The URL can be used to link to this page

Home My WebLink About10/15/2013 13A Council General Information t i t r jJIffJI t . _ �fY BUSINESS OF THE CITY COUNCIL YAKIMA, WASHINGTON AGENDA STATEMENT Item No. / 3 1 For Meeting of: 10/15/2013 ITEM TITLE: Council General Information SUBMITTED BY: Sonya Claar Tee, City Clerk SUMMARY EXPLANATION: 1. Weekly Issues Report 2. City Meeting Schedule 3. Preliminary Future Activities Calendar 4. Draft Preliminary Council Agenda 5. City Council Study Session Schedule 6. Newspaper /Magazine /Internet Articles: *City of Yakima Health Costs article, City Vision Magazine, September /October 2013 Resolution: Ordinance: Other (Specify): Contract: Contract Term: Start Date: End Date: Item Budgeted: Amount: Funding Source /Fiscal Impact: Strategic Priority: Insurance Required? No Mail to: Phone: APPROVED FOR City Manager SUBMITTAL: RECOMMENDATION: ATTACHMENTS: Description Upload Date Type ❑ info 10/10/2013 Cover Memo • MEMORANDUM October 10, 2013 TO: The Honorable Mayor and City Council Members FROM: Tony O'Rourke, City Manager SUBJECT: Weekly Issues Report • NO EXECUTIVE SESSION NEXT WEEK: The City Council does not have an executive session on Tuesday, October 15. The regular business meeting will begin at 6:00 p.m. • ASSOCIATION OF WASHINGTON CITIES MEETING: The Association of Washington Cities is having a regional meeting in Yakima at the Holiday Inn on Wednesday, October 16 at 6:00 p.m. If you are interested in attending please let Cally know. • COUNCIL BUILT ENVIRONMENT: The Council Built Environment Committee (Coffey, Ensey and Lover) has a meeting on Thursday, October 17 at 2:00 p.m. in the 2 Floor Conference Room. • CITY MANAGER LEAVE: I will be out of the office on Friday, October 18 to attend the Florida State showdown with Clemson. This game is BIG!! City Attorney Jeff Cutter will be the Acting City Manager in my absence. CITY MEETING SCHEDULE For October 14, 2013 — October 21, 2013 Please note: Meetings are subject to change Monday, October 14 8:30 a.m. Pension Board meetings — 1 Floor Conference Room 10:00 a.m. City Council Media Briefing — Council Chambers Tuesday, October 8 10:00 a.m. County Commissioners Agenda meeting — Council Chambers 6:00 p.m. City Council meeting — Council Chambers Wednesday, October 16 9:30 a.m. Emergency Services Executive Board meeting — Office of Emergency Mgmt 12:00 p.m. PAL Board meeting — PAL Center 3:30 p.m. Arts Commission meeting — 2" Floor Conference Room 5:30 p.m. Community Review Board — Council Chambers 6:00 p.m. Assn. of Washington Cities Regional meeting — Holiday Inn Thursday, October 17 9:00 a.m. County Hearing Examiner — Council Chambers 2:00 p.m. Council Built Environment meeting — 2" Floor Conference Room Monday, October 21 10:00 a.m. City Council Study Session — Council Chambers Office Of Mayor/City Council Preliminary Future Activities Calendar Please Note: Meetings are subject to change Meeting Date/Time Organization Meeting Purpose Participants Meeting Location Mon. Oct. 14 8:30 a.m. Pension Boards Board Meeting Coffey 1st Floor Conference Room 10:00 a.m. City Council Media Briefing Scheduled Meeting Ettl Council Chambers Tue. Oct. 15 12:00 p.m. Miscellaneous Issues Scheduled Meeting Cawley, Adkison, TBD Lover 6:00 .m, Cit Council Meetin. Scheduled Meetin. Council Council Chambers Wed. Oct. 16 9:30 a.m. Emergency Services Board Meeting Lover Office of Emergency Executive Board Meeting Management 12:00 p.m. PAL Board Board Meeting Coffey PAL Center 3:30 p.m. Arts Commission Scheduled Meeting Adkison 2nd Floor Conference Room 6:00 p.m. Association of Washington Scheduled Meeting Cawley Holiday Inn Cities - Regional meeting Thur. Oct. 17 2:00 p.m. Council Built Environment Scheduled Meeting Coffey, Ensey, 2nd Floor Conference Room Committee Meetin. Lover Mon. Oct. 21 10:00 a.m. City Council Study Session Scheduled Meeting Council Council Chambers Tue. Oct. 22 9:00 a.m. EMS Operations Board Board Meeting Lover EMS Office Meeting 12:00 p.m, Miscellaneous Issues Scheduled Meeting Cawley, Adkison, TBD Ettl 2:00 p.m. River Road project Scheduled Event Open River Road dedication Wed. Oct. 23 9:30 a.m. Emergency Services Board Meeting Lover Office of Emergency Executive Board Meeting Management 3:30 p.m. Yakima Planning Scheduled Meeting Ensey Council Chambers Commission 5:30 p.m. Historic Preservation Scheduled Meeting Bristol Council Chambers Commission Thur. Oct. 24 1:30 p.m. Council Economic Scheduled Meeting Bristol, Coffey, 2nd Floor Conference Room Development Committee Lover Meetin. Fri. Oct. 25 10:00 a.m. Council Public Safety Scheduled Meeting Cawley, Adkison, 2nd Floor Conference Room Committee Meeting Ettl , , , • , „ --- .-.