficult to ignore the savings that NOVO Health can generate per procedure.
“If we’re going to have two knee surgeries a year and we save $10,000 per surgery, there’s $20,000. And now there’s all these other surgeries that we can bundle. It just made sense,” said Lucius.
Yet Lucius also said it initially sounded too good to be true.
Therefore, there were extensive conversations about the program (How does it work? How do you generate the savings?) in the district’s insurance committee, which included the district’s independent insurance consultant.
“I was skeptical at first, but the model works,” said Lucius. “We’ve seen the savings and everybody I’ve talked to who has gone through the program has come back with such positive stories of how well they were treated. And that, to me, is the biggest benefit. The money side is
a big benefit, too, but if I know people are going to be happy going here, that’s where I want them to go.”
Like the ancient city of Troy, Smits’ desk remains buried, but the HR Coordinator is in full excavation mode. In several piles lie employee health care information, which Smits will disseminate at just the right time, as she always does.
Her efforts as the internal program advocate are key to its success.
“NOVO Health is an option. We don’t tell anyone they have to go there, but I love it that we’re able to award an incentive to folks who choose cost-effective health care that’s high quality and provides a great experience,” said Smits. “And when they realize that they are benefiting the entire district and their colleagues, it’s the “a-ha’ moment.”