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Special called meeting

Thursday, October 28, 2010

10:30 a.m. session


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10:32:16 >>THOMAS SCOTT: We'll have roll call.

10:32:18 >>GWEN MILLER: Here.

10:32:20 >>CHARLIE MIRANDA: Here.

10:32:22 >>CURTIS STOKES: Here.

10:32:22 >>THOMAS SCOTT: Here.

10:32:26 The first order of business is the comp plan amendment.

10:32:30 Who is going to address that?

10:32:34 >>GWEN MILLER: Move to open the public hearing.

10:32:37 >>THOMAS SCOTT: All in favor?

10:32:39 Opposed?

10:32:39 Okay.

10:32:46 Number one, this is the public hearing on adoption.

10:32:51 Does anyone from the public wish to address council on

10:32:53 item number 1?

10:32:55 Any comment by staff?

10:32:57 >>GWEN MILLER: Move to close.

10:32:58 >>THOMAS SCOTT: Moved and seconded.

10:33:00 All in favor?

10:33:04 >>CHARLIE MIRANDA: Move an ordinance presented for

10:33:06 second reading and adoption, Tampa comprehensive plan,

10:33:09 standards and economic development, economic

10:33:16 development overlay associated with the green tech

10:33:19 corridor that enables development of targeted

10:33:22 industries in selected areas of Tampa providing for

10:33:24 repeal of all ordinances in conflict providing an

10:33:26 effective date providing for severability, providing an

10:33:29 effective date.

10:33:29 >>THOMAS SCOTT: Seconded by councilman Stokes.

10:33:33 >>THE CLERK: Motion carried with Caetano absent at

10:33:47 vote.

10:33:47 >>THOMAS SCOTT: Item 2.

10:33:51 Anyone from the public wish to address council on item

10:33:54 2?

10:33:55 >>CHARLIE MIRANDA: Move to close.

10:33:56 >> Second.

10:34:00 >>THOMAS SCOTT: All in favor?

10:34:01 Councilman Stokes.

10:34:03 >>CURTIS STOKES: Move an ordinance for second reading

10:34:07 and adoption, an ordinance amending the Tampa

10:34:08 comprehensive plan, public school facilities element,

10:34:11 to modify an objective related to student generation

10:34:14 rates, providing for repeal of all ordinances in

10:34:16 conflict, providing for severability, providing an

10:34:20 effective date.

10:34:20 >>THOMAS SCOTT: Seconded by councilman Miranda.

10:34:23 Record your vote, please.

10:34:35 >>THE CLERK: Motion carried with Caetano being absent.

10:34:38 >>THOMAS SCOTT: Does anyone wish to address council on

10:34:41 the third item from the agenda?

10:34:43 >>CHARLIE MIRANDA: Move to close.

10:34:43 >> Second.

10:34:47 >>THOMAS SCOTT: Moved and seconded.

10:34:48 All in favor?

10:34:49 Councilwoman Mulhern, number 3.

10:34:51 >>MARY MULHERN: I move an ordinance being presented

10:34:54 for second reading and adoption, an ordinance amending

10:34:56 the Tampa comprehensive plan, mobility and capital

10:35:00 improvements element to modify and add objectives and

10:35:02 policies related to transportation concurrency and

10:35:05 strategies for mobility, providing for repeal of all

10:35:08 ordinances in conflict, providing for severability,

10:35:11 providing an effective date.

10:35:11 >>THOMAS SCOTT: Seconded by councilman Miranda.

10:35:16 Record your vote.

10:35:22 >> Motion carried with Caetano being absent.

10:35:25 >>THOMAS SCOTT: Item 4.

10:35:26 Anyone from the public wish to address council?

10:35:30 >>CHARLIE MIRANDA: Move to close.

10:35:31 >> Second.

10:35:32 >>THOMAS SCOTT: All in favor?

10:35:33 Item 4.

10:35:35 >>CHARLIE MIRANDA: Move an ordinance for second reading

10:35:37 and adoption, an ordinance amending the Tampa

10:35:39 comprehensive plan, to add goals, objectives an

10:35:42 policies to establish a 40th Street corridor community

10:35:45 vision plan, providing for repeal of all ordinances in

10:35:47 conflict, providing for severability, providing an

10:35:50 effective date.

10:35:50 >>THOMAS SCOTT: Seconded by Councilwoman Mulhern.

10:35:53 All in favor -- record your vote.

10:35:58 >>THE CLERK: Motion carried with Caetano being absent.

10:36:03 >>THOMAS SCOTT: Item 5.

10:36:05 Anyone from the public wish to address council on item

10:36:08 5?

10:36:09 >>CHARLIE MIRANDA: Move to close.

10:36:10 >> Second.

10:36:12 >>THOMAS SCOTT: All in favor?

10:36:13 Opposes?

10:36:13 Councilwoman Miller.

10:36:14 >>GWEN MILLER: Move to adopt the following ordinance

10:36:16 upon second reading, an ordinance amending the Tampa

10:36:19 comprehensive plan, capital improvement element by

10:36:21 updating the schedule for the of projects for fiscal

10:36:25 year 2011 through fiscal year 2016 providing for repeal

10:36:31 of all ordinances in conflict, providing for

10:36:33 severability, providing an effective date.

10:36:36 >>THOMAS SCOTT: Seconded by Councilwoman Capin.

10:36:38 Record your vote.

10:36:38 >>THE CLERK: Motion carried with Caetano being absent.

10:36:43 >>THOMAS SCOTT: Item 6.

10:36:45 Anyone from the public wish to address council on item

10:36:48 6?

10:36:48 >> Randy Goers, land development.

10:36:54 Just for the record this is a map amendment on Adamo

10:36:57 Drive going from heavy industrial to RMU 100.

10:37:02 The Planning Commission recommended not to approve

10:37:09 this.

10:37:09 The MPO, the board FDOT and region planning council all

10:37:15 had issues or objections as well as city staff.

10:37:17 Thank you.

10:37:17 >>THOMAS SCOTT: Councilman Miranda.

10:37:23 >>CHARLIE MIRANDA: Also for the record, if it had been

10:37:24 the other way around and this had been a residential

10:37:27 mix use that was going to go to industrial, I would

10:37:29 have voted against it because Adamo Drive is a main

10:37:32 corridor to the city, and all you see now is

10:37:36 dilapidated buildings, not that they are in great shape

10:37:40 but they are also in deplorable conditions.

10:37:43 When I see something like this, and I see land

10:37:46 developed all around the port, the port themselves have

10:37:48 not been here, if they weren't in the audience would

10:37:52 have never spoke, and when this council zoned all the

10:37:56 land north of Channelside and Kennedy for multifamily

10:38:00 use around Adamo Drive, and through 21st street,

10:38:05 the board had no objections there.

10:38:06 I wonder why they have objections to something this far

10:38:09 away.

10:38:09 Thank you.

10:38:10 >>JULIA COLE: City of Tampa legal department.

10:38:15 I did also want to reiterate for the record the

10:38:18 discussion that we had at the previous hearing.

10:38:21 You were shown this provision of the comprehensive plan

10:38:25 in staff reports and it was also verbally discussed

10:38:28 which provides standards upon which you are making your

10:38:31 decision today.

10:38:32 Given that this particular comprehensive plan amendment

10:38:35 doesn't meet your locational criteria that is set up in

10:38:39 subsection 2, that you would be reviewing this pursuant

10:38:42 to subsection 3.

10:38:44 In subsection 3 it requires City Council -- allows City

10:38:48 Council to approve this comprehensive plan amendment

10:38:51 upon the finding that this comprehensive plan

10:38:54 amendment -- that this land use amendment is no longer

10:38:58 in the best interest of the public, and I would say

10:39:00 that part of your approval process that finding would

10:39:02 be made.

10:39:03 I did also want to reiterate for the record -- and we

10:39:06 talked about this at the previous hearing -- if this

10:39:10 comprehensive plan designation is approved, that the

10:39:13 property owner will have to come forward with a site

10:39:16 plan controlled district.

10:39:17 It is something that is obligated with, within your

10:39:20 code, and it is something that has to be processed,

10:39:23 meaning that it wouldn't be able to come to City

10:39:26 Council in the Euclidean zoning district.

10:39:28 City staff would not even be able to move forward with

10:39:30 the application unless it's a site plan controlled

10:39:32 district.

10:39:32 Again I just wanted to make that clear for the record

10:39:35 so there's no questions later on.

10:39:38 >>CHARLIE MIRANDA: For the record, let me understand

10:39:40 what you said in laymen's terms.

10:39:42 They still have to come back for rezoning, and they

10:39:46 still have to meet all the regulations of that

10:39:49 classification.

10:39:50 >>JULIA COLE: That's correct.

10:39:52 But that rezoning must be a site plan controlled zoning

10:39:55 district.

10:39:55 Thank you.

10:40:01 >>YVONNE CAPIN: Site plan controls, meaning the

10:40:07 conditions that is on the site plan.

10:40:08 >>JULIA COLE: Like a PD district.

10:40:12 In this instance it would be a PD.

10:40:14 There's other parts of the city where you have site

10:40:15 plan control districts that are not PD zoning district.

10:40:21 But in this instance it would for this particular

10:40:24 property, it would be a planned development zoning.

10:40:26 >>MARY MULHERN: Ms. Cole, can you leave that up there?

10:40:33 Because I just -- I just want to point out, I voted --

10:40:38 I was the only one that vote against this at the first

10:40:41 reading and I am going to vote against it again based

10:40:45 on that number 3 criteria, that our local planning

10:40:47 agency and our planning staff did propose alternative

10:40:52 amendments, which could have happened, and they are

10:40:57 not.

10:40:57 >>THOMAS SCOTT: Motion to close?

10:41:05 >>CHARLIE MIRANDA: So moved.

10:41:06 >>JULIA COLE: I believe we should give the petitioner

10:41:09 an opportunity.

10:41:10 >>THOMAS SCOTT: Petitioner?

10:41:12 >> I first would like to thank council for being here

10:41:15 today.

10:41:15 This is a specialest by the council, and I want to give

10:41:19 commendation, because you are working in an extra

10:41:23 capacity regarding potential issues that may arise in a

10:41:26 few days that are on the ballot.

10:41:27 And I think that's very pro business and very proactive

10:41:30 and I personally appreciate it and I think the viewers

10:41:34 need to know that.

10:41:35 Staff made their opinions on this issue and we

10:41:37 understand them, and they put that on the record and we

10:41:41 heard that.

10:41:41 Thank you.

10:41:44 >>CHARLIE MIRANDA: Motion to close.

10:41:47 >> Second.

10:41:48 >>THOMAS SCOTT: All in favor?

10:41:49 Councilwoman Capin.

10:41:50 Item 6.

10:41:52 >>YVONNE CAPIN: I move an ordinance being presented for

10:41:57 second reading and adoption, an ordinance amending the

10:41:59 Tampa comprehensive plan, future land use element,

10:42:03 future land use map for the property located in the

10:42:05 general vicinity of southeast corner of Adamo Drive and

10:42:08 50th street from heavy industrial to regional mixed

10:42:11 use 100 providing for repeal of all ordinances in

10:42:14 conflict, providing for severability, providing an

10:42:18 effective date.

10:42:23 Original motion -- oh, do I need to read -- oh, thank

10:42:26 you.

10:42:26 >>THOMAS SCOTT: Seconded by councilman Caetano.

10:42:31 Record your vote.

10:42:41 >>THE CLERK: Motion carried with Mulhern voting no.

10:42:45 >>THOMAS SCOTT: Item 7.

10:42:46 Anyone from the public wish to address council on item

10:42:48 7?

10:42:50 >>GWEN MILLER: Move to close.

10:42:51 >> Second.

10:42:52 >>THOMAS SCOTT: Moved and seconded.

10:42:53 All in favor?

10:42:54 Opposes?

10:42:55 Item 7.

10:42:56 Councilman Caetano.

10:43:00 While you are trying to find that, ask if

10:43:09 administration wants to come over.

10:43:11 >> An ordinance amending the Tampa comprehensive plan,

10:43:15 future land use element, future land use map to

10:43:18 designate the economic development overlay in the

10:43:21 general vicinity of University of South Florida, Fowler

10:43:24 Avenue, Bougainvillea Avenue, 30th street, 46th

10:43:28 street, 50th street, and McKinley drive, providing

10:43:31 for repeal of all ordinances in conflict, providing for

10:43:34 severability, providing an effective date.

10:43:34 >>THOMAS SCOTT: Seconded by councilman Miranda.

10:43:48 >>THE CLERK: Motion carried unanimously.

10:43:49 >>THOMAS SCOTT: Item 8.

10:43:54 Anyone from the public?

10:43:56 Item 8.

10:43:56 >>GWEN MILLER: Move to close.

10:43:57 >> Second.

10:43:59 >>THOMAS SCOTT: All in favor?

10:44:00 Opposes?

10:44:01 Councilman Miranda.

10:44:02 >>CHARLIE MIRANDA: Move an ordinance for second

10:44:05 reading, an ordinance amending the Tampa comprehensive

10:44:08 plan, future land use element, future land use map for

10:44:11 the property general generally bounded by Busch

10:44:12 Boulevard on the north, 22nd street on the west,

10:44:15 Hillsborough Avenue on the south, and Tampa city limits

10:44:18 on the east from residential 10, residential 20,

10:44:21 residential 35 to community mixed use 35 providing for

10:44:25 repeal of all ordinances in conflict, providing for

10:44:27 severability, providing an effective date.

10:44:28 >>THOMAS SCOTT: Seconded by Councilwoman Capin.

10:44:35 Record your vote.

10:44:35 >>THE CLERK: Motion carried unanimously.

10:44:42 >>THOMAS SCOTT: Julia, do we need to take any other

10:44:48 action with these comp plans?

10:44:50 >>JULIA COLE: No, we don't.

10:44:52 They have been approved and we will move forward.

10:44:57 >>THOMAS SCOTT: Thank you very much.