- Mon. Oct. 28 12:00 p.m. Capitol Theatre Board Board Meeting Bristol Capitol Theatre Meeting 12:00 p.m. Greenway Board Meeting Board Meeting Ettl Greenway Visitors Center Tue. Oct. 29 12:00 p.m. Miscellaneous Issues Scheduled Meeting Cawley, Adkison, TBD Coffey Thur. Oct. 31 10:00 a.m. Yakima Regional PFD Scheduled Meeting Bristol Convention Center Meetin. Fri. Nov. 1 8:00 am. Sister City Meeting Scheduled Meeting Adkison 2nd Floor Conference Room DRAFT PRELIMINARY FUTURE COUNCIL AGENDA October 21, 2013 (Monday) 10:00 a.m. Study Session — Council Chambers 1) 2014 Budget 2) Downtown Plan Implementation November 5, 2013 (T) 5:00 p.m. Executive Session — Council Chambers 6:00 p.m. Business Meeting — Council Chambers • Set date of 11/19/13 for Public Hearing on the proposed 2014 Revenue and Expenditure Budget for the City of Yakima • Set date of 11/19/13 for Public Hearing on Revenue Sources and Consideration of Legislation pertaining to Ad Valorem Taxes to be levied for collection in Fiscal 2014 Year • 3 Quarter 2013 Accounts Receivable Status Report • 3 Quarter 2013 Treasury Report • 3 Quarter Financial Tend Monitoring Report • Quarterly Gang Free Initiative report • Resolution authorizing labor contracts with IAFF, Police and Transit • Resolution authorizing a Site Use Contract of the Miller Park Activity Center with the Yakima Police Athletic Public Hearings • Final Public Hearing and Resolution adopting the City of Yakima 2014 Annual Action Plan regarding the CDBG & HOME program funding. • Open record public hearing regarding consideration of the City of Yakima's Shoreline Master Program Update. • Public Hearing regarding revising municipal code re cellular telecommunication towers • Public hearing regarding recreational marijuana moratorium 10/10/2013 8'57 AM 2013 STUDY SESSION SCHEDULE Council Chambers 10:00 a.m. Oct. 21 1) 2014 Budget 2) Downtown Plan Implementation Nov. 12 1) Pit bull / Dangerous Dog Ordinance 2) Transit issues 10/10/2013 8:55 AM . . i , el/ # A \ N' 4 Cheryl Ann Mattia, Yaki HR manager, and Cit • Manager TorO'Rourke at the mRC employee health In 2011, the year Cheryl Ann Mat - clip' n downtown Yakima tia joined the city's human resources R. WO ' team, the City of Yakima spent $10 million on its health plan and was Illr e r expecting the bill to climb to $11 mil - • lion in 2012 —a 10 percent increase, F a nearly five times the average rate of N. .,r , inflation thatyear. As escalating medi- cal costs chewed away at cash reserves, Yakima's self- funded employee health mik. plan appeared to be barreling toward or ILI. a fiscal cliff. "We were not keeping our reserves e e * up to where they needed to be accord - . k !t ing to state standards," Mattia says. .� ( # . "We had to come up with ways to in- Lee f " =b , • s ;4411 troduce cost savings." At first the remedy remained elu- s sive. By the summer of 2012, when • i 4. , i Bronson Faul joined the plan and its le 1 employee -run board as an assistant ' city attorney, the situation was grow- ing ever more desperate. , ft i s "Our plan wasn't doing very well," l If ir4 i ll , Faul says. "There were questions about whether or not it would make it. There was still a ways to go, but we V { were headed in that direction." k II In a front -page article that October ( "Yakima Losing Fight Against Health . Care Costs "), the Yakima Herald - Republic reported that in 2013 the plan would need a $600,000 infusion from the city's general fund to cover costs, raising the specter of future layoffs and I" additional cuts to services. As city manager Tony O'Rourke put Thi is a significant it, "This is a significant legacy cost the city has to get its arms l egacy cost the city has to around. It's like the Cookie Monster. It's gobbling everything." et its arms around. It's B UT THERE WAS NOPE. EarlierthatJuly,arepre- 11 e the Cookie Monster sentative from Employee Benefits Management I t ' s gobbling everything Services cit city's a Montana -based firm that the processed the city's medical claims, had traveled -TONY O'ROURKE to Yakima's city hall to propose an innovative solu- YAKIMA CITY MANAGER tion: an in -house clinic for municipal employees and their dependents. In 2006, faced with double -digit annual increases from the self - insured health plan it maintained for its own 220 employees, EBMS had opened an on -site employee clinic in Billings, betting that the company could more effectively manage costs if it hired its own physicians and paid wholesale, rather than retail, prices for employee medical care. 1 16 CITYVISION MAGAZINE SEPTEMBER /OCTOBER 2013 PHOTOGRAPH BY KATHRYN STEVENS HEALTHY RETURNS The idea worked so well (this year, employee medical expenses q &A WITH RON GOETZEL actually decreased) that EBMS created a business around it: a subsidiary called miCare, which manages on -site employee As director of Emmy clinics for private companies and public agencies throughout University's Institute for in Yakima, where a local packaging Productivity the Northwest, including P g g Health and ; • manufacturer opened an on -site miCare clinic for its employees h 1? Studies , Ron Goetzel stud- • `'r`� ?: in September 2012. ies the impact that health Here's how the model works: after investing etween $40,000 ' ' g and wellness �'.