worksite clinics: comprehensive management of employee health and cost

Comprehensive Health Management

Powered Through A Worksite Clinic

Brian KlepperBrian Klepper

Worksite Clinics:

Comprehensive Management of

Employee Health and Cost

Brian Klepper

November 12, 2007

Daytona Shores




This presentation is, in part, about our need for health care change, and why its a lot more likely to happen here:

And here:

Than here:

The Unrelenting CrisisThe Unrelenting CrisisThe Unrelenting CrisisThe Unrelenting Crisis




Source: IBI Full Cost Benchmarking Study - 2002 Benefits Data

The real cost of poor employee/family health is in lost productivity from:

• Absenteeism

• Presenteeism

• Disability

• Workers’ Comp

• TurnoverThe Dilemma: Benefits The Dilemma: Benefits

or Productivityor ProductivityThe Dilemma: Benefits The Dilemma: Benefits

or Productivityor Productivity




Reno’s Employers Are Reno’s Employers Are Apoplectic Over HC CostApoplectic Over HC Cost

• Employers only. No HC folks.

• Only CEOs, CFOs, COOs.

• Objective: Pool and mine claims data to identify problems and opportunities. Address them.

• They agreed in 1.25 hours of a 2.5 hour meeting.

• Employers are tired of haggling over HC. They want results right now. They don’t understand why the HC industry isn’t cooperative. They’re now taking action on their own.

Employers Are Tired OF HCEmployers Are Tired OF HCEmployers Are Tired OF HCEmployers Are Tired OF HC




• 2.1x As Fast As 2.1x As Fast As Business Earnings Business Earnings GrowthGrowth

• 4.1x As Fast As 4.1x As Fast As Workers EarningsWorkers Earnings

• 4.8x As Fast As 4.8x As Fast As General InflationGeneral Inflation

Premium GrowthPremium GrowthPremium GrowthPremium Growth




$14,500 - Total employer-sponsored $14,500 - Total employer-sponsored health care costs for a family of four health care costs for a family of four in 2007. (Milliman)in 2007. (Milliman)

$19,300/yr or less - 1/4 of US $19,300/yr or less - 1/4 of US workers’ incomeworkers’ income

$36,000/year or less - 1/3 of $36,000/year or less - 1/3 of families’ income (US Census)families’ income (US Census)

It’s Very Difficult To It’s Very Difficult To Make This WorkMake This Work

HC Cost & Workers’ EarningsHC Cost & Workers’ EarningsHC Cost & Workers’ EarningsHC Cost & Workers’ Earnings




2004 - Earnings/EE Compared2004 - Earnings/EE ComparedTo Avg Health Care Costs/EE To Avg Health Care Costs/EE

of $6,227 (Hewitt)of $6,227 (Hewitt)

Retailers - Net Profit/Associate 2004 HC/NPAWalgreen's 8,939 70%Sears 8,271 75%Target (Dayton Hudson) 8,219 76%Gap 7,566 82%JC Penney 5,623 111%Dollar General 5,360 116%Wal-Mart 5,350 116%Dillards 2,180 286%Source: Hoovers

Here’s The Here’s The Retailer’s PerspectiveRetailer’s Perspective

HC Cost & ProductionHC Cost & ProductionHC Cost & ProductionHC Cost & Production




“If [Medicare and Medicaid’s] costs continue growing at the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Peter Orszag, Director, CBO

Testimony to the Senate Committee on the Budget, 6/21/07

HC InflationHC InflationHC InflationHC Inflation




Lack of Consensus and Infrastructure for Data Sharing,

Standards & Transparency

Can’t see problems in the system

Has cultivated an opportunistic culture.

Why Cost & Poor QualityWhy Cost & Poor QualityWhy Cost & Poor QualityWhy Cost & Poor Quality

The Deepest Driver Of The Crisis

Plz Keep Lid OnPricing &

PerformanceData!!

Health Care




“Hospitals [and surgeons], if they wish to be sure of improvement...must analyze their results, to find their strong and weak points, [and] must compare their results with those of [their peers]...[They should] make this information publicly known so that the future patients might make informed decisions.”

1920Dr. Ernest Codman

proposes the “end result system

of hospital standardization”

A Century Later And We’re Still Waiting!




Medicare Per Capita SpendingMedicare Per Capita SpendingBy Hospital Referral Region, 2003By Hospital Referral Region, 2003

Source: Dartmouth Atlas Project, The Dartmouth Atlas of Health Care

Perhaps the most Perhaps the most significant significant hallmark of the hallmark of the crisis is our crisis is our inability to provide inability to provide consistent care consistent care that adheres to that adheres to the evidence and the evidence and is independent of is independent of financial conflict.financial conflict.

