BY MICHELLE KEY
PUBLISHER
OPELIKA — A proposal to change the company operating Opelika’s employee health clinic could save the city more than $300,000 a year without changing the clinic’s location, medical staff or basic services, according to Opelika city officials.
But during an extended Sept. 15 work session, several Opelika City Council members questioned how the city arrived at the proposed agreement with Symbol Health and whether the city had given local healthcare providers sufficient opportunity to compete for the work.
No decision was made during the work session.
Human Resources Director Brian Weiss told the council the proposal is not for a new clinic or an expansion of the existing clinic. Instead, he described it as essentially changing the company name on the door of the city’s existing employee clinic at 105 N. 10th St.
“We’re, for lack of better words, looking to just change the logo on the door,” Weiss said. “It’s the same exact business model. There’s no change in operations.”
The clinic opened Feb. 27, 2013, initially under CareHere. Premise Health later acquired CareHere and has operated the clinic for Opelika since Jan. 1, 2023, Weiss said.
Weiss said Premise has “just not been a good fit for the city,” describing the company as a large global organization and saying the relationship has presented operational difficulties behind the scenes.
He added the proposed change to Symbol Health would produce immediate savings of between $314,000 and $354,000 a year, depending on the staffing model selected.
“That’s real money,” Weiss said.
Clinic serves employees, dependents and retirees
The city clinic is available to eligible city employees, their dependents and eligible retirees.
When Ward 1 Council Member and Council President George Allen asked what percentage of employees use the clinic, Weiss said about 540 people, some of whom are dependents, currently use it. The city has 893 eligible employees.
The clinic provides primary and preventive care, prescription services and laboratory services.
Ward 5 Council Member Todd Rauch asked whether the city receives employee satisfaction information from clinic users.
Weiss said patients receive a satisfaction survey following appointments, and he reviews monthly reports with Premise representatives.
“From the current staff, it’s excellent care,” Weiss said, adding that satisfaction results are above the 98th percentile.
Weiss said under the proposed Symbol agreement, the physicians, nurse practitioner and nurses working at the clinic would remain.
“The staff will remain the same,” he said. “There’s literally no change in the business model other than the company that’s running it and changing the logo on the door.”
Ward 4 Council Member Chuck Beams said he strongly supports continuing the employee clinic.
“I think the employee clinic is a wonderful idea, and I am fully committed to continuing it for the city’s employees,” Beams said.
Beams said an employer clinic can help control the cost of a self-funded health plan, and he believes the clinic should continue.
He said his main concern was how the city selected the operator.
“I think my thing is we should try to keep care local,” Beams said. “We should try to keep business local at any chance we get.”
Beams said the city could issue a request for proposals spelling out exactly what it expects from a clinic operator, allowing interested providers to determine whether they could meet those requirements.
Where the savings come from
Much of the discussion centered on how Symbol could provide essentially the same clinic operation for hundreds of thousands of dollars less.
Weiss provided the council with a category-by-category comparison of projected 2027 costs.
Premise Health’s projected total was $914,392.
Under the comparable Symbol Health model, Weiss gave a projected total of approximately $603,336 and repeatedly described $314,000 in projected savings.
A second Symbol staffing option would reduce the estimated annual cost to $560,373, which Weiss said would produce $354,000 in savings.
The largest difference is in medical staffing.
Weiss said Premise’s projected personnel cost was $630,948, compared with $360,844 under Symbol’s comparable model.
Medication costs were projected at $90,345 under Premise and $71,964 under Symbol.
Premise’s combined laboratory and medical supply costs came in at $69,547, while Symbol listed $32,300 for laboratory expenses and $27,000 for supplies.
Premise also listed $5,112 separately for insurance, while Weiss said Symbol included that expense in its administrative costs.
Both companies’ management fees include a $23 monthly charge per employee. Weiss said Premise’s projected management cost was $118,440, while Symbol’s was $111,228 using current participation numbers.
Ward 3 Council Member Leigh Whatley questioned how personnel costs could decrease by roughly $270,000 while the clinic retained the same medical staff.
City Administrator Joey Motley said part of the city’s concern with Premise involves the way physician hours have been managed.
“Some of the problems we’ve been having with Premise is on certain days, they’ll have two doctors there all day long, making the rate higher,” Motley said.
He said the city has raised concerns about the practice with Premise.
“It’s all in how they manage the clinic to make it the most efficient way,” Motley said.
Weiss said a physician is generally scheduled for Tuesday, another for Thursday and one for a half-day Friday, and additional physician hours have driven up costs under the current arrangement.
Because those expenses are passed through to the city, Opelika ultimately pays the additional physician costs, he said.
Weiss said Symbol would retain the same doctors, nurse practitioner and nurses while more closely adhering to the planned staffing schedule.
He said the nurse practitioner works Monday through Wednesday, while a full-time nurse works Monday through Friday and a part-time nurse works Monday through Wednesday. The city selected those days based on a three-year review showing they have the highest clinic usage.
A second Symbol option using a supervising physician model would reduce the estimated total cost to $560,373, Weiss said.
Weiss also told the council Premise recently submitted a renewal reflecting another increase of approximately $80,000 over the previous year.
Rauch asked whether city officials had spoken with the city of Auburn, which uses Symbol Health.
Weiss said he had recently spoken with his Auburn counterpart at a conference.
“She said she wouldn’t change a thing,” Weiss said. “Very happy with the services.”
Ward 2 Council Member Janataka Hughley-Holmes asked what information, beyond the cost reduction, showed the council that Symbol was the best option.