• and $60,000 in a clinic build t icall a storefront with a : °f ( YP Y have on medical costs and reception area, two examination rooms, a lab, and a small phar- employee productivity. macy), miCare hires a medical assistant /receptionist, a physi- Here, he gives AWC his ., cian, and a midlevel provider (a nurse practitioner or physician prescription for a wellness assistant) who are contracted at a set fee to staff the clinic for a program that will work — specific number of hours per week (typically between 20 and 40 and pay dividends for hours). Employees and their dependents schedule appointments your city. via phone or online. Upon arrival at the clinic (patients must be seen within two minutes of the scheduled time), the employee is What's the first step in want to smoke, you're go- escorted into an exam room and spends a full 20 minutes with a starting up a successful ing to have to pay a higher physician. ( Nationally, the average patient-physician consultation wellness program? insurance premium." Or you lasts five to seven minutes.) In addition to conducting an exam, If you want an individual to can say, "I know you smoke, the physician maytake ablood sample or dispense a prescription; make changes, there needs but I will give you the tools laboratorytests are performed in-house, and prescriptions are dis- to be an awareness of what and the resources to fix and pensed on-site from a store of the 100 most-prescribed generics. constitutes good health change that. As long as you Total cost of the visit to the employee: $0. habits: knowing what to eat, participate in the change how to exercise, how much process, you won't have to In this scenario, miCare would bill the city $62 for the office to drink, why you shouldn't pay a higher premium on visit, $7.75 for the lab work, and 55 cents for prescribed antibi- smoke. your health insurance." It's otic. Alternately, if the same patient were to see a doctor at one And how do you effectively about giving people incen- of the dozens of conventional medical offices that would still communicate that? tives. be accessible to employees under the city's self- insured plan, The wrong way is to hand What's the role of city the city would receive a bill of $150 for the office visit, $120 for out pamphlets. leaders in modeling What's right way? wellness? Tailoring lab work and $52 for the same prescription. By using the n the your your message If the HR department sends city's miCare clinic instead of a conventional medical office, the to what will make a dif- out an e-mail that says employee would save the city $251.70, or 78 percent. (Typically, ference for people. Take everybody's got to start Yakima could expect purchasing medical care on a wholesale the example of smoking. doing this wellness stuff, basis to result in a three -to -one rate of savings.) Everybody knows it's bad then the mayor, the city Meanwhile, the patient could forgo three copays (for the office for you, but what will it take manager, and all of the visit, for a blood draw at a laboratory, and for the pharmacy) and for somebody to quit smok- department heads —who are ing? There are different even more important —need avoid trips to and waits at three separate facilities. In its first motivations. You can keep to be walking the talk and year of operation, the miCare representative told the City of raising the price of a pack practicing what they're Yakima' semployeebenefitsboardinJulythatyear ,thecitycould of cigarettes until it's too preaching. That means be- expect the clinic to reap $326,514 in medical savings —along with expensive to keep smoking; ing physically active and $ 164,060 in employeeproductivitythatotherwisewouldbelost New York City is looking at losing weight. in travel to and from and waits at conventional medical offices raising the minimum price Any notable examples? and pharmacies. That revenue, of course, could help shore up the for a pack of cigarettes to Former King County Execu- $20. tive Ron Sims, who moved city's ailing self - insured plan, and once costs were under control, What's another way? to Washington, DC, to be further savings could be used to slash employee premiums. Policy influences. An em- deputy secretary of the "The idea is that it saves money," explains EBMS miCare ployer may say, "I want you US Department of Housing director Jarrod Weenum. "And the way it saves you money is not to smoke. But if you continued on page 19 — that you are purchasing health care on a wholesale basis and moving away from the fee - for - service model. When you do that, you have a very lean, efficient medical system. With