10:44:57 Then we'll move to our next item on the agenda which is

10:45:01 the health care issue that we voted on last week.

10:45:08 I sent a memo out, back to the agenda for today.

10:45:14 So in the process, so council will understand, I did

10:45:19 receive a call from the mayor stressing the urgency and

10:45:22 importance of this particular plan, and also advising

10:45:25 that we needed more information and council wanted to

10:45:30 be briefed on this issue so that we can try to bring

10:45:33 some resolve to the issue.

10:45:34 So at that point, that's where we are today.

10:45:37 Any question.

10:45:42 >>CHARLIE MIRANDA: For clarity of ourselves I would

10:45:44 like to ask our attorney do we need to waive the rules

10:45:47 to have the special called meeting?

10:45:48 I'm not saying that the chairman can't do it but I want

10:45:50 to make sure that we do it so that no one else in the

10:45:53 audience or someone watching or listening can come back

10:45:55 and say we did something that we shouldn't have done.

10:45:57 >>MARTIN SHELBY: Mr. Miranda, that would be

10:46:01 appropriate.

10:46:02 Rule 7-B does state an item may be placed on a future

10:46:06 agenda by majority vote of the City Council.

10:46:08 The chairman does have the ability to call an emergency

10:46:11 meeting, but in lieu of the fact he didn't, the

10:46:14 appropriate step would be to waive the rules.

10:46:17 >>CHARLIE MIRANDA: I move a motion to waive the rules,

10:46:18 Mr. Chairman.

10:46:18 >>JOSEPH P. CAETANO: Second.

10:46:21 >>THOMAS SCOTT: Moved and seconded.

10:46:23 All in favor?

10:46:24 Opposes?

10:46:25 Let me just be clear.

10:46:26 Under the rules that we could have called an emergency

10:46:28 meeting, but in that we were already having a special

10:46:31 called meeting.

10:46:32 I just want to be clear on that issue.

10:46:34 All right.

10:46:35 We'll have administration come forward and make a

10:46:37 presentation at this time.

10:46:43 You may have a number of questions.

10:46:47 Wise

10:46:49 Kimberly Crum, director of human resources.

10:46:51 I really appreciate the opportunity to come before you

10:46:53 today and revisit this important initiative which is

10:46:56 designed to improve the health of our employees and

10:47:01 their family.

10:47:03 I prepared just a very brief presentation today that

10:47:06 will address some of the questions that we received so

10:47:08 since our last presentation before you.

10:47:10 So if we could have the slides.

10:47:22 The City of Tampa covers over 10 that you people today

10:47:25 with a total for fiscal year 2010 of $35 million.

10:47:29 This the benefits provided for employees and retirees

10:47:33 under all bargaining agreements.

10:47:35 And we have the goal of providing high quality benefits

10:47:37 while effectively managing the costs to employees and

10:47:40 the city.

10:47:41 And just as a reminder we talked about last week how

10:47:44 the cost of the plan is based on claims so if we are

10:47:46 able to reduce claims in future years our costs will be

10:47:49 reflected.

10:47:59 Voluntary centers are being use across the nation --

10:48:06 excuse me.

10:48:07 The wellness centers here at the city are planned to be

10:48:10 managed by an outside vendor, Care ATC, by physician

10:48:14 and staff at each location.

10:48:15 They will be providing hey quality medical care

10:48:18 designed specifically to be proactive so that wellness

10:48:21 screening can help uncover health issues early so that

10:48:24 they can be properly treated.

10:48:37 By cutting the cost of visits in half, by ensuring that

10:48:41 consumable medical supplies and prescriptions are

10:48:44 charged to the city at cost and impact on those five

10:48:50 primary risk factors that drive the costs in our plans.

10:48:53 We will see ease of employment scheduling so time away

10:48:58 from work is limited and have fewer barriers to getting

10:49:00 treatment when needed.

10:49:02 The benefits to employees include convenience.

10:49:06 Each visit they make to a voluntary wellness center

10:49:08 will be zero cost payments as well as zero co-payment

10:49:12 for generic prescriptions that heir stocked there.

10:49:15 They will have continuity of care, seeing the same

10:49:18 doctor at each location, and they'll receive support

10:49:21 for wellness initiatives like diabetes management,

10:49:24 weight loss and tobacco cessation, three of the primary

10:49:27 risk factors that drive a great portion of our costs.

10:49:30 And just a reminder that all participation within the

10:49:33 voluntary wellness centers is voluntary.

10:49:38 Moving onto the cost comparison.

10:49:40 Several questions were raised around this, just to

10:49:43 ensure that we are all working from the same sheet of

10:49:47 music.

10:49:48 But Humana based renewal premiums as we shared with you

10:49:52 before was nearly 40,800,000, or an increase of over

10:49:59 20%.

10:50:00 Humana's final offer was 38.6 million or increase of

10:50:04 13.9%.

10:50:06 In contrast, United Health Care's best and final offer

10:50:10 was just over $36 million or increase of just over 6%.

10:50:15 And their best and final offer after considering

10:50:18 voluntary wellness clinics and the savings that they

10:50:21 would provide was just over $35 million.

10:50:24 You see the premium savings with the voluntary wellness

10:50:28 clinic listed at 951,773.

10:50:37 So the question has arisen, what happens to the

10:50:39 premiums if we don't go with the voluntary wellness

10:50:42 clinics?

10:50:45 If they aren't approved premiums have to go up to cover

10:50:48 that increase in cost.

10:50:50 Now, we know that the city bears the majority of that

10:50:53 cost increase, but in order to cover the full cost of

10:50:55 the employee premiums would be reflected here on this

10:50:58 slide.

10:50:59 The first column you see is the premium rate with

10:51:02 voluntary wellness centers, and the second column is

10:51:05 the premium rate without voluntary wellness centers.

10:51:09 So in addition to having an increase in premiums,

10:51:11 employees would also not have the benefit of free

10:51:15 visits, free generic drugs where appropriate.

10:51:19 In the choice plan, which is the plan that requires two

10:51:22 activation steps, those employees instead of paying

10:51:27 less than $117.46 per pay period, they would be asked

10:51:30 to pay $126.19 or 7% increase.

10:51:35 You see the select plan goes from 133.10 to 144.59 for

10:51:40 an increase of 8.6%, and the foundation plan $150.63 to

10:51:48 168.45 for an increase of 11.8%.

10:51:55 With the approval of the voluntary wellness centers,

10:51:58 we'll see additional savings on worker's comp.

10:52:01 Because we'll be using the downtown location of primary

10:52:05 triage for nonthreatening or non-life threatening on

10:52:08 the job injuries, we'll save 550,000 in the first year.

10:52:14 So coupling the unit health care credits that we would

10:52:17 get, having implemented voluntary wellness centers

10:52:21 along with the workers' compensation saving, we are

10:52:24 looking at a savings of over $1.5 million.

10:52:29 We have been asked about the second year savings.

10:52:32 While it's difficult to predict until we are at renewal

10:52:36 time, the best and most conservative information shows

10:52:41 that we will likely have a one to one savings.

10:52:44 So for every dollar we invest into the wellness

10:52:46 centers, we'll receive a dollar back in our renewal

10:52:50 next year.

10:52:51 So with that we are estimating $2.6 million in savings

10:52:56 with United Health Care, and 1.4 million under worker's

10:53:01 comp savings for a full year for a total of about $4

10:53:04 million.

10:53:08 And with that, I thank you for your attention and for

10:53:11 your continued interest in the wellness center concept

10:53:14 and we would be happy to take questions.

10:53:16 >>THOMAS SCOTT: One we can question and I will

10:53:18 recognize Councilwoman Mulhern.

10:53:20 Under the 4.1, is that after expenses, the savings?

10:53:25 >> What we are showing here, councilman, is that the

10:53:27 2.6 would be the cost of the clinic.

10:53:31 We expect that next year when we go to renewal with

10:53:35 United Health Care they will see that the clinics have

10:53:37 saved at least that much money, and will weave that

10:53:42 into their premiums for next year.

10:53:44 >>THOMAS SCOTT: Councilwoman Mulhern, then councilman

10:53:46 Miranda.

10:53:46 >>MARY MULHERN: Yeah, I mean, it kind of boils down to

10:53:49 that.

10:53:50 I if we felt comfortable with your numbers it would be

10:53:58 different.

10:53:58 I mean, I wasn't comfortable, and I just found out

10:54:02 yesterday, and I just got this memo which was very

10:54:05 helpful.

10:54:06 I appreciate it, and basically boils down to what you

10:54:09 have up there.

10:54:10 But I have a couple of questions.

10:54:11 One is in looking through this, you have the time --

10:54:17 implementation time line checklist.

10:54:20 And it occurs to me, you have already signed the letter

10:54:23 of intent, right?

10:54:24 >> I believe the letter of intent happens as soon as

10:54:28 the committee moves forward, but we have signed no

10:54:33 contract with them.

10:54:34 >> But the letter of intent, I mean, you are doing all

10:54:37 these things -- I guess at the employee meeting, that's

10:54:48 what got ahead of us, I think, right?

10:54:52 Because you got these employee meetings already

10:54:55 happening.

10:54:57 And then, you know, arranging space, recruiting

10:55:01 physicians, space buildout.

10:55:03 You haven't done any of that.

10:55:04 >> Care ATC has been reviewing available space but we

10:55:08 have not listed any space because we don't have a

10:55:11 contract.

10:55:11 >>MARY MULHERN: So maybe Mr. Fletcher could tell me,

10:55:14 is there a letter of intent that was already signed?

10:55:17 >>CHARLES FLETCHER: No.

10:55:21 If I understand the concept -- Chip Fletcher, city

10:55:24 attorney.

10:55:25 Sometimes vendors call them different things.

10:55:27 But when we do a bid, when that bid is awarded, we

10:55:30 issue a notice of award.

10:55:32 And that might be what you are referring to as the

10:55:35 letter of intent.

10:55:35 >>MARY MULHERN: Well, attachment C, implementation,

10:55:41 time line responsibility checklist.

10:55:43 So this is part of what you are asking us to approve.

10:55:45 >>CHARLES FLETCHER: That would be part of -- no,

10:55:48 that's their proposal.

10:55:50 >>MARY MULHERN: I'm just trying to understand how

10:55:56 we -- it looks like -- much of this is already being

10:55:59 implemented, so --

10:56:02 >>CHARLES FLETCHER: What you are looking at -- I'm

10:56:04 sorry.

10:56:04 What you are looking at is what the vendor gave us, in

10:56:07 an interview, in a presentation.

10:56:11 We don't have anything -- they are using the term

10:56:14 letter of intent.

10:56:15 We are not issuing anything called a letter of intent.

10:56:18 It's just a semantic --

10:56:22 >>MARY MULHERN: Well, it's not just semantics because

10:56:24 you are already meeting with employees and offering

10:56:26 this.

10:56:30 It's not semantics.

10:56:31 That's real happening.

10:56:34 >> These time lines you see in this interview material

10:56:37 is not in the contract.

10:56:38 It is not in any document I use as part of the

10:56:43 contract.

10:56:45 It is a marketing piece that was provided to us by the

10:56:47 vendors.

10:56:47 >>MARY MULHERN: Well, I just wanted to point out that

10:56:51 we are being asked -- I'm not even sure what we are

10:56:54 being asked to approve.

10:56:55 But this is the question I have.

10:56:58 Because based on your numbers -- and I think Chairman

10:57:01 Scott asked the question already, and I don't feel like

10:57:04 we really -- I didn't understand the answer.

10:57:09 Your telling us that in the first year you are

10:57:15 projecting to save between the credit, what is the

10:57:25 credit based on?

10:57:26 How much we are going to be paying them?

10:57:27 Is that basically how much they are estimating they are

10:57:30 going to get a year?

10:57:32 >> The $951,000 is the credit that United Health Care

10:57:36 is giving to the city in its premium.

10:57:41 If we implement voluntary wellness centers -- you may

10:57:45 recall in the first presentation --

10:57:46 >>MARY MULHERN: Okay.

10:57:48 No, I understand.

10:57:48 But the numbers sort of come close, because when I

10:57:52 added up your figures about the total cost to implement

10:57:57 three clinics, the overhead, the rent, and what you are

10:58:02 estimating for overhead and estimating for

10:58:07 compensation, the total comes to $2.8 million a year,

10:58:13 for the rent and the personnel.

10:58:17 And I guess the overhead, although I don't know how

10:58:20 you -- you know, I'm not sure how you figured that out.

10:58:23 So to me, in the first year, and that's a recurring

10:58:28 cost every year, $2.8 million.

10:58:31 >>> Yes.

10:58:33 >>MARY MULHERN: So your cost, that's the cost running

10:58:37 these clinics.

10:58:40 Based on your numbers which, you know, I certainly

10:58:44 haven't had time to really look into, but my question

10:58:48 is, so if we accept this estimate of 4 million, you are

10:58:55 actually saving -- you have to subtract the cost, those

10:59:01 administrative costs, right?

10:59:02 >> The cost and the savings in the health plan should

10:59:05 be a one-to-one trade-off.

10:59:07 That is the conservative estimate that we are using.

10:59:10 >> Right.

10:59:11 >> So, yes, we will still pay each year, based on the

10:59:14 numbers that we provided, $2.68 million for a full year

10:59:18 to operate all three --

10:59:21 >>MARY MULHERN: Okay, well, my numbers that I did with

10:59:24 a pencil in my own math skills, so maybe I was off, but

10:59:29 I was 2.8 million, not 2.6.

10:59:35 The next question -- so those costs -- that's not

10:59:40 really a credit.

10:59:41 They are giving us a credit, but we are paying for it.

10:59:44 >>> You're paying to operate the wellness centers, but

10:59:49 you are getting the benefit of what the wellness

10:59:51 centers provide in the health plan.

10:59:55 They are a handshake.

10:59:56 There's no question about it.

10:59:58 That's why United Health Care was willing to give us a

11:00:01 credit this year for implementing the voluntary

11:00:02 wellness centers, because they know the more people use

11:00:05 the wellness centers, the fewer visits we'll have in

11:00:08 the health plan.