“We do have to make this informed decision,” Hughley-Holmes said. “I just want to be able to make sure we’re making the best decision.”
When she asked what separated Symbol from the alternatives, Weiss first cited the cost savings.
He also pointed to the working relationship with Premise.
“We hear from them when something’s wrong,” Weiss said. “We don’t hear from them. It’s not a business partnership. It’s just not a good fit for the city.”
Weiss said he was considering the interests of the city, its employees, dependents and retirees, as well as the projected savings.
“We’re talking $314,000 to $354,000 of immediate real-money savings for the same business model,” he said.
Council questions selection process
The projected savings did not resolve questions about how Symbol was selected.
Hughley-Holmes repeatedly questioned whether the city had made local healthcare providers aware of the opportunity.
She said council members had received calls and emails from local providers and wanted to make sure those providers had an opportunity to demonstrate whether they could operate the clinic.
Weiss said East Alabama Health had expressed interest and made a presentation to the city, but he did not believe its proposal demonstrated an understanding of all the services required to operate an employer clinic.
He said operating the facility involves more than placing a physician in an office. The operator also handles medical compliance and must account for staffing, medications, supplies and other operational requirements.
Weiss said local physicians Dr. Power and Dr. Mecca had also contacted him about the clinic, although he said Power subsequently told him she was not ready to make a proposal at that time.
The discussion indicated the city had not issued a formal request for proposals to local medical providers for operation of the existing clinic. Instead, interested providers had approached city officials after learning the city was considering a change.
Earlier industrial park proposal adds to questions
An earlier proposal involving a possible expansion or relocation of the city clinic to the industrial park and participation by industrial partners also influenced the council’s questions.
Rauch brought up that history during the work session.
“This is really hard because we as a council know more because of things that have been taken on and off the agenda,” Rauch said.
He asked whether costs could change if the clinic were later expanded or relocated.
Weiss said the Symbol agreement currently under discussion applies only to the existing clinic.
“The agreement we’re going to sign, if it’s approved, is for the current clinic,” Weiss said. “It’s no more than literally the same on-site clinic. It’s not growing. It’s to maintain that clinic for the employees, their dependents and the [few] retirees we have.”
Rauch then explained more directly why the earlier proposal mattered to his questions.
“The city clinic has had on the agenda before about proposing to move out to the industrial park and having these industrial partners be a part of it,” Rauch said.
He said the council later removed that proposal from an agenda after pushback from medical providers who said they had not had an opportunity to bid.
“So knowing that ahead of time, that’s what I’m trying to encapsulate,” Rauch said, asking whether a future move or expansion would increase costs.
Weiss responded that, hypothetically, growth could affect costs and again emphasized the current proposal involves only the existing clinic.
Hughley-Holmes followed with concerns about the size of the projected staffing-cost difference.
She said a reduction from $630,948 under Premise to $360,844 under Symbol raised questions about whether costs would be recovered elsewhere.
She also referred to the earlier discussions about potentially moving the clinic to the industrial park and involving other businesses.
“We just want to make sure we’re being fair and do the right thing,” Hughley-Holmes said.
Weiss said the numbers presented to the council were based strictly on the existing clinic.
He said if industrial partners were added at some point in the future, they would be expected to bear a portion of the costs.
“That’s going to drive our cost as a city down,” Weiss said.
Contract gives council additional time
Rauch also questioned the timing of the existing Premise agreement.
He initially asked whether the city was required to provide six months’ notice before ending the contract.
Weiss said the requirement is 60 days.
If the city does not provide notice, the Premise agreement automatically renews, officials said.
That means the council still has time before it must make a final decision on the clinic operator.
Toward the end of the discussion, Weiss clarified that the city had not directly approached local physicians to operate the clinic.
“They have approached us,” Weiss said.
He said he had spoken with Power, Mecca and East Alabama Health representatives who made a presentation to the city.
Hughley-Holmes said she wanted local providers to have an opportunity to submit proposals before she made a decision.
“That just helps me as a council person to know we’ve done the right thing by giving them the opportunity to at least apply for it or bid on it,” she said. “If they can’t fulfill it, we at least know we gave them that opportunity.”
Later in the discussion she added: “In the end, this might be the best company to run it, but it hasn’t been a fair process.”
East Alabama Health approaches city
Mayor Eddie Smith provided additional details about East Alabama Health’s involvement.
Smith said East Alabama Health was not prepared during its initial presentation to provide a complete proposal comparable to what the city currently receives from Premise or what Symbol was proposing.
“When East Alabama Health came and made their presentation, they weren’t prepared to offer anything beyond the $23 per person,” Smith said.
Smith said he told East Alabama Health representatives that after the city was no longer obligated under its premise agreement, he would be willing to provide the cost information necessary for them to better understand what they would be expected to provide.
“They cannot make one until they get the numbers and understand what they’re bidding on,” Smith said.
Smith said if the city moved to Symbol and East Alabama Health later presented a better proposal, it could consider changing operators again according to whatever termination provisions applied.
“Right now, East Alabama Health has not made us a proposal that would match anything we currently have or which we are getting,” Smith said.
Hughley-Holmes then asked how East Alabama Health had learned the city was considering a change and whether the city had sought the organization out.
Smith said East Alabama Health contacted him.
“They knew we had a clinic and they said, ‘Would you consider allowing us to bid on the clinic?’”Smith said. “And I said absolutely.”
The work session ended shortly afterward without action on the proposed Symbol agreement. Allen said the discussion could continue at a future meeting.
The council voted to remove the item from the agenda during the regular council meeting, and it took no further action.