health care reform, there is not one thing that I have come across that offers SEPTEMBER /OCTOBER 2013 CITYVISION MAGAZINE 17 more control and savings than an �' l • ,. vs on -site clinic." - - ; Initially, after listening to Wee- _ _', T "ii'\ num's pitch, Faul was skeptical. E. '34. I So, late that August, he took a road trip to inspect a miCare clinic that 1 r had just opened in Bellingham, a `,; shared facility serving the employ s. 2 v. ees of a seafood processor and a :4+ S • :r' l 'l cold - storage warehouse. The expe- •r; j' rience convinced Faul that miCare ' p + 1 , �: t., was just what Yakima needed. ;e� 4 "My visit on Friday to the Bell- ' '�• Ingham miCare clinic exceeded I i. the expectations I had set," he J - wrote in an August 27, 2012, e -mail to the plan's board. "I talked with [the clinic's medical assistant] for Mayor Mike Cassinelli 2 quite awhile about what she likes and Treasurer Elaine q McMillan het co - and how it's different from other reel in re t lit offices. One thing that stuck out g' ...A was that she and the doctor were always smiling. I can't remember the last time I was at a doctor's office where everyone was happy We had two options: and smiling.... While we were talking, a ladywalked by the front of the clinic and stuck a sticky note shaped like a heart on the either we could file for front door. It was a note to the doctor about how she was doing the walking he told her to do. In the short months they have been bankruptcy, or we could opened, they are already needing to expand the hours as the try save the city. doctor has been sneaking in an extra two appointments per day." • His recommendation? e are savin g it• "My vote would be to proceed as fast as possible with imple- menting a miCare clinic. Not only does it save significant costs, —MIKE CASSINELLI ILWACO MAYOR but they really do provide superior medical care." Six months later, on February 20, 2013, Yakima's mayor cut a ribbon draped across the entrance of a freshly renovated former who, in addition to previously advising AWC's Employee Benefit physical therapy office just down the street from city hall, opening Trust, serves as chief strategic innovation officer at Providence the first municipal employee clinic in the state of Washington. Health .Sr Services. "As long as technology advances and people "Cities and municipalities are funded by the people, by tax continue to age, health care costs are going to be big. We do get dollars, and anytime you can come in and offer a higher level of a lot for our dollar compared to the way our lives were 100 years service that costs less money, it's hard to believe," Weenum says. ago, but it still feels like it costs too much, and it goes up every "This is the wave of the future." year. The question is: Where do we go from here ?" It's a question not easily answered, even from a professional who's spent the past three decades of his career tackling just that W RILE THE MICARE CLINIC may be the conundrum. Gifford says he's developed aPowerPointpresenta- wave of the future for self- insured cities tion with 230 bullet points summarizing the many strategies that like Yakima, at least one expert says it's no have shown promise in containing ever - rising health care costs. panacea for the health care financingwoes One is the on -site employee clinic. ailing most Washington municipalities. "It works well when it works — Microsoft does it, Swedish "I don't think there's any magic bullet," Hospital does it —but you have to see that it pencils out," Gif- says Dr. Joe Gifford, aveteran Seattle emergency room physician ford cautions. "There are negative things —not everybody wants and former chief medical officer ofRegenceBlueCrossBlueShield their employer to take care of their health; it's none of their 18 I CITYVISION MAGAZINE I SEPTEMBER /OCTOBER 2013 PHOTOGRAPH BY DON FRANK , business —but it can add value" and Urban Development. the program is making a For the majority of employers who use conventional health Basically, he said, "I'm in difference, it will not sur- plans —only 16 Washington cities, for example, are currently terrible health; I even had a vive. You need to be able to self- insured —on -site clinics would only add to the overall health heart attack. I have to get document that the invest myself in shape and provide ment is paying off in terms care overhead (factoring in start-up and operational costs), since services for my employees of health improvement and any savings accrued from the clinic would benefit the bottom to have access to health costs savings and employee line of the insurance company, not that of the employer. In these improvement programs." retention. cases, Gifford recommends choosing a managed care plan that He was leading by example, What's the average payoff contains costs by steering members to a contracted pool of