11:00:10 And so they are charging us less out of the gate.

11:00:12 >>MARY MULHERN: So we are paying --

11:00:15 >>> You are going to pay for it.

11:00:17 >>MARY MULHERN: They are charging us less than we are

11:00:20 paying somebody else if we have another contract.

11:00:22 >>> That's right.

11:00:23 We tried to be very transparent by that up front and

11:00:26 say that is how we are opening the wellness centers

11:00:29 under budget.

11:00:30 >>MARY MULHERN: But you are including that credit as a

11:00:32 savings without debiting it, the cost of the

11:00:35 administration.

11:00:36 So I think at the very least we have to subtract --

11:00:42 just take that 2.68 million out, and your actual

11:00:50 savings is only the worker's comp portion.

11:00:53 That is because it balances out, United Health Care

11:00:56 gives you that credit, but you are paying it in rent

11:00:59 and you're paying those administrative costs to the --

11:01:04 whatever, Care ATC.

11:01:06 So, really, I think your estimate of savings is 1.45

11:01:11 million, not 4.13 million for the first full year.

11:01:16 So my next question is, what is your -- what is this

11:01:22 based on, these estimates?

11:01:28 It's based on 40% of employees using this within that

11:01:31 first year?

11:01:32 >> In the first partial year, it's estimated that 40%

11:01:35 of our employees will go to the doctor at the voluntary

11:01:41 wellness center.

11:01:42 So that's a 40% estimate for the first partial year in

11:01:46 the way that we had rolled out the concept of three

11:01:50 wellness clinics.

11:01:51 >> So what happens if we don't get to that?

11:01:55 >>> What would happen if we don't get to that, that

11:01:57 would involve the service level agreement that we have

11:01:59 with Care ATC.

11:02:01 They are very motivated to ensure that 40% of our

11:02:07 people go.

11:02:07 I can tell you that in Clearwater, who is in the very

11:02:10 early stages of their implementation, they are on track

11:02:12 to not only meet that but surpass it because of the

11:02:15 activities that Care ATC has put in place in

11:02:19 conjunction with the administration there.

11:02:21 After 90 days they are at 32% participation already,

11:02:24 and their office visits are full, because employees are

11:02:28 interested in utilizing the voluntary wellness centers.

11:02:32 And our employees have given up great -- given us great

11:02:36 feedback following implementation of their rollouts.

11:02:41 >>MARY MULHERN: Okay.

11:02:45 I guess that's -- those are my questions.

11:02:48 But I also just want to ask you, what you showed us, is

11:02:52 there anything new from last week?

11:02:55 >>> The only thing that you see that's new in the slide

11:03:00 from today was the memo that was provided earlier.

11:03:03 So there's nothing beyond that.

11:03:04 >>MARY MULHERN: So that's what I was asking you about.

11:03:12 And I'm still not completely convinced that the savings

11:03:14 are really guaranteed.

11:03:20 It is all based on the assumption that this is all

11:03:25 going to happen.

11:03:28 But it would be nice if all the questions that we had

11:03:31 last week about this, if we could get some answers

11:03:34 about the idea of having -- starting out with one

11:03:41 clinic, starting out with one year contract, to see if

11:03:46 this is worth it.

11:03:47 So it goes along with the -- the health care proposal.

11:03:54 We need to hear about that, hear from you on that,

11:03:57 because basically we are déjà vu, back here again with

11:04:02 nothing new and no compromise or really new

11:04:05 information.

11:04:07 >> With regard to starting out with one clinic, you

11:04:15 must understand that the pro forma that's been put

11:04:18 together by Care ATC uses basic assumptions in its

11:04:24 business plan, and respectfully, it's very important in

11:04:30 that business model, in order to meet the number of

11:04:32 visits, that Care ATC has given us credit for, even in

11:04:36 the first partial year, the first year of their

11:04:39 contract, the first partial year of the Care ATC

11:04:43 wellness clinic.

11:04:46 We really need to make the investment into the clinic

11:04:48 so that we can get started on the savings, and to try

11:04:51 to do a clinic scenario within one year is just not

11:04:55 feasible.

11:04:57 And to try to cut back on the number of visits or the

11:05:00 implementation schedule means that Care ATC's proposal

11:05:05 to us is not valid, and we would have to start all over

11:05:09 and promise fewer visits under a different scenario as

11:05:12 in just one clinic to begin with.

11:05:16 So I have deep concerns in the way that the agreement

11:05:20 is structured that we would be able to make that work,

11:05:24 because I wouldn't want United Health Care to enter

11:05:28 into an agreement with us where we promise a certain

11:05:30 number of visits and we can't possibly meet that.

11:05:33 >>THOMAS SCOTT: Councilman Miranda.

11:05:37 >>CHARLIE MIRANDA: I really don't know where to start

11:05:39 because there's so many things to discuss here.

11:05:41 First of all, we are not discussing anything that

11:05:44 wasn't discussed last week, in my opinion.

11:05:47 It was already on the table.

11:05:49 I offered a 30-day grace period and I was turned down

11:05:52 by the administration.

11:05:53 So instead of having a 30 day grace period we only had

11:05:56 a one-week to come back on the same thing.

11:05:59 Let me say what I think happened.

11:06:02 And you may not like it but I'm going to say it.

11:06:08 You met with Humana, you did your due diligence and saw

11:06:11 it was better to go with United.

11:06:13 In that contract with United even though last week or

11:06:15 so the administration said health care is one thing,

11:06:18 wellness is another, they are not combined.

11:06:20 And today by your own admission you stated that they

11:06:25 are combined because that was a promise that was made

11:06:28 to United.

11:06:29 We were not privy to that.

11:06:30 You said that this morning.

11:06:32 If you want me to replay the tape I will.

11:06:34 Let me go back and say this.

11:06:36 When you go back and you make a decision to go with

11:06:41 United, that's a decision between yourself and the

11:06:43 mayor and the administration.

11:06:47 I don't believe this council has any quarrel with you.

11:06:49 When you start making promises without getting approval

11:06:51 from the council, there's where the line is drawn in

11:06:55 the sand, because you don't have the right to do that.

11:06:58 You didn't have the right to do that under that

11:07:01 assumption you were going to get rubber stamped by this

11:07:03 council.

11:07:04 So what you have done now is put the burden on us like

11:07:07 we are the bad guys or bad ladies, as the case may be,

11:07:11 and handle it in that fashion.

11:07:14 When I look at some things, and I look at number,

11:07:19 facilities, number and location, how many do we have?

11:07:23 >>> We have in a facilities.

11:07:24 >> How many are you going to have if this passes?

11:07:27 >>> The plan is to have three.

11:07:29 >> All right.

11:07:29 The plan is to have three.

11:07:30 Did that change from last week?

11:07:32 >>> No, sir.

11:07:33 >> Where are the locations?

11:07:34 >>> We have not determined locations.

11:07:37 >> So you don't have --

11:07:38 >>> The recommendation is that one would be located

11:07:40 near downtown, one would be on the north side, and one

11:07:43 would be near Brandon.

11:07:45 >> All right.

11:07:46 So two of them, I assume, are outside the city limits.

11:07:49 >>> That was the recommendation.

11:07:50 >> I'm making an assumption.

11:07:52 I don't know if.

11:07:55 Let me go to math, something I know very little about.

11:07:59 When I look at the second bullet down approximately 20

11:08:02 to $22 a square foot is the asking rate.

11:08:06 I guess that whatever this company name made that sums,

11:08:10 the wellness people.

11:08:12 Care ATC made that assumption.

11:08:15 And that the clinics were going to be approximately

11:08:17 three clinics at 2500 to 3,000 square foot, and that

11:08:21 the budget of 220,000 for 10,000 square foot before

11:08:27 negotiations.

11:08:28 I'm making another assumption because that's all we

11:08:30 have to go on is assumptions here.

11:08:32 Here is where the problem lies.

11:08:34 That's why I wanted 30 days.

11:08:35 When you look at the assumptions that I am making

11:08:37 myself, okay, the clinics are approximately 3,000 to

11:08:41 3300 square foot, at $22 a square foot, that will give

11:08:45 you $6,600 a month rent.

11:08:49 Am I correct in that number?

11:08:52 >> Without a calculator I am going to take your word

11:08:54 for it.

11:08:54 >> Don't take my word for it.

11:08:56 I'm just going by what you gave us.

11:08:58 So that being the case, if I multiply $6,000, forget

11:09:05 the other part, times 6,000 times 12, the rent for one

11:09:10 clinic is $72,000 a month.

11:09:15 I mean a year.

11:09:15 >> Per year.

11:09:17 >> I knew I would make a mistake somewhere.

11:09:20 So now you are looking at $72,000 a month times --

11:09:24 >>> Per year.

11:09:25 >> I want to see if you caught me the second time

11:09:27 A.year times three locations of 72,000.

11:09:31 That's why the budget down here is 220.

11:09:34 Now, what is 72,000 times three?

11:09:40 $216,000.

11:09:43 So you are asking us to approve rents of $216,000 plus

11:09:51 all the complete pass throughs, where the city had its

11:09:55 own building for a clinic.

11:09:57 And still may have other properties for a clinic.

11:10:00 Now, we talked about differences in time and location

11:10:06 that people won't go.

11:10:08 Let me tell you what I have done.

11:10:10 If there was an airline leaving Tampa to New York round

11:10:13 trip for $300 and there was an airline leaving Orlando

11:10:16 to New York for free, people would drive to Orlando

11:10:22 because it's free.

11:10:24 When McDonald hamburgers it started with one location.

11:10:32 But the people from Outback restaurant, good people,

11:10:34 had a model where they are at today.

11:10:39 You know how many places they started? Uno, one,

11:10:43 Henderson and Kennedy.

11:10:44 So the doctor costs, 260,000, not by my numbers but the

11:10:51 numbers we received here.

11:10:52 A family practitioner or general practitioner in this

11:10:56 area takes home between 120 and 150,000, not 260,000.

11:11:04 And we have to pay the rent, we have to pay the pass

11:11:09 throughs.

11:11:10 Who knows what the relocation costs are?

11:11:12 I don't know that.

11:11:14 This council doesn't know that.

11:11:16 What I am trying to say is give us something to pass.

11:11:20 Why don't we start with one clinic, like business

11:11:23 people have start, and promote yourselves? Let me tell

11:11:26 you this and very sincere.

11:11:28 I went and talked to the former administrator of the

11:11:31 county commission.

11:11:32 I didn't pursue it any further because they had their

11:11:35 own problems.

11:11:36 We talked in detail about the size of just the

11:11:40 governments in this area between ourselves, the county,

11:11:44 state attorney, public defender's office.

11:11:47 The sheriff has a different type of insurance.

11:11:50 It would have been the largest most cost savings, and I

11:11:54 stopped because I saw what was happening.

11:11:58 Maybe in the country.

11:12:00 And the taxpayers are the ones that are funding this.

11:12:02 So before I think as an elected official, my heart

11:12:09 tells me about being a taxpayer first.

11:12:12 And I tell myself, is this the best we can do?

11:12:16 If we market ourselves, if we go and ask the doctors

11:12:18 and family practice and general practitioners if they

11:12:22 needed some more business?

11:12:24 I don't know if you did or not.

11:12:26 I don't know that.

11:12:28 Have we looked at any model where we just call

11:12:30 different cities and put out an RFP in the Penny Saver,

11:12:35 which is a great newspaper, and I don't know how many

11:12:37 health clinics and professional doctors read that

11:12:39 section of the paper.

11:12:41 Did we do that?

11:12:42 I don't know.

11:12:43 So it's difficult for me.

11:12:49 And how do we get to the number?

11:12:53 I believe that's called capitalization where you think

11:12:56 you have so much that you think are going to go so

11:12:58 therefore you base it on that number and the revenue is

11:13:00 based on that number, whether they go or not, we pay.

11:13:04 Because that's how it's capped out.

11:13:06 It's not based on the 10,000.

11:13:08 It's based on the 4,200, whatever the number was.

11:13:12 You cap that number.

11:13:13 You multiply it by a certain fact.

11:13:15 You take percent.

11:13:16 That's what they get, whether we use it or not.

11:13:20 I'm not an insurance agent, but I did take all the

11:13:26 insurance tests there are in America.

11:13:28 So it is -- we talk about things that are wonderful.

11:13:33 Same doctor.

11:13:35 Well, could be and maybe not.

11:13:37 But let me show you another thing,

11:13:43 Number 3.

11:13:45 Low upfront costs or installation fee.

11:13:47 That sounds wonderful.

11:13:48 And it is.

11:13:51 Until the dot is there and you follow it and it says,

11:13:54 these charges will be amortized over a three-year

11:13:58 period.

11:13:59 So the front part is not true.

11:14:03 There is front upcost.

11:14:06 It's just spread out.

11:14:08 So why don't we say it the way it is?

11:14:10 Your costs will be amortized over 36 months.

11:14:13 The first sentence makes the brain think, oh, there's

11:14:16 no cost because that's what you read.

11:14:18 But then you have to go in detail and understand.

11:14:19 It's the same thing with the human part about the cost

11:14:23 of rent.

11:14:24 The way it's worded -- I had to look at it and say,

11:14:30 what are they say saying?

11:14:32 Instead of putting the cost per clinic would be $6600 a

11:14:36 month, they don't say that.

11:14:38 They say in the verbiage.

11:14:41 You it's like you want to have a romance with

11:14:43 yourselves but it's not.

11:14:44 It's the fact that there are too many -- I see this

11:14:57 that I don't understand.

11:14:58 I'm all for saving money.

11:14:59 I guess you can call me cheap.

11:15:00 You can call me frugal.

11:15:02 What is that word that was used?

11:15:05 Parochial.

11:15:07 You can call me anything you want.

11:15:08 But at the end of the day, I read everything that comes

11:15:11 through here.

11:15:13 And I want to make sure that not only the employees get

11:15:17 a good deal, but that the taxpayers that are paying for

11:15:21 the employees get a good deal also get a good deal.