Practice VariationPractice VariationPractice VariationPractice Variation




Specialty Condition Low Average High

FP

Otitis media $46 $109 (+137%) $412 (+796%)

Bronchitis $89 $150 (+69%) $771 (+766%)

IM

UTI $81 $140 (+73%) $778 (+860%)

Angina $86 $297 (+245%) $743 (+764%)

Cardiology

Angina $241 $611 (+154%) $1389 (+476%)

Orthopedics

Knee surg. $2,727 $4,473 (+64%) $9,383 (+244%)

Source:Source: Jerry Reeves MD, Culinary Fund Heatlh Plan, 2005 Jerry Reeves MD, Culinary Fund Heatlh Plan, 2005

Practice VariationPractice VariationPractice VariationPractice Variation




Insanity:Insanity: doing the same thing doing the same thing over and over again over and over again

and expecting different and expecting different results.results.

Albert EinsteinAlbert Einstein

Self-Insurance

Reduced Coverage

Higher Co-Pays

Better Networks

Mailing Brochures for Patient Education

Telephonic Patient Mgmt

A Different ApproachA Different ApproachA Different ApproachA Different Approach




Worksite ClinicsWorksite Clinics

ComprehensiveComprehensive

Physician-Directed Physician-Directed

Preventive/Primary/Preventive/Primary/Urgent/Walk-InUrgent/Walk-In

For Employees & DependentsFor Employees & Dependents

A Platform To Manage A Platform To Manage Downstream CareDownstream Care

Clinic As PlatformClinic As PlatformClinic As PlatformClinic As Platform




Program Savings AreasProgram Savings Areas

Health PlanHealth Plan

Occupational MedicineOccupational Medicine Workers CompWorkers Comp Disability (STD and LTD)Disability (STD and LTD) FMLA, ADAFMLA, ADA Pre-Employment ScreeningPre-Employment Screening Fitness for DutyFitness for Duty

ProductivityProductivity





HealthHealthPlanPlan

The Clinic is Separate From And In Front Of The Health Plan

Patients Don’t Use The PlanUntil They Leave The Clinic.

So It Can Be Implemented At Any Time and Does Not Require Plan Changes.





The Clinic Is NOT MandatoryFor Employees/Dependents

Employees mayEmployees may

Wish to keep their primary care doctor.Wish to keep their primary care doctor. Wish to access care away from the employer setting.Wish to access care away from the employer setting.

This is completely acceptable. Normal health plan This is completely acceptable. Normal health plan deductibles and co-pays apply.deductibles and co-pays apply.





Feasibility CriteriaFeasibility Criteria

Employer self-insured for health coverage.Employer self-insured for health coverage.

Minimum of 100 employees on site.Minimum of 100 employees on site.





The BasicsThe Basics Total Costs - $50-$60 per month per employee.Total Costs - $50-$60 per month per employee.

Three year contract.Three year contract.

Pass-through build-out & operational costs plus management fee.Pass-through build-out & operational costs plus management fee.

Invest in clinic; ROI in claims. Highly transparent. Continual Invest in clinic; ROI in claims. Highly transparent. Continual

performance feedback.performance feedback.

Extremely convenient and employee friendly. No co-pay or drug Extremely convenient and employee friendly. No co-pay or drug

costs. Extended hours for dependants. Easy employee opt-out if costs. Extended hours for dependants. Easy employee opt-out if

desired.desired.





What We’ve LearnedWhat We’ve Learned Most health industry professionals have a financial stake in promoting higher Most health industry professionals have a financial stake in promoting higher

costs.costs.

Care is highly variable within and across markets. Half of all care/cost is Care is highly variable within and across markets. Half of all care/cost is unnecessary or inappropriate.unnecessary or inappropriate.

Convenient, open access to care reduces the need for downstream services.Convenient, open access to care reduces the need for downstream services.

Primary care, health care’s entry point, provides the best platform to manage Primary care, health care’s entry point, provides the best platform to manage full continuum care/cost.full continuum care/cost.

Chronic disease is responsible for more than half of cost, and can be Chronic disease is responsible for more than half of cost, and can be reduced significantly with lifestyle counseling and management.reduced significantly with lifestyle counseling and management.

Data can be analyzed to identify physicians and hospital services that Data can be analyzed to identify physicians and hospital services that routinely get the best outcomes at the lowest cost.routinely get the best outcomes at the lowest cost.

Given tools, patients respond to incentives to manage their health.Given tools, patients respond to incentives to manage their health.