health not just providing the re- of an employee wellness care providers with discounted fees for service (similar to the sources and giving people program? financial formula of on -site clinics), which runs counter to the sending out the message to -one return on invest - time to do these things, but Typically you'll have a three- unlimited and unrestricted access that long has been the norm that this is the culture here. ment: three dollars will be in municipal health plans. What are some practical saved for every dollar that's "If you are a city or any government agency, you have this ways to implement a invested. Even if it were a problem with broad access, letting people go to any doctor they wellness program in the one -to -one ROI, that's still a want," Gifford says. "Benefit plans like this are structured against workplace? pretty good investment. efforts to control costs, because if your employees are allowed to Some companies have What sorts of savings are go to any doctor or hospital theywant, there's no accountability offices with treadmill you talking about? workstations so employees Lower increases in health to keeping costs managed. If they get all their care in one place, can build physical activity care costs, healthier em- then that organization is held accountable." into their schedules. In the ployees, less absenteeism, And countering the no -fee model of the on -site employee cafeteria, you can subsidize and productivity improve - clinic, Gifford stresses the importance of shared fees for service, the salad bar so employees ments. like copays, in containing costs with traditional plans. pay less for a salad than What's the mistake most "Be sure consumers have some skin in the game," he advises. they would for a hamburger employers make when it "Not everything can be free. Be sure people pay a share of every- and french fries. You can comes to implementing a g p p p y slow down the elevator and wellness program? thing they do so they'll think twice before getting a new service, and open up the stairwells; if Most employers will say, make sure they have information so they can make good decisions." you put in carpeting or non- "We have a wellness pro- Those good decisions don't begin with choosing care, Gifford skid flooring and hang kids' gram: our health plan has stresses. "We have to get employees responsible for their own paintings on the walls and a website." But only 1 or 2 wellness," he says. " There's no better way to drive down the care pipe in music and put in a percent of employees will costs than to have healthier people. You need to give your em- good odor, all of sudden ever look at it, and those ployees economic incentives to stay well, exercise, and eat right." you will have an increase in are the health nuts who al- the number of people using ready are doing it. Going to And looking to 2018, he adds, it's just as critical that all cities the stairwell. a website, that's not going educate employees and bargaining units about the financial "Good odor," as in cooking to change anything. consequences of sticking with status quo premium health care french fries? Bottom line? plans, which will be subject to a 40 percent government tax No, no, no. You learn from The big takeaway for the when the "Cadillac tax" provision of the Affordable Care Act Las Vegas, where you walk public sector is that your goes into effect. (See our Noted feature on page 8 for more on into any hotel and there's people are your biggest a distinct odor, a pleasant asset. You're not produc- the Cadillac tax.) odor, like French vanilla. ing widgets; it's service "On the benefits side, you are going to have bite off new ways If an employer invests that you're providing, and to frame the discussion," Gifford says. "Nobodycan see verywell money in all of this stuff, you want your people to into the future about this stuff,, but I don't think anybodythinks how can you be sure it's be as sharp as possible, as health care costs are going to go down." paying off? energetic and motivated as Measurement and evalu- possible. This is one way to ation is critical: you may show that you care about have a great program with them and their well- being. OU DON'T HAVE TO TELL thatto Elaine McMil lovely brochures, but unless Ian, treasurer of Ilwaco, where city leaders were you have data that show contemplating filing for bankruptcy to deal with runaway costs — including employee health care — when she was hired to do the job in 2010 after Mike Cassinelli, a councilmember who runs a local charter fishingbusiness, was elected mayor. In his first week SEPTEMBER /OCTOBER 2013 CITYVISION MAGAZINE 19 1 1 I I _,_ --- III 4 ± _ ' , .a •� • l . .1 I = • — ' d :' ' '' I . ,. I iN on the job, Cassinelli slashed the city's payroll by 25 percent —lay- just the way it has to be ing off 3 out of 12 employees —to