11:15:26 This thing they have done in such a way that you set a

11:15:28 model not only for Hillsborough County, not only for

11:15:30 the State of Florida, but for the country, where this

11:15:33 thing were successful, something in health care would

11:15:37 be change including the taxpayers having an opportunity

11:15:40 to go to the clinics.

11:15:41 But we don't do that.

11:15:42 We take the easy way out.

11:15:44 We put an RFP out, which you don't have to do in

11:15:48 medicine.

11:15:48 You don't have to do it in legal.

11:15:50 Am I correct?

11:15:51 >>CHARLES FLETCHER: This would probably be considered

11:15:59 an operating agreement over the charter which we have

11:16:01 would RFP.

11:16:04 >>CHARLIE MIRANDA: So then go out for a bid to a legal

11:16:06 firm to do that.

11:16:07 It's also the same thing, isn't it?

11:16:09 >>CHARLES FLETCHER: No, that is not correct.

11:16:11 Professional services agreement can be contract out

11:16:13 directly.

11:16:13 So if we were going to hire directly a doctor, then we

11:16:17 would not have to bid that.

11:16:19 If we were going to open a clinic that would be

11:16:21 operated, and we would have an operating agreement,

11:16:24 that would have to be bid.

11:16:27 >>CHARLIE MIRANDA: All right.

11:16:29 So you just said it.

11:16:30 You would hire a doctor that would open a clinic, you

11:16:31 don't have to do it.

11:16:33 That doctor has his own clinic.

11:16:34 >> The distinction is whether or not you are getting

11:16:37 professional services of a professional, somebody to

11:16:42 come in and do something or provide services.

11:16:45 If you are actually requiring someone have a facility

11:16:48 that is managed in a certain way, then you would have

11:16:51 to have an RFP operating agreement.

11:16:53 >>CHARLIE MIRANDA: So what you just said is if you are

11:16:55 an existing doctor, with an existing office of your

11:16:59 own, sir, and the city never -- they just say I am

11:17:03 going to call 15 doctors, in the county, in the city,

11:17:07 where they, quote-unquote, the population is of

11:17:10 retirees, then by your own admission you don't have to

11:17:13 have an RFP.

11:17:14 >> So long as we didn't have any standard on how they

11:17:16 operated the clinic.

11:17:17 But in this instance the choice was to have standards

11:17:19 for how the clinic was operated.

11:17:21 >> I understand that.

11:17:22 So you are telling me that a doctor from eight to five

11:17:26 doesn't keep it clean -- the first paragraph on the

11:17:29 first page is you must have clean wonderful beautiful

11:17:31 place.

11:17:32 All doctors have that.

11:17:33 I mean, that's another lighting on the Christmas tree.

11:17:40 And it's just too quick, too fast.

11:17:43 I didn't make these agreements.

11:17:45 This council didn't make agreements with United.

11:17:48 We weren't even told -- if we talked about this council

11:17:52 getting briefed by the administration from last weak to

11:17:55 this week, I can swear to you on a stack of Bibles I

11:17:58 have never been called.

11:17:59 I don't know about how many council members were called

11:18:01 but I wasn't called.

11:18:02 I don't know about other council members.

11:18:05 My number hasn't changed.

11:18:09 So I'm just saying what's there.

11:18:15 The cost, St. Josephs has an operation.

11:18:21 Tampa general doesn't have it.

11:18:22 Because the way it was formatted was formatted for only

11:18:26 specialty items that these good folks are bringing us.

11:18:29 It's a miniature HMO in another form.

11:18:32 You can change it wellness, you can call it best

11:18:37 standards practice, you can call it anything you want.

11:18:40 We can do better than what we have done.

11:18:43 We can meet our obligation with United.

11:18:47 Notice we, not the council members, that made those

11:18:49 promises to United.

11:18:50 I didn't make them.

11:18:51 This council members didn't make them.

11:18:53 >>CHARLES FLETCHER: I need to be clear on this.

11:18:58 We structured the RFP and the negotiations with United

11:19:01 so that we knew exactly what the financial choice was,

11:19:05 whether we have the clinic or not.

11:19:07 So one of the reasons we have not finalized or even

11:19:11 gotten that far in negotiation was United was because

11:19:14 we didn't know where council was going to be on this

11:19:16 issue.

11:19:17 So we had the number with the clinic and without the

11:19:20 clinic.

11:19:21 So clearly we have respected council's roles in that

11:19:25 context.

11:19:26 >>CHARLIE MIRANDA: Well, that's fine, but it was never

11:19:29 brought to us in that format.

11:19:30 However, the enrollment time, when you change, and you

11:19:32 have enrollment -- and I'm not in the enrollment

11:19:36 because I don't have any insurance with the city other

11:19:38 than death, and if I die I get somebody else collects

11:19:41 it.

11:19:42 Maybe they want to give it to me in the casket, I don't

11:19:45 know.

11:19:46 So what I am saying in the enrollment time, these

11:19:50 employees have to make a choice between this plan, that

11:19:54 plan and that plan, and at the same time, I guess,

11:19:58 whether we like it or not, whether they have been told

11:20:00 or not, they are smart people.

11:20:05 They understand about the health clinic.

11:20:07 This is all getting to them in a way that it should not

11:20:12 happen this way.

11:20:13 But it has happened this way, for whatever reason.

11:20:17 There is nothing wrong but I guarantee you the cost of

11:20:24 rent would be eliminated.

11:20:26 They are already paying their own insurance for

11:20:30 whatever malpractice they may do.

11:20:34 That would be eliminated, or charged very minimal for

11:20:37 patients.

11:20:38 So what I am saying is that we haven't looked outside

11:20:40 our little sandbox at all.

11:20:42 We just took the standard, get it done, and forget

11:20:49 about it.

11:20:49 There was only one mistake.

11:20:53 On this side of the dais, no one really knew all the

11:20:57 details.

11:20:59 So it's not about me voting it down.

11:21:02 I have had three letters, three, in a week.

11:21:05 I answered all three of them.

11:21:07 And let me tell you about this.

11:21:09 I use my agent, I asked yesterday.

11:21:17 She told me.

11:21:18 I hate to say where you had your hair done, and she

11:21:23 told me. It was a much greater distance than anyone

11:21:28 would drive to go to the health clinic for free.

11:21:32 Because there's a common bond with somebody you like,

11:21:35 common bond with somebody you appreciate to talk to,

11:21:38 whether you are a doctor or a nurse.

11:21:42 There is no doubt in my mind, none whatsoever, that

11:21:45 anyone that lives in those zone zip codes, whatever

11:21:49 they are in Brandon or Lutz, can drive to an empty

11:21:53 location, that may be or maybe not have a lot of

11:21:56 build-out or more than likely doctor's vacancy, because

11:22:02 now doctors are going to work for hospitals for the

11:22:04 same reason, for costs.

11:22:07 And there is plenty available that we could do this,

11:22:11 save costs, that we have taken a route just because

11:22:16 other cities have taken the same route.

11:22:19 This is not taking a chance, this is not gambling, this

11:22:21 is facing it so that the employees get a better deal,

11:22:25 the taxpayers get a better deal, and maybe the county,

11:22:30 state attorney's office, the public defender's office,

11:22:33 and other analysis will come on board.

11:22:35 We made it so political that even union leaders are

11:22:38 doubting.

11:22:39 I got one today, God bless 'em.

11:22:46 And, you know, that's how I am.

11:22:49 I like to lay it all on the table.

11:22:51 We gave away a building that we had that would have

11:22:53 been the most perfect health center in the city.

11:22:57 And I'm going to pay $6600 rent for an office.

11:23:03 I told you I was a taxpayer before I became an elected

11:23:06 official.

11:23:06 And I'll always be a taxpayer first.

11:23:10 So what I'm saying to myself is, you drive to Orlando

11:23:16 for something for free.

11:23:18 If you had gas in Wesley chapel for 1.50 a gallon and

11:23:23 today it's 2.75 you would drive to Wesley chap toll get

11:23:26 gas.

11:23:27 And we are saying the employees are not smart enough to

11:23:29 go get something for free?

11:23:31 I'm not a doctor and I'm not a chemist, but let me also

11:23:35 tell you those good folks that are, that there is a

11:23:37 difference between generic and the real McCoy.

11:23:43 And that's in the metabolism of the pills and the

11:23:47 contents of the pills.

11:23:50 The real McCoy is guaranteed to be 100 percent of

11:23:53 whatever the compound is.

11:23:56 The generic is not.

11:23:59 It may be 80% of it, whatever.

11:24:02 See, they have got to give it to you.

11:24:04 The law says brand X must give brand Y up to so many

11:24:09 years all of the ingredients, but they don't have to

11:24:14 tell you how to formulate those ingredients to make to

11:24:17 the that compound, and there's where we are at today.

11:24:22 So do I take generic?

11:24:24 Only when the doctor forgets to put medically

11:24:28 necessary.

11:24:28 Those are two very important words.

11:24:30 "medically necessary."

11:24:33 And this is what happens to me when I don't take the

11:24:36 real McCoy as a diabetic.

11:24:40 My sugar level goes way high when I start taking

11:24:42 Metformin versus Glucophage, or Glipizide versus

11:24:51 Glucotrol XL.

11:24:57 I don't like to look at mannequins in windows.

11:25:02 Get to the meatballs and let's get going.

11:25:05 I mean, it just doesn't make sense to open three at

11:25:07 once.

11:25:08 I understand you made a commitment.

11:25:10 But I didn't make that commitment.

11:25:12 Neither did this board.

11:25:13 >>THOMAS SCOTT: Councilwoman Capin has a question.

11:25:18 >>YVONNE CAPIN: Thank you.

11:25:21 On the credit, the 2,680, did you refer to that as a

11:25:28 handshake?

11:25:28 Or is that a guarantee?

11:25:31 >>> No, ma'am.

11:25:33 Our contract with United Health Care, as Mr. Fletcher

11:25:35 said, was bid two ways.

11:25:38 One way -- and it's just for this year.

11:25:41 So I was very clear, or tried to be very clear in my

11:25:44 comments regarding the second year, or the first full

11:25:47 year savings, and that is that we are estimating for

11:25:50 the first full year what united health care's credit to

11:25:56 us might be, and the best estimate that we can give is

11:25:59 based on Care ATC and other wellness clinic operators

11:26:03 to use a similar model, physically offer for every

11:26:07 dollar that's spent in the maintenance of the clinic,

11:26:10 there is a 1.5 to sometimes a $2 payback.

11:26:16 What we have done on this slide is given you only a

11:26:19 one-for-one payback because we certainly don't want to

11:26:22 overestimate or overpromise what might be the trade-off

11:26:26 in the first year.

11:26:29 >>YVONNE CAPIN: Okay.

11:26:31 I understand that part.

11:26:32 Let's say that it is the credit that is 1,680,000.

11:26:43 It's a number.

11:26:47 What I am asking is United Health Care, that is a

11:26:51 guaranteed credit, whatever that number may be.

11:26:54 >> It is not a guaranteed credit.

11:26:58 We will have to renegotiate next year with United

11:27:00 Health Care, or whatever vendor we use for health care

11:27:04 next year.

11:27:05 It will be a new negotiation.

11:27:07 And it will be based on the expenses that we incur

11:27:10 during this year, just like it has been forever.

11:27:15 Because we are a fully insured plan, they look at the

11:27:19 costs we have incurred, the claims expenses that we

11:27:21 had, for the current most recent year as well as

11:27:26 several other itself, and they predict what's going to

11:27:28 happen next year with the city, the health of the city

11:27:31 employees and retirees, and that's when we'll know for

11:27:35 sure what the rates will be for next year.

11:27:36 But our goal was to give you an idea, a very

11:27:39 conservative idea of what you might expect the clinic,

11:27:44 the wellness centers to pay back.

11:27:51 >>YVONNE CAPIN: Thank you.

11:27:56 >> It's fixed under the upcome contract that you have,

11:27:58 but with any health care plan you have to renegotiate

11:28:01 rates every year based upon the experience for the

11:28:03 insured pool.

11:28:04 So that's the part that she said handshake, there's a

11:28:09 belief and expectation it will continue over multiple

11:28:11 years but we have to negotiate that each year.

11:28:13 This year, it will be fixed.

11:28:15 It is fixed in the draft that we have now.

11:28:17 It will be fixed when we bring --

11:28:20 >>YVONNE CAPIN: I understood that.

11:28:21 But thank you for clarifying that.

11:28:23 So again, it will be renegotiated depending on our

11:28:26 claims, depending on which is every year.

11:28:29 It's done -- that's the way it's done every year.

11:28:32 >>> Yes, ma'am.

11:28:35 >> The other thing I want to talk about is that the

11:28:38 employees being briefed on this, is this something --

11:28:44 is this done every year, the employees are told?

11:28:48 >> Both in of the enrollment meetings are held every

11:28:52 year, regarding the health plan for the coming year.

11:28:55 >>YVONNE CAPIN: Okay.

11:28:55 Thank you.

11:28:56 >>THOMAS SCOTT: Councilman Stokes and Councilwoman

11:28:59 Mulhern.

11:29:01 >>CURTIS STOKES: Ms. Crum, I have a couple of

11:29:03 questions.

11:29:03 The contract, looking at the thing about the business

11:29:09 plan and the business model, I'm trying to think this

11:29:11 out long-term.

11:29:12 You all mentioned projections in the business model.

11:29:15 If Care ATC's business model based on a three-year plan

11:29:19 with three years or three options, and the health care

11:29:21 plan is based on the one-year option, what happens next

11:29:29 year when we renegotiate the contract?

11:29:33 With Humana or United, and the wellness clinics are

11:29:47 part of that?

11:29:48 Assuming United rebid for the same contract.

11:29:50 They are going to put in their increased costs, if it's

11:29:57 6.3%, $35 million this year.

