In union-dense New York City, Local 3 has long operated a medical clinic for members from its headquarters in Queens. Its nearly 30,000 members could populate a respectably-sized small town, so it's little wonder the local has the means to offer its Pension Hospitalization and Benefit Plan participants a wide range of services, from apprentice entry exams to X-rays.

But smaller membership numbers don't have to mean affordable health care and clinic solutions are out of smaller locals' reach, and they're proving it at IBEW locals in Cincinnati and Las Vegas.

Delivering better health care service was something Business Manager Al Davis had long wanted to do for the 3,400 members of Las Vegas Local 357.

"I brought it up when I became business manager in 2011," he said. "But I was told that it wasn't cost-effective."

A few years ago, however, at a construction trades meeting in California, Davis had an informative discussion with a leader from another union, who spoke glowingly about his own local's success with operating a health care clinic.

That conversation made Davis more determined than ever to get something going for his members.

"When I got back to Las Vegas, I told our trustees that I wanted to make this happen," he said.

Davis also learned a great deal about clinics and pharmacies for union locals as the agent on the health care facility built for Nevada's Culinary Workers Union Local 226, a UNITE HERE affiliate that represents about 50,000 gaming, hotel, and food-service workers at casino resorts in Las Vegas and Reno.

It was crucial for Davis to find an outfit that understood the needs of electrical workers as well as the unique regulatory and reporting requirements unions face. His local eventually decided on Activate Healthcare, a Midwest-based company that specializes in providing clinic services to nonprofit organizations, including labor unions and a variety of corporate clients.

Typically, a local negotiates with Activate a fixed per-month price for services, accounting for the estimated number of people eligible to use the clinic — say, the members of the local and their families.

"But one of the reasons we selected Activate was that they were willing to do a 'cost-plus' for us," Davis said. Cost-plus is a pricing strategy that is not based on usage. Instead, Activate agreed to provide services for a fixed management fee, plus lab and prescription costs, to achieve long-term savings.

"Cost-plus works better for construction locals. It certainly worked out better for us," the business manager said, noting that Local 357's members have a clearer understanding of the fixed service costs going forward while Activate keeps a strong handle on its profit margin.

Activate estimates that such partnerships can help locals reduce hits to their health and welfare funds anywhere from 10 percent to 25 percent.

"We have the potential to save a ton of money on lab fees because we can buy them in bulk," Davis said, offering an example. "We're cutting out the middle man." He also said that the clinic has helped to lower health costs for retired Local 357 members, who have free access with no copay and no deductible.

Local 357's clinic, which opened last September about two miles from the L.U.'s downtown office, is set up to handle about 2,500 visits a month, Davis said, a figure that easily meets his local's objective of providing a comprehensive line of free, primary-care medical services for members and their families. The clinic employs a doctor, a nurse practitioner, and three medical assistants.

Davis has been pleased with how the clinic encourages Local 357's members to take an interest in their health.

"It does a good job of catching members who might not go to a primary care physician," he said. "Right now, we're at 30 to 40 percent usage, well ahead of the curve and growing."

Cincinnati Local 212 Business Manager Rick Fischer is finding similar health care success thanks to his own local's experience with Activate.

"A lot of members who've never been to a doctor are checking it out," he said.

Local 212 has jurisdiction in three southwestern Ohio and four northern Kentucky counties and in three counties in neighboring southeastern Indiana.

Leaders of some IBEW locals in Indianapolis had told Fischer about their interest in operating health-care clinics. He'd also spoken about the idea with representatives of other Hoosier State locals, mainly from the Ironworkers and Plumbers unions.

United Association Local 440 in Indianapolis, for example, runs an Activate clinic for its members, as does Cincinnati's UA Local 392, located just across the Ohio River in Erlanger, Ky.

Fischer worked out a plan for the UA local to share its Erlanger site with Local 212. "We thought, 'If we could both use the same office for our southern members, it could serve them and save some money at the same time," he said.

Shortly before Las Vegas Local 357 opened its clinic last September, Cincinnati Local 212 cut the ribbon both on its Kentucky clinic and on a second location in the local's headquarters in Cincinnati's northern suburb of Sharonville.

Both of Local 212's clinics are conveniently located, and the dual locations mean reasonable driving distances for all of the local's widespread members. Giving them easy access to the facilities' doctors, nurse practitioners and nurse's aides was a top priority, Fischer said.

The clinic means there are no logistical hurdles to things like pre-employment drug testing, for example. Generic prescription drugs dispensed by the clinic are free for members as well.

"Everybody that uses it has high praise for it," Fischer said, adding that the number of clinic visits has been steadily growing.

"Right now, it's more of a benefit for members than a savings for us," Fischer said, "but we're getting there. It's a good thing. It'll pay off in 24 to 26 months."

A grand-opening incentive plan helped grow Local 212 members' interest in the clinics, the business manager said.

"Members could get a $50 Visa gift card on their first visit," he said. "For some of them, this is how they're finding out for the first time that they have health issues."

Many locals already have found ways to save money on health care with the Family Medical Care Plan, the health benefit organization operated jointly by IBEW and the National Electrical Contractors Association. Local-run clinics can work hand in hand with the FMCP, which serves nearly 100,000 participants from about 170 locals, as well as a few larger companies that use it to provide insurance for IBEW members who are covered by a union contract.

"Keeping members healthy and working — and caring for those who need care — have long been top priorities for this organization," said International President Lonnie R. Stephenson. "Getting creative to help take away some of those stresses — by making quality health care available to members — is a can't-lose proposition."