balance Ilwaco's hemorrhaging But Cassinelli isn't so sure. budget. Even after those extreme measures, McMillan recalls, "The thing that concerns me now is that we're trying to find for the first six months, there were weeks when she didn't think younger employees who have families, and it's very difficult to she'd be able to make payroll. bring them on board when you don't have something that covers "I ran for mayor because I saw how bad things were going," their whole family," he says. "We're looking for some better plans Cassinelli explains. "We had two options: either we could file for that cover the whole family —that we can afford. That's tough." bankruptcy, or we could try and save the city. We are saving it." McMillan, the city's chief financial officer, sees it differently. In part by slashing health care spending. When the city's pre- "For a lot of small, self - employed businesses around here, mium health plan was up for renewal, Ilwaco's council, working having any kind of a health care insurance is a pretty good deal," closely with AWC's Employee Benefit Trust, switched to a high- she says. "I feel fortunate in this economy just to have a job." deductible plan that that would save the city $250 per month per employee —or $27,000 a year, the cost of a half -time employee. "For a small city like ours, that's a good amount," McMillan EANWHILE, IN YAKIMA, things couldn't be says. "We wanted to put ourselves in a good position to deal going better at the employee clinic on Third with the new health care act and have employees start managing Street. Approaching its first anniversary, their benefits instead of always using them " To that end, the city Yakima's miCare clinic has been so popular, funneled $125 a month into individual health savings accounts with 95 percent of all available appointments for every employee, money that could help employees meet their booked, that the citywill expand its operations $1,500 deductible or, if unused, could be spent in the future for from 26 hours a week to 40 in 2014. Next year, Yakima also will health care expenses. But there was little Ilwaco could do to make debut awellness incentive, anteing $300 into the health savings up for the most unpalatable change put in place by the previous account of every employee who undergoes a basic laboratory administration: the city's plan no longer covered the dependents diagnostic test and a follow -up appointment at the clinic; in 2015, of employees. For McMillan, that means paying $900 a month the incentive will double to $600. "Once we know their numbers, we may be able to catch high blood pressure or cholesterol and be preventive, instead of having them turn into serious health conditions that we end up paying a lot more for," says Cheryl Ann Mattia, now the city's human Thi program is totally a resources manager. "This program is totally awin -win situation. • I I am so proud of Yakima being a pioneer in this. It's an idea that wi n -win situation. am has flourished and has changed the lives of employees and their so proud of Yakima being families. I got an e -mail from our water quality specialist, a guy T who hadn't been to a doctor in 10 years, who says, `I can't wait to I an a pioneer in this. tell others to use your clinic!' It's fantastic. I have no concerns at a11 id And she's that has fl ourished .I'mshst likin what numbers!' liking what shhe e sees. . In its first year of operation, and has char' ed the liv es the clinic will shave $326,000 off the city's tab for health care expenses, and it is on target to save a total of $1.8 million by 2016. of our em o gees and For City Manager Tony O'Rourke, who just a year ago likened 7 n Yakima's all- consuming health plan to the insatiable, dessert - their families. loving puppet from Sesame Street, the turnaround in fortunes — CHERYL ANN MATTIA couldn't be more dramatic. YAKIMA HR MANAGER "There's no downside; I can't find any negatives," he says. "The clinic has been operating for a little less than a year with out of pocket to cover the health insurance premiums of her very significant results. It's convenient; it's more affordable; it's husband and two children. a good service for our employees and ultimately our taxpayers, Although that's a struggle for employees with dependents, who are saving money." the city's finances have rebounded to the point that Ilwaco will And what can other cities, self- insured or not, learn from have enough cash in its 2014 budget to hire two new employees. Yakima when it comes to containing health care costs? "It's health care savings that helped us get to this point," she "If you lay the groundwork with your employees and tell them says. "Being the one who's trying to figure out the budget, this is what the savings are," O'Rourke reports, "they'll jump right in." C 20 CITYVISION MAGAZINE SEPTEMBER /OCTOBER 2013