11:30:01 Assuming they increase 6% this year, and project a

11:30:07 savings won't add up, because we are making this based

11:30:14 on six year projections or three year projections, one

11:30:17 year project savings for Humana, and the numbers aren't

11:30:22 syncing up.

11:30:23 The savings aren't real.

11:30:25 >> Let me see if I can help with that.

11:30:27 Of course we are going to renegotiate our health care

11:30:30 expense every year just as we always have.

11:30:32 And each year it will be based on the claims experience

11:30:35 that the city employees and retirees and covered

11:30:39 dependents had for that year so we never know what our

11:30:44 expense will be for the next year until that evaluation

11:30:46 has taken place.

11:30:48 That's done in conjunction with our consultant

11:30:50 Gallagher, and with the renewal company, the company we

11:30:53 are working with, for the RFP process.

11:30:56 So it's really important that as we look towards

11:30:58 renewal next year, we need to have had the wellness

11:31:02 centers in place, so that employees could begin using

11:31:05 them, and begin uncovering health conditions and

11:31:09 getting treatment for those early before they turn into

11:31:14 health issues, like strokes, cancer, et cetera.

11:31:17 And so that's why it's so important for to us get

11:31:20 started on the clinics, the wellness center program, so

11:31:24 that we have those savings next year when it's time to

11:31:27 renew.

11:31:32 >>CHARLES FLETCHER: We are expecting to bring you a

11:31:34 multiyear contract with United Health Care but the

11:31:36 rates will be negotiated this year.

11:31:39 >>CURTIS STOKES: Right. If their rate increases every

11:31:42 year the cost savings presented here aren't really --

11:31:46 >>CHARLES FLETCHER: The way the cost savings would be

11:31:48 analyzed is we would get a cost with the clinics and

11:31:51 then you would determine the cost savings based on that

11:31:54 relative value of the rate premium with the clinic, and

11:31:57 the premium without the clinic.

11:31:59 That's how that would have to be determined as we all

11:32:02 know, health care insurance rates go up every year,

11:32:07 unless we have some miraculous change in the economy.

11:32:10 So I think we will have an increase in the premium.

11:32:13 The question is, how does that compare to the premium

11:32:16 without the clinic?

11:32:20 >>CURTIS STOKES: Are the savings still savings?

11:32:22 >> That is something we have to evaluate he have year

11:32:23 based upon what the estimates are negotiated each year,

11:32:28 but the track roared is there would be the credits that

11:32:30 are described by the administration.

11:32:36 >>CURTIS STOKES: Another question.

11:32:37 Two more questions for Ms. Crum.

11:32:40 The devil is always in the details.

11:32:42 I have two sample monthly invoices for two different

11:32:46 amounts.

11:32:47 >>> Yes, sir.

11:32:48 >> One is for 223,397 and the other for 225,080.

11:32:56 >> In the memo, we transmitted to you the first sample

11:33:02 monthly center invoice wellness center invoice that had

11:33:05 the 223,000 number.

11:33:07 That is the most up-to-date sample invoice.

11:33:11 The second one was provided as part of the final

11:33:13 presentation that was dated July 26th.

11:33:16 That was their initial proposal, but that is not the

11:33:20 proposal -- that's just a test of time, and our back

11:33:23 and forth during negotiations.

11:33:25 They were able to make several updates to some of the

11:33:30 projections they made.

11:33:31 While the numbers aren't that different, the lower

11:33:33 number is the most recent updated version.

11:33:37 >>CURTIS STOKES: Thank you.

11:33:37 The last question.

11:33:38 My main concern, Ms. Crum, has always been the for the

11:33:44 employees and the upkeep of these clinics.

11:33:52 I not Pinellas on numbers, but in case three emergency

11:33:57 patients should use them currently in place, assume

11:34:00 that it's after hours, emergency, someone will go to

11:34:05 the emergency room, assume it's not an emergency, we

11:34:12 will also propose a one team consisting of nurse

11:34:15 practitioners and medical assistant to rotate between

11:34:19 three clinics and provide evening and weekend hours.

11:34:22 Nonemergency.

11:34:25 Example.

11:34:27 If Ms. Mulhern is at the clinic in Brandon, if we put

11:34:32 it in Brandon, after hours, the nurse practitioner is

11:34:36 currently seeing a patient in Lutz, does she have to

11:34:43 wait until that nurse practitioner completes the exam

11:34:46 in Lutz, then drives to Brandon?

11:34:48 >>> No.

11:34:49 We don't anticipate having people moving between

11:34:51 locations on a given day.

11:34:52 >> Or they would drive from Brandon to Lutz?

11:34:57 >> There would be posted hours for each of the centers

11:35:00 and those hours would be fixed.

11:35:02 And either a physician or the nurse practitioner may be

11:35:05 available for night or weekend hours.

11:35:07 But there would be no "in an emergency call a number."

11:35:14 There would be fixed hours.

11:35:15 >> So three different hours.

11:35:19 So if you want to go to the clinic, if you are living

11:35:22 in Brandon, and you want to go to the clinic after

11:35:25 hours, you have to drive to Lutz or drive to the center

11:35:29 of Dale Mabry?

11:35:31 >>> The hours would be posted, councilman Stokes.

11:35:35 So everyone would know what hours the clinics are open.

11:35:38 If that clinic is not open, then they should go to

11:35:41 their nearest health care provider within the network.

11:35:45 So we wouldn't have people traveling during a given day

11:35:48 or a given evening or weekend hours.

11:36:00 >>CURTIS STOKES: Thanks.

11:36:01 >>THOMAS SCOTT: Councilwoman Mulhern.

11:36:02 >>MARY MULHERN: The more questions we ask the more

11:36:07 questions we have.

11:36:08 Okay.

11:36:08 One thing that I don't think you gave me when I asked

11:36:12 earlier about the your projections.

11:36:18 And you said your projection for the first half year

11:36:22 was 40%.

11:36:26 What is it in that projection you gave us for the first

11:36:30 full year?

11:36:30 >>> The first full year's projection is that 80% of our

11:36:34 employees and their families will make visits to the

11:36:36 clinic within the first full year, and that is Care ATC

11:36:42 standards, and that is what they are meeting in their

11:36:44 other locations.

11:36:44 >> 80%.

11:36:47 >>> Doesn't mean that 80% of all the people go.

11:36:50 It means that 80% of the families go.

11:36:52 >>MARY MULHERN: Okay.

11:36:56 That sound like a pretty high percentage.

11:36:57 But then the other question is, well, I'm confused

11:37:04 about this after hours stuff, because I thought this

11:37:06 were in a after hours.

11:37:10 Are there after hours or not.

11:37:12 >> When we opened the centers and it was proposed by

11:37:15 Care ATC that the hours at opening would be 8 to 5,

11:37:18 basic standard hours.

11:37:19 And as employees begin to come and visit the clinics,

11:37:22 we are going to be watching at the end of their visit,

11:37:25 they do a customer service type survey, no names, no

11:37:31 indication, but simply say how they felt about their

11:37:33 visit that day, and there will be questions about

11:37:36 hours.

11:37:38 So we have not established --

11:37:40 >>MARY MULHERN: So that's not then part of any of your

11:37:43 projections for the cost?

11:37:44 >>> The costs are projected, yes.

11:37:46 Because we do have been the costs of the nurse

11:37:48 practitioner and the cost of the additional staff

11:37:51 person that would help cover those hours.

11:37:54 But it's very difficult to answer questions about what

11:37:57 the hours will be at each location because we haven't

11:37:59 established them yet.

11:38:00 >>MARY MULHERN: These total?

11:38:08 >>> Yes, ma'am.

11:38:09 >>MARY MULHERN: For the staffing?

11:38:11 You are including having after hours?

11:38:13 >>> Yes, ma'am.

11:38:15 If you look at the sample monthly wellness center

11:38:17 invoice, the very first line item says facility health

11:38:23 care and staff costs, that cost is based on three

11:38:27 doctors, one for each of the wellness centers, one

11:38:30 nurse practitioner, which is the floating nurse

11:38:33 practitioner, and seven medical assistants, two for

11:38:36 each of the locations, and one which can float.

11:38:39 Between the three.

11:38:40 >> Okay.

11:38:43 So I guess those are the questions that councilman

11:38:47 Stokes asked.

11:38:48 And I'm not sure that it really makes sense.

11:38:56 But I guess you are saying your projections include 24

11:38:59 hour care in one location?

11:39:02 >>> We do not anticipate 24 hour care at any of the

11:39:05 three locations.

11:39:06 After hours or weekends segment does not mean 24-hour

11:39:11 open wellness centers.

11:39:14 So just to be clear, we do anticipate 8 to 5 being the

11:39:19 normal work day type schedule, but then having people

11:39:22 who will float and do the earlier hours, later hours,

11:39:27 or weekends.

11:39:28 >>MARY MULHERN: But they don't know what those are.

11:39:30 So what did you base your estimates on?

11:39:34 >>> We based the estimates on the personnel costs so we

11:39:36 know we will have people --

11:39:38 >>MARY MULHERN: For what hours?

11:39:40 >>> For their full time salary.

11:39:42 So they will have a 40-hour week.

11:39:44 We just haven't plugged in which location they will be

11:39:46 in for each of those 40 hours.

11:39:48 >>MARY MULHERN: Oh, okay.

11:39:50 >>> Is that helpful?

11:39:52 >>MARY MULHERN: Yeah, yeah, but it doesn't -- it

11:39:55 doesn't -- still doesn't really make sense.

11:39:57 But the other question is, back to these questions that

11:40:02 we have and the new questions that keep coming up,

11:40:08 people have been briefed on this as an option for them

11:40:14 to sign up for, right?

11:40:16 >>> They don't have to sign up for them.

11:40:18 But, yes, employees have been briefed about our plan to

11:40:21 implement these.

11:40:25 >>MARY MULHERN: I guess I don't remember -- I guess

11:40:27 because it's a new option, but normally, the other

11:40:31 years, is this the practice of this administration that

11:40:37 you offer options for health care before council has

11:40:42 even been briefed on it, much less passed it?

11:40:46 >>> First of all let me say that each of the plans that

11:40:48 are before our employees this year remain the same.

11:40:52 The benefits are the same, whether with the clinic or

11:40:56 without the clinic.

11:40:57 Now, obviously if we don't implement wellness centers,

11:41:00 then they will have the option of zero co-payment or

11:41:03 zero generic prescriptions at a wellness center.

11:41:06 But the network that's provided and the level of

11:41:10 benefits that are provided remain the same.

11:41:13 So there's no difference there.

11:41:15 Unfortunately, each year, when we do the insurance

11:41:17 renewal, because the contract doesn't come to council

11:41:21 until later in the year, we are often in front of

11:41:24 employees talking about open enrollment before the

11:41:29 insurance plan.

11:41:31 >>MARY MULHERN: Right, but you had this proposal in

11:41:34 July, you said.

11:41:34 >>> They made their proposal in July.

11:41:37 >>MARY MULHERN: So we could have heard about it in

11:41:41 July.

11:41:41 >>> You could have heard about it earlier, certainly,

11:41:44 than you have.

11:41:45 >>MARY MULHERN: I just want to point out, too, that

11:41:49 Mr. Miranda asked for 30 days, and then he said you

11:41:53 gave us a week but I only found out this was on the

11:41:55 agenda yesterday.

11:41:57 So really we have only had maybe 24 hours to look at

11:42:02 this.

11:42:02 So -- yeah.

11:42:14 I -- I don't know.

11:42:16 But I do feel that, you know, what you are claiming as

11:42:22 savings is not actually -- really, the only thing I can

11:42:26 see in the projection for your first year based on your

11:42:30 numbers is 1,450,000 because the cost -- the cost --

11:42:39 credit you are getting -- claiming you are going to

11:42:43 get, but we are not sure, that we are not actually

11:42:46 going to have it in writing of, you know, this

11:42:50 2,687,060, you know, the same as -- or less than your

11:42:59 estimate, what I add in your figures up to be the

11:43:02 estimate for the cost, as well as the administrative

11:43:05 costs.

11:43:06 So the numbers just aren't adding up.

11:43:11 You know, I would just like to also point out the fact

11:43:15 that not only are we not using historic buildings, but

11:43:22 we are hiring some company out of Oklahoma to run a

11:43:25 local -- three local health care clinics.

11:43:29 And it's not just that, as Mr. Miranda pointed out,

11:43:32 that we have people here, and we have buildings here.

11:43:36 I mean, we probably have after-hours clinics that are

11:43:41 open during the day that we can use.

11:43:44 There's all kind of possibilities for getting a better

11:43:46 deal.

11:43:47 And, you know, if we hadn't seen a lot of deals -- I

11:43:52 shouldn't speak for anybody else.

11:43:54 But I have seen a lot of deals where we didn't get the

11:43:57 best deals, the taxpayers didn't get the best deal, and

11:44:01 when something gets rushed through, it just seems

11:44:05 very -- it's worrisome, because it feels like -- it's

11:44:13 not necessarily going to stand up to the, you know, the

11:44:17 scrutiny that we are giving it, just at the council

11:44:20 meeting.

11:44:22 So I think the -- you have put us in this position

11:44:27 where we didn't have the information we kneed, which we

11:44:33 could have had months ago, and the employees are asking

11:44:39 us to pass this because of promises that have been made

11:44:42 to them and offerings that have been made to them, but

11:44:46 it puts us in this really bad position where we are not

11:44:49 necessarily convinced that we are going to be saving

11:44:54 money, and basically are talking about another

11:45:00 insurance contract, another privatized plan where they

11:45:06 are going to have to be -- the other thing that is very

11:45:09 strange is how do they make money?

11:45:12 When you look at the numbers, it doesn't seem to add

11:45:14 up, because they have got to make some money.

11:45:17 They have got to be able to make money on this.

11:45:21 And certainly doctors and the pharmaceutical industry

11:45:30 know how to make money and they'll figure it out.