Managing DifferentlyManaging DifferentlyManaging DifferentlyManaging Differently




How The Clinic At Least How The Clinic At Least Pays For ItselfPays For Itself

Changes to Primary Care and the Changes to Primary Care and the Drug Formulary pay for the clinic. Drug Formulary pay for the clinic.

Other services enhance the savings. Other services enhance the savings.

Typically, Before Clinic:Typically, Before Clinic:Primary Care = 22% of costsPrimary Care = 22% of costsDrugs = 18% of costDrugs = 18% of cost

Each drops by 50% = Each drops by 50% = 20% of cost20% of cost

Managing DifferentlyManaging DifferentlyManaging DifferentlyManaging Differently




Management Tools/ApproachesManagement Tools/Approaches

Primary Care Management

Drug Dispensary

Open Access

(Onsite) Chronic/Acute Care Management*

Data Analysis/Network Refinement*Each is proven to

reduce risk and cost.

How It WorksHow It WorksHow It WorksHow It Works




Doctors don’t profit from care services. They have no incentives to over-utilize.

All doctors use Electronic Medical Records and follow Best Practice Guidelines, for better, more consistent care/outcomes.

Patients make appointments by calling, through the Web-based scheduler, or by walking in.

Patients pay nothing for clinic visits or for drugs prescribed through the clinic.

Clinic doctors replace a primary care network where the care, referral patterns, and tools are often inconsistent and outdated.

Better access and convenience and prevents conditions (and costs) from becoming worse than they should be.





Analyzing claims data and having all enrollees take a Health Risk Assessment helps us identify health issues and chronic diseases that should be managed.

Nurses manage patients with chronic diseases and with complex acute conditions.

Claims data also let us identify the specialists and inpatient services that consistently get the best outcomes at the lowest costs.

A refined, high performance “downstream” network is more efficient and further reduces costs.





Works With

• Existing Programs• Open Enrollment • HR• Risk Management• Occ Med

Integrates With Existing ProgramsIntegrates With Existing ProgramsIntegrates With Existing ProgramsIntegrates With Existing Programs




Pricing/Performance Transparency

Provides Monthly Group Transaction Reports

and,

With Access To Complete Health Plan Data, Routine Performance Reports.

HOWEVER -

Data Is Crucial For Data Is Crucial For Accountability and Mgmt!Accountability and Mgmt!

Data Is Crucial For Data Is Crucial For Accountability and Mgmt!Accountability and Mgmt!




Identified Patient Information

Remain Inaccessible To The Employer.

It Is In Patient’s AND Employer’s Interests That

So Is Privacy & HIPAA ComplianceSo Is Privacy & HIPAA ComplianceSo Is Privacy & HIPAA ComplianceSo Is Privacy & HIPAA Compliance




Employer 1After 2 years, total health plan costs were

$430,000 per year lower than expected because of the clinic.

Case StudiesCase StudiesCase StudiesCase Studies




Employer 2222 employees (plus dependents)

• 2005 Project Initiation $6,181.08/year.

• End of Year One $4,088.64/year.

• End of Q1 2007 $3,392.52/year.

This is a 45% reduction over 15 months!**

**Case Study reference available on

request.

Case Study222 Employee (+ Dependent) Manufacturer

Per Employee Per Year Savings After 15 Months With A WeCare Clinic

$4,089

$6,181

$3,393

$-

$2,000

$4,000

$6,000

Jun-05 Dec-06 Apr-07

Case StudiesCase StudiesCase StudiesCase Studies




Employee OrientationEmployee Orientation

Initially and AnnuallyInitially and Annually

To Help Employees To Help Employees Understand Clinic Rules and Understand Clinic Rules and UsesUses

Conducted by WeCare Senior Conducted by WeCare Senior Clinical StaffClinical Staff

Getting Employees ComfortableGetting Employees ComfortableGetting Employees ComfortableGetting Employees Comfortable




Brian Klepper, PhDBrian Klepper, PhD904.246.9643o, 904.343.2921c904.246.9643o, 904.343.2921c

[email protected]@gmail.com

www.wecaretlc.comwww.wecaretlc.com

www.brianklepper.netwww.brianklepper.net

The Health Care BlogThe Health Care Blogwww.thehealthcareblog.comwww.thehealthcareblog.com

Health Policy and Market ReviewHealth Policy and Market Reviewhealthpolicyandmarket.blogspot.comhealthpolicyandmarket.blogspot.com

The Doctor Weighs InThe Doctor Weighs Inwww.thedoctorweighsin.comwww.thedoctorweighsin.com

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