Over protest from many employees, Monroe County to change health clinic vendor by Aug. 1

Monroe County is starting a transition to a different vendor for its employee health clinic, which was established in 2010.

At their regular meeting on Wednesday, Monroe County commissioners voted unanimously to approve a $59,750 business associates agreement with ProActiveMD to start the transition work.

The move was opposed by many county employees, who will no longer be able to get healthcare at that clinic from the current clinic physician, Clifford Mitcheff.

Speaking from the public mic at Wednesday’s meeting, county auditor Cathy Smith pled with commissioners not to change vendors, which would mean Mitcheff’s departure from the clinic: “I’m begging you to allow it to stay as it is—an amazing clinic with access to a wonderful general practitioner, and our own internal medicine doctor.”

Smith added, “Losing Dr. Mitcheff will sever the long-standing institutional knowledge of our medical needs, and of us, as people. And that alone is irreplaceable, and will affect our long-term medical care.”

The current healthcare vendor is Everside Health, which is merging with Marathon Health. According to county personnel administrator Elizabeth Sensenstein, with no changes to the current physician-based healthcare model, Everside’s merger would have meant a $1.5-million cost increase over five years, compared to current costs.

Opposing the change to a new vendor from the public mic were three other elected officials: county assessor Judy Sharp; county councilor Peter Iversen; and county surveyor Trohn Enright-Randolph. Speaking along the same lines were: sheriff’s office administrative coordinator Liane Johnson; Democratic Party nominee for District 3 county commissioner Jody Madeira; and county planner Anne Crecelius.

A letter to county commissioners signed by several employees, concludes with an appeal: “We respectfully request that the Commissioners reconsider these anticipated changes and take employee preferences into account when making decisions that directly impact the health and safety of employees and their families.” The letter reportedly received several pages worth of employee signatures.

Sensenstein had briefed county commissioners at their May 15 meeting on the selection of ProActiveMD as the clinic’s healthcare vendor.

On Wednesday, Sensenstein presented a lot more detail about the process the county went through to select a vendor, after learning of the increased costs associated with Everside’s upcoming merger.

There were five vendors who submitted responses: Franciscan Health; Ascension Health; Marathon Health (Everside Health); ProActiveMD; and QuadMed. The three finalists were Marathon, ProActiveMD and QuadMed.

Here’s the timeline Sensenstein ticked through:

Timeline: Monroe County Employee Health Care Clinic Vendor Selection

• Feb. 2, 2024: Clinic bid opportunity email sent to vendors by Apex Benefits
• Feb. 13, 2024: Vendors submitted their intent to participate in the RFP
• Feb. 20, 2024: Interested vendors attended pre-submittal meeting and took a tour of the clinic
• Feb. 22, 2024: Email notifying employees and survey
• Feb. 23, 2024: Deadline for RFP questions from vendors
• March 13, 2024: Deadline for RFP submissions
• March 14, 2024: Vendor presentations publicly noticed
• March 25, 2024: Vendor presentations
• April 15, 2024: Finalist interviews
• May 15, 2024: Final recommendation to commissioners

The Feb. 22, 2024 email with a link to the survey was a point of contention for some employees, because they said it did not convey the significance of the survey. County assessor Judy Sharp told commissioners: “I do read my emails, and I didn’t notice that email where we were sent a survey [about the health care clinic].”

Sharp added, “But I can also tell you that a lot of our county employees do not have access to email—the highway department, they’re in the truck, we don’t have computers on their trucks where they can sit and answer their email.”

The idea that employees had little forewarning of the possibility that they would be losing a long-time healthcare provider was a common theme from the public mic.

During deliberations, board of commissioners president Julie Thomas, responded to concerns about a lack of communication: “Things have been on the calendar. Things have been on our agenda.”

Thomas continued, “We’ll have a conversation about what else we could have potentially done—outside of hiring carrier pigeons to land on everyone’s desk.”

Thomas added, “You don’t know what’s important to people, but clearly we knew this was important all along—we knew this was important. It has been something we have talked about a lot.”

The 5-year cost breakdown provided by Sensenstein at Wednesday’s meeting contrasted Everside Health’s current physician-led model ($3,034,582.75) with the post-merger cost for a physician-led model for Marathon Health ($4,523,718.27).

That’s the $1.5 million difference that a May 22 email message sent by Sensenstein to Monroe County employees characterized as “unsustainable increases in the cost of our employee clinic.”

According to Sensenstein, in the end, all of the vendors recommended a nurse practitioner model for the health clinic. The finalists were asked to submit proposals for a health clinic led by a nurse practitioner. Here’s how those proposals stacked up.

• Quad Med nurse practitioner model: $3,737,307
• ProActiveMD nurse practitioner model: $3,267,994
• Marathon Health (Everside) nurse practitioner model: $3,247,214.

Even though Marathon Health’s proposal was slightly lower than ProActiveMD’s, Sensenstein said that there was more to the choice than just the financial concerns—including ongoing issues with Marathon Health (Everside) as a vendor. Sensenstein cited the following problems that Monroe County government had seen with Everside as a vendor over the years:

• Multiple changes in Administration
• Real time appointment issues
• Incomplete reporting
• Out of date technology
• Lack of wellness programming and patient engagement

Sensenstein and commissioners made a point to distinguish between Everside as a vendor and the actual providers of healthcare at the clinic—Clifford Mitcheff, the physician, and Wendy Veeder, the physician’s assistant, whom they praised for providing excellent healthcare. The issue was with Everside as the vendor, not the people providing the health care.

Administrator for the commissioners, Angie Purdie, talked about the efforts that Sensenstein and Seth Elgar, employee services assistant in human resources, had made to keep Everside as the vendor. “They bent over backwards,” trying to keep Everside, Purdie said. That’s because they know how much the clinic staff is appreciated by the county’s employees.

On Wednesday, Jody Madeira, who prevailed in the Democratic Party’s primary over incumbent commissioner Penny Githens, said from the public mic that she was speaking in her role as the party’s nominee, and as an expert in law and medicine. Madeira is a professor of law at Indiana University.

Speaking in support of a physician-led clinic, Madeira said, “I would love to use this clinic as it currently stands.” She called the nurse practitioner model an “unhealthy direction.” Madeira said the county should retain “those providers that county employees and their families have come to trust.”

Madeira said that nurse practitioners are particularly useful when there just aren’t enough doctors to serve a population, particularly in rural areas. But Madeira said, “That’s just not the situation here.”

Sensentstein presented a slide indicating that the clinic, as administered by ProActiveMD, would be staffed for the same number of hours as it currently is, but without a physician. According to Sensenstein 37 percent of patient visits to the clinicare currently with the physician, with the remaining visits covered by a physician’s assistant or nurse practitioner.

The target date for the transition to ProActiveMD is Aug. 1. At Wednesday’s meeting, county attorney Jeff Cockerill gave an explanation for the significance of the date.

Aug. 1 is the anniversary date for Everside’s contract. The vendor had to be given notice of cancellation at least six months in advance, Cockerill said. A new vendor has to be in place by Aug. 1, Cockerill said.