11:45:33 >>> If I may, one of the reasons that I think we are so

11:45:38 excited about this opportunity is that while there are

11:45:42 other doctors' offices and clinics and certainly

11:45:45 24-hour offices with availability here in town, this

11:45:51 group is dedicated to make sure that we are getting

11:45:58 each visit half the costs that our folks pay within the

11:46:02 network plan.

11:46:03 They are looking at giving us significant cost breaks,

11:46:06 as you can see from their presentation.

11:46:09 They have only listed a small portion of the generic

11:46:12 drugs that they will likely stock.

11:46:14 And there is a significant savings there.

11:46:16 And so in bringing this to you, our goal is to have

11:46:21 done an RFP that was a widely cast net, where there

11:46:25 were many companies that came to view it, but two

11:46:29 companies that bid, that each of them came back with

11:46:34 similar proposals.

11:46:37 This is what they do.

11:46:38 And so I bring this before you asking for your support

11:46:43 of it.

11:46:45 >>THOMAS SCOTT: Well, let me just say that it is now 15

11:46:47 minutes of 12.

11:46:48 I have to be gone by 12.

11:46:49 I have a series of questions.

11:46:51 Councilman Caetano has some.

11:46:58 Councilman Caetano and Mr. Miranda.

11:47:00 And Mr. Miranda, I do have a series of questions.

11:47:03 >>CHARLIE MIRANDA: I understand.

11:47:03 >>JOSEPH P. CAETANO: As Ms. Mulhern said, we have to

11:47:09 get the best deal.

11:47:10 A couple months ago there was an article in the "The

11:47:13 Tampa Tribune" yesterday about the parking meters.

11:47:15 I hate to bring it back.

11:47:16 But the city of St. Petersburg put 1,400 parking meters

11:47:22 at a zero cost.

11:47:23 We spent $2.1 million, okay.

11:47:27 So we did not get the best deal, in my opinion.

11:47:30 And I'm very concerned.

11:47:35 Our job here is to be a watchdog.

11:47:37 I talked to a doctor this morning who has done nothing

11:47:39 but emergency room.

11:47:41 And I am not going to say everything that he said, but

11:47:43 he said you take this plan to a bank, they won't give

11:47:47 you a loan because it's not a good business plan.

11:47:49 This is what this gentleman does for a living.

11:47:52 I faxed him the 30-something pages that I got

11:47:55 yesterday, and he read it overnight and called me this

11:47:57 morning.

11:47:58 And I'm not going to go into all the detail because we

11:48:01 don't have enough time.

11:48:01 But I'm very uncomfortable with this.

11:48:05 I'm burnt over the parking meters and I don't want to

11:48:09 be burned again.

11:48:10 Okay?

11:48:11 Thank you.

11:48:11 >>CHARLIE MIRANDA: Thank you.

11:48:15 This will be my second bite at the apple.

11:48:16 I won't make this as long as the first one.

11:48:19 Two things that come up to me.

11:48:21 $72,000 rent for location, the administration has not

11:48:26 changed, has not budged, does not want to compromise,

11:48:29 to come back with real figures.

11:48:30 That's number one.

11:48:33 Two of them are outside the city limits.

11:48:37 Number three, in my mind, forget the other two.

11:48:39 One clinic.

11:48:40 What is $72,000 a year debt service?

11:48:45 Over a million dollars.

11:48:50 And 4.5 percent, much more than a million dollars.

11:48:55 Am I correct?

11:48:56 >> Yes.

11:48:56 >> So the city can build its own clinic.

11:48:59 It chooses not to do that.

11:49:01 I'll tell you what I am going to offer you.

11:49:03 And I'll put it in writing. My whole net worth that

11:49:05 you can do better.

11:49:06 Not I.

11:49:07 You.

11:49:08 You go out and shop it to the right people.

11:49:13 This is two times what the normal family or general

11:49:15 practitioner makes, 260,000.

11:49:20 That's absurd.

11:49:23 The costs are absurd. The pass throughs, I don't even

11:49:27 know what they equal.

11:49:29 You don't either.

11:49:30 You don't know where the doctors are coming from.

11:49:32 You don't know what their relocation cost is.

11:49:35 We are doing all of this when we have people in this

11:49:37 city that have vacant buildings, that we can rent, at a

11:49:43 much lower rate, and maybe even give it to us at half

11:49:46 price for a year.

11:49:47 Why do I say a year?

11:49:49 Because the health insurance plan basically, even

11:49:51 though it's multiple years, is on a yearly basis, based

11:49:55 on the conditions of the contract and the amount of

11:49:59 volume that was created when they had a profit or loss.

11:50:04 So you have a one-year contract with United, and a

11:50:07 three-year contract with a clinic.

11:50:13 At one clinic for one year to meet the United needs.

11:50:16 See how it goes.

11:50:17 Test it.

11:50:17 See if it works.

11:50:19 I hope that I'm right and wrong at the same time.

11:50:22 Because I want to see this happen.

11:50:24 I want to see this happen throughout this county,

11:50:28 throughout the state, throughout this nation.

11:50:30 That's the only way you are going to solve health care.

11:50:33 But by just giving it to another company to run, they

11:50:37 are not doing this for free.

11:50:39 You think they don't have administration costs,

11:50:41 transportation costs, travel costs, legal costs, party

11:50:44 costs, vice-president, president, secretary, treasurer?

11:50:47 Of course they do.

11:50:49 But that's what's wrong with America.

11:50:51 We take the easy way out.

11:50:53 I don't.

11:50:55 I still offer you my total net worth.

11:50:58 You want to offer me yours?

11:51:01 >> I think we have ten minutes left.

11:51:03 Let me just raise a couple of questions so that we can

11:51:05 move forward.

11:51:06 I guess the bottom line becomes this, and I'll make

11:51:09 some closing comment.

11:51:11 You have a proposal before us, and you have a proposal

11:51:15 that says, as I understand it, Humana this, United is

11:51:24 this with or without the clinics.

11:51:30 Basically when you look at this last memorandum you

11:51:32 sent us, I'm assuming that Humana original cost was

11:51:37 2011 was at 40.7 or 20.3% increase.

11:51:42 The best and final offer was 38.6%.

11:51:47 30.6 million.

11:51:49 13.9.

11:51:51 United is 36.

11:51:54 And then with the clinic it drops to 35.

11:51:57 So in essence, if the clinics are not approved today,

11:52:03 you are still looking at United for a very minimal

11:52:08 savings.

11:52:08 Is that right?

11:52:09 >>> We would be looking at the United price, which was

11:52:11 the $36 million price.

11:52:15 Their best and final without the clinic.

11:52:17 >> So that still would be -- well, it would still be an

11:52:20 increase of 6.3.

11:52:24 Right?

11:52:24 >> Correct.

11:52:24 >> With the health care clinic, with the wellness

11:52:29 clinic, their final offer is 35.1.

11:52:39 I guess my question, what would be then the -- I guess

11:52:43 it would still be the same.

11:52:44 If you didn't have the clinic, it would -- the increase

11:52:47 would still be 6.3 over what we are currently maying

11:52:50 now.

11:52:51 >> That's correct, sir.

11:52:52 >>THOMAS SCOTT: So then what will be the increase with

11:52:57 the 35.1?

11:52:59 What is the increase with the clinics?

11:53:03 Follow what I'm saying?

11:53:05 >>> What percentage increase is it?

11:53:08 >> Yes.

11:53:08 Over what we are paying now.

11:53:09 >>> That's reflected in the memo as well.

11:53:14 That's -- I'm sorry.

11:53:16 I can have the Elmo.

11:53:17 It's one of the slides that we had just a moment ago.

11:53:22 That's the 3.5% increase.

11:53:31 >> 3.5.

11:53:32 So then let's say the clinic goes away, if council

11:53:37 decides not to move this today, the plan would go up by

11:53:42 6.3%, assuming you are still going with United Health

11:53:46 Care, is that right?

11:53:49 >>> Yes, sir.

11:53:49 Secondly, you hired a consultant.

11:53:58 Is that right?

11:53:59 >> We have a consultant.

11:53:59 >> Well, you have a consultant.

11:54:03 Your consultant helped you through this process?

11:54:05 >> Yes, sir.

11:54:05 >> Based on that consultant, I'm assuming he looked at

11:54:08 all of these plans, based on his experience, based on

11:54:13 his research, he has recommended, or she has

11:54:18 recommended, or the company has recommended that you go

11:54:20 with the wellness clinics?

11:54:22 >> That is correct.

11:54:23 >> Based on that recommendation, could you tell us

11:54:30 where did he get his information or what did he look at

11:54:32 in terms of other municipalities?

11:54:35 For instance, you talk about Clearwater.

11:54:38 >>> Yes, sir.

11:54:39 >>THOMAS SCOTT: What has been the success or the story

11:54:42 of Clearwater?

11:54:43 What has been the success of the store at Lakeland

11:54:45 since he recommended this?

11:54:46 I haven't seen any of that other than you say all of

11:54:49 the clinics are full.

11:54:50 Well, right now a lot of the original ones are full for

11:54:55 that matter.

11:54:55 But we need to know based on the recommendation, why

11:54:58 this recommendation?

11:54:59 Follow what I'm saying?

11:55:00 >>> I absolutely follow.

11:55:01 With your permission, Chuck Tobin from Gallagher

11:55:05 benefits has been our consultant now for three years,

11:55:08 and chuck is with us and I think he should answer the

11:55:11 question directly.

11:55:13 >>THOMAS SCOTT: Okay.

11:55:14 Yes, ma'am.

11:55:14 >> Good morning.

11:55:15 I'll speak fast.

11:55:16 >> State your name for the record.

11:55:17 >> Chuck Tobin with Gallagher benefits services.

11:55:22 The clinic concept is really an old concept, when

11:55:26 companies used to have doctors in-house, and come as a

11:55:31 new concept in the last couple of years.

11:55:33 We put this in with the city of Lakeland several years

11:55:35 ago, and savings of about $1 million a year off the

11:55:38 health plan which is significantly smaller than what

11:55:42 the City of Tampa is, and that includes the price of

11:55:45 running the wellness center.

11:55:47 It's a smaller center.

11:55:49 It only deals with employees, dependents -- all these

11:55:54 items are what we are trying to get to with what you

11:55:56 guys are achieving.

11:55:58 That's the one that I have direct contact with.

11:56:00 We are seeing this across the board with a lot of our

11:56:04 clients are asking for us to start reviewing the idea

11:56:07 of clinics.

11:56:08 You guys are a little bit ahead of the game.

11:56:11 Like I said, step out of the box or kind of on the edge

11:56:14 of the box, but it is -- really has saved, what we have

11:56:17 seen, saved employers money by concentrating the care.

11:56:21 It really has to do with the patient-doctor

11:56:25 interaction.

11:56:26 When you are going to the doctor, through any health

11:56:29 plan, it's a turning mentality, how fast can they get

11:56:33 people in and out of the doctors' office?

11:56:35 A patient usually spends about three to five minutes

11:56:37 with the actual doctor.

11:56:38 Under the clinic scenario, we are looking that they

11:56:42 spend 15, 20 minutes with the doctor.

11:56:45 This is where disease management program and how you

11:56:49 can identify that there are health care costs, health

11:56:52 care issues that are come about.

11:56:53 >>THOMAS SCOTT: Okay.

11:56:58 I have the floor right now.

11:57:00 Let me finish.

11:57:05 You had your turn.

11:57:06 You had your time.

11:57:09 So, then, based on your recommendation, your

11:57:12 experience, that is a real cost savings of dollars, is

11:57:17 what you are saying?

11:57:17 >> Yes.

11:57:18 Lakeland is smaller than Tampa.

11:57:19 >> They realized over a million dollars in savings?

11:57:23 >> That's correct.

11:57:24 >> In terms of clinic, how many clinics do they have?

11:57:26 >> They have one very, very small clinic.

11:57:29 And it's really the problem with -- one of the problems

11:57:31 that they have is it's so small they can't get people

11:57:37 in.

11:57:38 It's that's why when we looked at the City of Tampa

11:57:41 model, we understood the number and volume that we had

11:57:46 to experience.

11:57:47 That is why we came up with the number of three.

11:57:51 Didn't come up with some magic number.

11:57:52 The number three came out with how many people we

11:57:56 expected to see, how many office visits can we see

11:57:59 within a given day?

11:57:59 They all come down to number of people that we can get

11:58:02 in the clinic.

11:58:04 >>THOMAS SCOTT: Now based on that, you looked at the

11:58:07 data on the geographical location or zip codes of

11:58:10 whereof we get, so you came up with the three

11:58:13 recommended sites.

11:58:14 Is that pretty much it?

11:58:15 >> That's exactly how we did it, yes.

11:58:17 >> Based on what time?

11:58:22 >> We tried to get them within the general area,

11:58:26 usually about 10 to 15 miles is about the most that

11:58:30 someone is going to travel.

11:58:31 >> Would there be an issue with moving, let's say, two

11:58:37 of the clinics within the city, which I talk to the

11:58:40 mayor, and that was going to be a convert -- concerted

11:58:43 effort to move another one of those into the city, in

11:58:46 my discussion, anyway with, administration.

11:58:48 So pretty much that should not have any major

11:58:51 ramifications if another clinic is inside the city.

11:58:53 Is that right?

11:58:56 Driving time?

11:58:57 >> It comes close.

11:58:58 We really have an issue and can separate the two areas,

11:59:03 the north Tampa area, we have traffic concerns, that

11:59:09 the timing to get to the doctor's office would take too

11:59:12 much time.

11:59:13 And in the Brandon area, it's the distance from the

11:59:19 bedroom communities to into the city limits area.

11:59:26 >> All of that, though, is based on assumptions.

11:59:28 Is that right?

11:59:29 >> That's correct.

11:59:29 >> And so based on sums, it's a possibility you still

11:59:34 could move one of the clinics within a certain driving

11:59:36 distance and still be successful given the fact that

11:59:39 you already, given your experience with Lakeland, they

11:59:43 already saved a million dollars with one clinic.

11:59:45 >> Yes, that's right.

11:59:46 Certainly the intent here was to draw more dependence

11:59:48 into the program -- dependents into the program, and

11:59:52 that's by bringing them out to the residential

11:59:54 communities.

11:59:56 City of Lakeland is really concentrating on the

12:00:00 employees only and really factored in the employees'

12:00:03 wellness.

12:00:04 The design of the plan is a little different.

12:00:05 It's really factoring in the employee's wellness by

12:00:10 getting the wellness centers he out to the community

12:00:12 the intent was to get the dependent's more engaged.

12:00:16 >> I do have more questions, but Mr. Miranda wants to

12:00:19 raise a question.

12:00:21 >>CHARLIE MIRANDA: I want to raise a question quickly.

12:00:23 >>THOMAS SCOTT: Okay, because --

12:00:26 >>CHARLIE MIRANDA: You made a statement that I don't

12:00:27 believe, and I'll tell you.

12:00:29 You say the doctor in the different wellness center

12:00:34 gives you 15 minutes?

12:00:35 The only way to give you 15 minutes is if the body is

12:00:39 cold, and in a movement in the vascular, and you're

12:00:42 dead.

12:00:43 No doctor can be in business just giving patients three

12:00:46 to five minutes.

12:00:48 I take great offense to that because that's not a true

12:00:50 statement.

12:00:51 The doctors in this community, I don't know about

12:00:54 Lakeland, but I can tell you that they give you the

12:00:57 right and they at least check your heart, your lungs,

12:01:00 tip of your toes to make sure you are not getting --

12:01:03 that you are getting enough blood circulation.

12:01:05 Let me tell but the Clearwater experience.

12:01:07 They do have 700 employees going to the clinics out of

12:01:13 1600 and had to give them $25 Publix cards to go there.

12:01:17 >> I respectfully disagree.

12:01:18 The idea of the gift card was an incentive for the

12:01:21 employees with the health assessment.

12:01:24 It had no bearing --

12:01:25 >> Then I spoke to the wrong gentleman, the gentleman

12:01:28 that negotiated the deal so I respectfully disagree

12:01:31 with you.

12:01:31 >>THOMAS SCOTT: Mr. Stokes.

12:01:38 >>CURTIS STOKES: What's the start-up amount?

12:01:41 What's the start-up fee?

12:01:43 >> The start-up fee?

12:01:46 What do you mean a start-up fee?

12:01:48 >> The contract, compensation.

12:01:50 The start-up fee.

12:01:51 >>I don't have the contract in front of me.

12:02:26 >> Michael Laberge, Risk manager.

12:02:29 Respectfully, the answer to the question is that we are

12:02:30 asking Care ATC as part of this contract to front all

12:02:34 of the costs of any renovations of facilities.

12:02:38 The start-up fee would be the costs associated with

12:02:40 that.

12:02:41 The cost would accrue to the city.

12:02:44 However, they would be amortized over the full 36

12:02:46 months.

12:02:49 It is subject to the budget that we have provided to

12:02:52 you in the contract.

12:02:58 >>CURTIS STOKES: I didn't see in the here.

12:02:59 >> It's actual costs.

12:03:03 >> So when the clinic is finished we'll know what the

12:03:06 actual costs are.

12:03:06 We'll have the right to audit.

12:03:09 Mike has estimates, but it will be actual costs.

12:03:11 It's actual costs will be amortized over the life of

12:03:15 the contract.

12:03:16 >> So we won't no exactly what the dollars are until

12:03:19 it's completed but we have oversight.

12:03:27 But to get projections in the business plan you had to

12:03:30 plug in a number and the spreadsheet.

12:03:32 >> The initial discussions that Care ATC had with one

12:03:36 location where they are considering or leasing, all of

12:03:40 the costs with the exception of the x-ray equipment

12:03:42 would be part of the actual lease cost.

12:03:46 >>CURTIS STOKES: The reason I ask that question is when

12:03:49 I read this contract, it sound as if the city is

12:03:51 putting Care ATC into business.

12:03:58 The city shall be responsible in section 1.05 and 1.06

12:04:02 for all rent, security, property taxes, utility,

12:04:08 staffing, medical supplies, equipment, other items that

12:04:13 may be required by Care ATC or physicians to provide

12:04:17 adequate medical services under this agreement.

12:04:19 I think the reason I bring that up, as Mr. Miranda

12:04:23 alluded to, we have doctors in this community, and

12:04:27 would jump at the opportunity to open a clinic with the

12:04:31 city providing security, rent, because all the doctor

12:04:36 has to do is show up.

12:04:41 $260,000 a year.

12:04:43 >> Respectfully, councilman, is there a question that I

12:04:47 can answer?

12:04:50 >> The question I had was how much the start-up fee and

12:04:53 the shut-down fee.

12:04:56 Seems ware going to pay them to start up and to shut

12:04:59 down we have to pay them another fee.

12:05:01 And I was questioning what those fees were.

12:05:04 Page 11, 2.5.

12:05:07 >>CHARLES FLETCHER: The only purpose of those fees is

12:05:10 if we terminate prior to the end of the contract.

12:05:13 They bear those costs.

12:05:14 We do not terminate.

12:05:17 It is their capital that is covering those costs.

12:05:20 If we terminate, then we have to cover a portion of

12:05:25 those fees.

12:05:29 I'm sorry, I'll repeat that.

12:05:31 Those costs are calculated only for the purpose if we

12:05:35 terminate not for cause during the three years of the

12:05:38 contract.

12:05:41 >>CURTIS STOKES: What is that dollar amount?

12:05:43 >>CHARLES FLETCHER: We will know that.

12:05:44 There's an estimate in here.

12:05:46 >>CURTIS STOKES: A business plan and model it.

12:05:49 In my experience when you do a business plan and model

12:05:52 it, generally numbers connected to that.

12:05:57 We are.

12:06:00 >>CHARLES FLETCHER: We are not paying that cost unless

12:06:02 we terminate. If we are in a position where we are

12:06:04 terminating we will know what those costs are at that

12:06:06 time.

12:06:06 >> But if we give projections and came up with the

12:06:15 sample monthly cost, then there has to be a number we

12:06:20 plug into the projections.

12:06:21 It would not be part of the invoice.

12:06:25 It is not part of the invoice because they are

12:06:28 capitalizing the project.

12:06:31 They are taking care of all these costs up front.

12:06:33 >> They are capitalizing the project but at what cost?

12:06:44 >>> The basis for the contract is we are seeking

12:06:46 authority for the full $7.6 million -- let me answer

12:06:51 the question completely -- over a three-year period for

12:06:53 the entire service.

12:06:55 That's what we are seeking council authority to do.

12:06:58 The actual expenses that would be accrued is subject to

12:07:02 a service level agreement on an annual basis that the

12:07:05 city attorney, the purchasing director and the HR

12:07:08 director would agree with Care ATC.

12:07:11 And what you are doing is you are setting the maximum

12:07:13 threshold, and we are going to be required to work

12:07:16 below that level.

12:07:18 We are going to provide those services within the

12:07:21 budget constraints that City Council provides.

12:07:25 >>CURTIS STOKES: So that 7.6 over three years or six

12:07:28 years --

12:07:31 >>> 7.6 million respectfully is the total amount of the

12:07:34 contract over three years.

12:07:35 That's what we are requesting authority for.

12:07:37 The question you are asking is with respect to the

12:07:40 initial start-up fee.

12:07:41 The initial start-up fee will be negotiated with Care

12:07:44 ATC once we have identified the locations that will be

12:07:47 set up.

12:07:47 We don't know what those are yet.

12:07:49 But we are asking and seeking the authority up to that

12:07:52 7.6 million total over three years.

12:07:55 And staff is going to be working with Care ATC to

12:07:58 maintain within that budget over the three-year period.

12:08:01 The cancellation fees and the set-up fees would be a

12:08:04 function of the locations that are selected.

12:08:09 We are looking to find locations that are currently

12:08:11 suitable and ready to go so that we don't have a lot of

12:08:13 initial set-up expense.

12:08:15 We may have to do some painting, we placement flooring.

12:08:18 We do know that we have to purchase an x-ray equipment

12:08:20 for the main location since we'll be doing some

12:08:23 worker's comp related activities there.

12:08:25 >> So the only part that Care ATC is providing is the

12:08:31 doctor, the nurse practitioner and the assistants?

12:08:36 >> They are providing all of the expertise, all of the

12:08:37 computer technology, they are providing all of the --

12:08:40 >>CURTIS STOKES: The city is taking care of the

12:08:41 capitalization costs?

12:08:43 >>> It would be accrued over a 36-month period.

12:08:45 >>CHARLES FLETCHER: Let me address -- we are not

12:08:50 communicating well the business plan, apparently.

12:08:53 They are covering those capital costs.

12:08:56 We will be required to repay those if we terminate

12:09:01 early.

12:09:02 If we do not terminate, they will never show up on an

12:09:05 invoice, they will never show up on an annualized

12:09:09 payment, they will only be paid if the city terminates

12:09:13 early.

12:09:14 They are covering those costs.

12:09:17 Does that help?

12:09:18 >> Councilwoman Capin.

12:09:23 >>YVONNE CAPIN: Mr. Fletcher, please.

12:09:26 You just opened something.

12:09:28 We will repay if we terminate.

12:09:31 Is it prorated if we terminate the second year?

12:09:35 >>CHARLES FLETCHER: Yes.

12:09:36 Let me say one thing, and that is also if we terminate

12:09:39 for convenience.

12:09:40 If we have a problem with the doctor, have a problem

12:09:42 with the service, if we have a problem with the

12:09:44 management, and terminate for cause, then they eat

12:09:47 those costs.

12:09:47 We are not responsible for those costs under that

12:09:50 scenario.

12:09:51 >>YVONNE CAPIN: Thank you.

12:09:53 I'm going to say, I really appreciate all the questions

12:09:58 that my colleagues asked, and what it has done is

12:10:01 confirmed my vote for this plan that I approved last

12:10:10 week.

12:10:11 So I really appreciate all the questions.

12:10:14 I understood many of it before we came on, and just

12:10:18 made it more clear to me today.

12:10:20 Thank you.

12:10:21 >>THOMAS SCOTT: Okay, councilman Caetano.

12:10:23 >>JOSEPH P. CAETANO: Mr. Tobin, you said Lakeland has

12:10:27 a clinic do. They run their own clinic there or do

12:10:30 they have an outside company running it?

12:10:32 >>> They have an outside company.

12:10:33 >> Who is that company?

12:10:34 >>> The name of the company is health stat.

12:10:37 >> How come we.

12:10:38 Heard from you other than at the meeting and we hired

12:10:40 you as a consultant for three years, and you are up

12:10:42 here today for two minutes?

12:10:46 >> I don't know.

12:10:48 I'm always welcome to come here.

12:10:50 >> I spoke to my consultant last night, and as Mr.

12:10:53 Stokes said you need a business plan.

12:10:54 And if you go to the bank with this, they are not going

12:10:56 to give you a loan.

12:10:59 >>THOMAS SCOTT: Let me just ask a follow-up question

12:11:01 and then we need to make a motion or whatever we are

12:11:04 going to do here.

12:11:09 Three years for the clinic.

12:11:10 Why three years?

12:11:11 >>>

12:11:12 >> Three years for the clinic, there's an idea we

12:11:15 wanted to spread the cost, those buildout costs over

12:11:18 those three years.

12:11:19 But the three years of the clinic is really designed as

12:11:21 a more clinical basis for really engaging people over

12:11:25 time and getting them engaged in management.

12:11:29 Three years is the typical time when we start seeing

12:11:32 the significant return in investment.

12:11:33 That's why the three years is kind of three years and

12:11:36 not four or something different.

12:11:39 That's when we really start seeing really engaging

12:11:41 people, chaining their behaviors and getting the cost

12:11:43 savings.

12:11:44 So.

12:11:46 >> In your experience, how long have you been doing

12:11:48 this?

12:11:49 >>> Consulting or the wellness center?

12:11:52 >> The wellness sent jeer we brought the first one into

12:11:55 the city of Lakeland three years ago.

12:11:57 >>THOMAS SCOTT: So anyone outside of that?

12:12:00 >>> not that I'm directly involved in.

12:12:02 >> What about your company?

12:12:04 >>> We have several throughout the state that were

12:12:07 involved.

12:12:09 City of Dell way beach is one that was mentioned last

12:12:12 week and some others.

12:12:14 City of Palm Bay.

12:12:19 >>THOMAS SCOTT: Mr. Fletcher -- thank you, I appreciate

12:12:21 your help.

12:12:22 So we can try to wrap this up, what's before us today

12:12:26 actually is moving forward on a contract for the

12:12:29 wellness center, not the actual United Health Care

12:12:33 plan.

12:12:33 >>> That's correct.

12:12:34 >> So the administration wants no, no council's

12:12:38 position based on these so they can go back and

12:12:40 complete, I guess, the other negotiated part of the

12:12:43 contract with United.

12:12:44 Is that correct?

12:12:45 >>> That's correct.

12:12:45 >> One last question.

12:12:48 Do we enter into a three-year contract with the clinic.

12:12:51 However, they can be terminated in the at any point.

12:12:55 >>CHARLES FLETCHER: That's correct.

12:12:56 >> And thoughts costs will be prorated?

12:13:00 >>CHARLES FLETCHER: If we terminate for convenience.

12:13:02 If we terminate for cause the contractor has to eat

12:13:06 those costs.

12:13:08 >>THOMAS SCOTT: Now, council, with all that being said,

12:13:09 no matter what, and I hear about it, what the clinics,

12:13:15 you are going to realize at least a million-plus

12:13:19 savings no matter what.

12:13:20 That's what I heard.

12:13:21 The idea is to save taxpayers dollars.

12:13:24 Now, perhaps if we had more time we maybe could have

12:13:30 done these other things but right now we are at a time

12:13:34 sensitive I shall you have.

12:13:37 But the issue for me at this point is, do we save

12:13:39 taxpayer dollars?

12:13:39 The answer is what?

12:13:41 Yes.

12:13:41 You save taxpayer -- how much is that savings?

12:13:44 We know based on testimony today and looking at what is

12:13:47 provided that we are looking at at least a million

12:13:50 dollars.

12:13:50 Is that safe to say?

12:13:54 >> Kimberley Crum: Yes, sir.

12:13:56 >> So we are looking at at least a million dollars

12:13:59 annually in terms of savings.

12:14:00 It could be more.

12:14:01 >> That's correct.

12:14:02 >> And secondly, in my discussion with the

12:14:08 administration, with the mayor, there is the

12:14:11 opportunity or at least there's going to be an

12:14:13 aggressive opportunity or at least to try to put

12:14:16 another clinic within side the city.

12:14:19 We have one but we are going to look at, as I

12:14:21 understand, talking to the mayor and also the

12:14:23 administration, making sure we are going to look at

12:14:26 trying to move one closer inside the city boundaries.

12:14:30 >> We are going to evaluate all sites very carefully.

12:14:32 >> Okay.

12:14:34 Now, I am going to support this today based on that and

12:14:38 plus the fact the savings of at least a million

12:14:41 dollars.

12:14:41 Okay?

12:14:43 I will close with this, and then we'll want to make a

12:14:48 motion.

12:14:48 I will say this.

12:14:49 Actually, what we have today is a tension, and the

12:14:57 tension is that the administration brought us this

12:15:00 document really at the last minute when we should have

12:15:04 had this much sooner so we could have done a workshop

12:15:07 and had opportunity to answer all of the questions, and

12:15:11 afford you the opportunity to go back out and do

12:15:13 additional research.

12:15:15 Okay.

12:15:16 We got this document, we got this information at the

12:15:19 last minute.

12:15:20 In fact, we first found out about it when we read about

12:15:23 it in the paper.

12:15:24 I think we all were kind of concerned about really the

12:15:27 paper.

12:15:29 That's the issue.

12:15:31 That's the issue for this council.

12:15:33 Because what you have said to this council is this.

12:15:39 We pretty much look to you to rubber stamp because we

12:15:41 have already done it.

12:15:43 Now, you may not say that, but the action of bringing

12:15:49 it to us at the last minute caused us to be where we

12:15:52 are.

12:15:53 So that has created some tension here with us.

12:15:57 Okay?

12:16:00 I will say, my position is when you are bringing these

12:16:05 kind of things that need to be approved, council needs

12:16:08 to have these things far enough in advance so we can

12:16:12 have an opportunity to digest them, research them, and

12:16:15 look so that we know we are making -- or approving --

12:16:21 understand, we are elected officials, too, and we have

12:16:25 an obligation to do our due diligence and work hard to

12:16:27 make sure we are getting the best bang for our buck as

12:16:29 well.

12:16:30 I recognize the fact the charter, we have a strong

12:16:35 mayor form of government, but within that strong mayor

12:16:38 form of government this council has a responsibility to

12:16:39 review and to look at and to sign off on certain

12:16:43 contracts.

12:16:44 Either vote it up or down.

12:16:45 I recognize that.

12:16:46 So I will say, I am going to support this today with

12:16:51 the understanding that in the future that you all bring

12:16:54 these kind of things to us in enough time, not at the

12:16:57 last minute, and put us in this kind of position that

12:17:01 does not afford us the opportunity to get certain

12:17:04 answers and to maybe send out a clear signal and

12:17:07 message.

12:17:09 So with that the floor is open.

12:17:20 >>CURTIS STOKES: Mr. Chairman, I am in strong support

12:17:21 of what you do.

12:17:22 I believe the wellness clinic will work.

12:17:25 But I still have grave concerns about the costs.

12:17:29 I don't believe the numbers.

12:17:32 But I do believe we may save about a million dollars a

12:17:36 year.

12:17:36 Anytime the city can save taxpayers money, I

12:17:39 wholeheartedly agree with that.

12:17:41 Next year, this council, whatever council, maybe the

12:17:46 mayor, will face a daunting task of balancing the

12:17:51 budget.

12:17:55 With that, the million dollar saved next year, it's

12:17:59 almost certain that United Health Care, they will raise

12:18:03 rates, and it will be in excess of a million dollars.

12:18:07 Because it seems to me as a maximum savings that we

12:18:11 realize from these wellness centers, there's a cap of

12:18:14 about a million dollars.

12:18:15 Next year when United raises rates, say they raise them

12:18:19 6%, that's an additional $2.6 million.

12:18:24 We will be in the red on this contract on this

12:18:27 endeavor.

12:18:30 I just have real serious concerns about this going

12:18:33 forward.

12:18:35 I support the wellness clinics.

12:18:36 But looking in the crystal ball five years out, three

12:18:39 years out, the city is going to end up paying money for

12:18:44 this going forward.

12:18:45 >> That raises a question, though, because that's not

12:18:51 what the consultant said.

12:18:52 They are saying it will save money every year with the

12:18:54 increase.

12:18:56 Anyway --

12:18:57 >>CHARLIE MIRANDA: No, I don't want to speak to --

12:18:59 >>THOMAS SCOTT: If you want to speak to that.

12:19:00 >> Chuck Tobin again with Gallagher.

12:19:05 The important part of these clinics is in taking the

12:19:07 dollars and cents out of it is the clinical interaction

12:19:10 with the patient-physician.

12:19:12 What we see with these is typical health care trend,

12:19:16 what the health care carriers are trending out is 12% a

12:19:20 year.

12:19:20 We could look at it without clinics, a 12% increase

12:19:24 with the clinic, a 6% increase.

12:19:27 That's kind of what we are seeing here.

12:19:28 That's different so that 6% difference is then

12:19:31 compounded the next year.

12:19:32 And then compounded the year after that.

12:19:34 So with the clinic mentality and really engaging these

12:19:39 people in the disease management programs, eventually

12:19:41 we are going to see what we anticipate is a three to

12:19:45 one return on investment for each year.

12:19:47 So when we are spending $2.6 million for the clinic

12:19:51 services, we are going to probably see a 7 to $8

12:19:54 million savings on the health insurance premium over --

12:19:58 at that third year, that third year.

12:19:59 >>THOMAS SCOTT: Okay, let's get a motion.

12:20:04 >>GWEN MILLER: I am going to make --

12:20:06 >>MARY MULHERN: I just want to be really clear about

12:20:09 this, unless I have been somewhere else.

12:20:14 We are paying the administrative costs of these

12:20:17 clinics, right?

12:20:20 We are paying the rent, the overhead, the City of

12:20:23 Tampa, right?

12:20:26 >>> That's correct.

12:20:29 >>MARY MULHERN: That's estimated by you at, based on

12:20:32 the second -- so going with your figure of 2.68 million

12:20:40 credit, that's about the same amount that we are paying

12:20:43 to open three clinics.

12:20:45 >>> That's correct.

12:20:46 >> So you have to subtract?

12:20:50 I mean, if you add that, basically, cost, United Health

12:20:57 Care is basically, you know, one or the other, either

12:21:01 we pay to open the clinics, we build out these clinics,

12:21:04 or we pay more of a premium.

12:21:09 I don't, you know -- I guess the projection is based on

12:21:12 the worker's comp.

12:21:15 I guess that's what we come down to.

12:21:22 I guess I'm talking to myself.

12:21:23 >>THOMAS SCOTT: Is there a motion?

12:21:24 >>CHAIRMAN: Before I make the motion I would like to

12:21:26 say that I was briefed about this, so I don't know why

12:21:31 other councilmen weren't briefed, but was briefed and I

12:21:34 understood it clearly when they came to my office and

12:21:36 talked to me about it.

12:21:37 So I am going to make a motion that we give the

12:21:41 administration or whoever it is the permission to

12:21:43 proceed with the wellness clinic.

12:21:46 >>YVONNE CAPIN: I let me speak to the motion

12:21:52 >>YVONNE CAPIN: I second it.

12:21:52 >>CHARLIE MIRANDA: Let me speak to the motion.

12:21:54 That's what I was waiting for.

12:21:55 The administration said it wasn't for 18 months, is

12:21:59 that correct?

12:21:59 I can run back or whatever the tape.

12:22:01 Yes, I was briefed.

12:22:02 I was briefed about four weeks ago when I told them I

12:22:04 would not vote for any clinic outside the city.

12:22:09 That is before I knew what the costs were.

12:22:11 When I start looking at costs, and I start running

12:22:13 numbers, it is catastrophic that you don't change, and

12:22:18 you don't budge, that you don't say it's either this

12:22:20 way or the highway.

12:22:23 Let me tell you that between last week to this week, I

12:22:28 don't know about the other council members, but my

12:22:31 number has not changed.

12:22:33 My office has not moved.

12:22:34 And I have had the same aide.

12:22:37 And no one has called.

12:22:39 I don't know about the other council members.

12:22:42 Because I'm sure they have been briefed.

12:22:47 So I guess maybe I never got elected.

12:22:50 So what I'm saying is that knowing what I know about

12:22:55 costs, knowing what I see here, knowing that United

12:23:00 health is for one year, the clinic contract is for

12:23:04 three, knowing what they said that if we get out

12:23:08 without cause, meaning if United Health Care wanted to

12:23:12 change, something happened, whatever, and you can't

12:23:15 forecast the future because everything we talked about

12:23:16 today is based on one word -- assumption.

12:23:21 I can't go on a business plan on assumption.

12:23:25 I didn't buy my house on assumption.

12:23:28 I didn't buy my car on assumption.

12:23:30 I bought it because I assumed I could pay for it.

12:23:38 This plan could be reduced if the city build their own

12:23:42 clinic.

12:23:42 And let me tell you, Clearwater, you can check, the

12:23:46 gentleman I spoke to, looking into the future of

12:23:48 building their own building or having their own

12:23:50 building.

12:23:52 That's a savings in itself.

12:23:56 The scare tactic is that you either do it now, it costs

12:23:59 the employees more money, I am going to pressure you

12:24:06 doing it my way or the highway.

12:24:09 That's not the attitude to take.

12:24:11 That's the attitude that was given.

12:24:13 And I will not be supporting the motion because when

12:24:17 you start to build out in the county, when you have

12:24:19 vacant spaces in the city, people that pay taxes in the

12:24:22 city, doctors that are here in the city that can do the

12:24:26 same thing for much less than $260,000 a person, a

12:24:29 doctor, is a waste of money.

12:24:33 You are wasting talent.

12:24:34 These are not just board certified.

12:24:37 These are specialists.

12:24:40 But, in a, we are going to take the easy way.

12:24:43 Ware going to hire a consultant.

12:24:44 Something went wrong with that guy with the yellow tie

12:24:47 that went wrong.

12:24:48 I don't do it that way.

12:24:50 Something goes wrong, I did it.

12:24:52 So it went wrong, I take responsibility for it.

12:24:55 We are afraid to take responsibility of going outside

12:24:57 the box.

12:24:59 By creating something different, something that works.

12:25:03 And therefore I will not be supporting that motion on

12:25:05 the floor.

12:25:06 Thank you, Mr. Chairman.

12:25:07 >>THOMAS SCOTT: Yes.

12:25:09 >>MARTIN SHELBY: I want to clarify the motion.

12:25:12 The motion is to move the substitute resolution?

12:25:14 >>GWEN MILLER: Yes.

12:25:15 Move the substitute resolution.

12:25:17 >>THOMAS SCOTT: Motion made by councilman Miller,

12:25:20 seconded by Councilwoman Capin.

12:25:22 All in favor of the motion say Aye.

12:25:23 Opposes?

12:25:24 >> CLERK: Caetano, Scott, Miranda --

12:25:30 >>THOMAS SCOTT: I voted yes.

12:25:30 >> CLERK: Caetano, Miranda, Mulhern and Stokes voting

12:25:34 no.

12:25:35 You voted yes?

12:25:36 Okay.

12:25:37 So the final vote would be Caetano, Miranda and Mulhern

12:25:40 voting no.

12:25:40 >>THOMAS SCOTT: So the motion passed by a vote of 4-3.

12:25:44 Is that right?

12:25:45 >>GWEN MILLER: Yes.

12:25:47 >>CHARLIE MIRANDA: Administration did a good job of

12:25:50 lobbying.

12:25:50 >> I will say this to us before we leave again.

12:25:53 I think it's always wise --

12:26:00 >> I take offense.

12:26:01 >> I think it's always wise that the administration

12:26:02 always talk to all council people and that's what I

12:26:05 recommended when I called the meeting that they brief

12:26:08 all of the council persons, even if you don't agree,

12:26:10 it's always wise to talk to everybody.

12:26:13 Okay.

12:26:16 Motion to receive and file?

12:26:19 >> So moved.

12:26:20 >> Second.

12:26:22 >>THOMAS SCOTT: All in favor?

12:26:22 Council, I have one thing here from Greg Hart.

12:26:28 They want to schedule a workshop for the MBE update for

12:26:32 January.

12:26:34 I would like to move that.

12:26:36 That's the workshop on --

12:26:40 >>MARTIN SHELBY: The 22nd, Mr. Chairman, your workshop

12:26:43 date.

12:26:44 You have the bicycle safety action plan at 9:00.

12:26:48 >>THOMAS SCOTT: Okay.

12:26:48 9:00.

12:26:49 >> Do you want to set this for 9:30?

12:26:52 >> Whatever time after that we'll move.

12:26:54 Okay.

12:26:56 I move that.

12:26:59 >>GWEN MILLER: We have a motion and second.

12:27:01 All in favor of the motion say Aye.

12:27:03 Opposed, nay?

12:27:06 >>CHARLIE MIRANDA: We need accommodation for the award

12:27:08 winners?

12:27:09 I can move for the water wise award winners for the

12:27:12 year.

12:27:15 >>THOMAS SCOTT: Moved and seconded.

12:27:16 All in favor?

12:27:17 Opposes?

12:27:17 Okay.

12:27:18 Anything else?

12:27:19 Motion to receive and file, did we that already.

12:27:21 All right.

12:27:22 We stand adjourned.

12:27:23 Thank you.



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