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Greetings!
Lots of things happening in the on-site space. We reported on a terrific article that was done by FORTUNE on our companion Web site ( www.onsiteclinics.org). We note with interest that Walgreens will now sell health insurance and that hosptials are more interested in on-site programming than ever before. With insurance companies, pharmacies, and hospitals entering the vendor space, there will be some interesting RFPs out there in the future. We'll have to wait and see what ACOs have to do with all of this.
Speaking of ACOs (and the impact of the new health care law), we are reminded of a question posed by our good friend Jim Sheeran, Benefits Director for MillerCoors. Jim recently voiced what much of the readership has been wondering about - "How will health care reform impact on-site clinic programming?" In my humble opinion, not much; but my opinion is "humble" for a reason. When you involve government and the marketplace in something, the input of many experts is probably better than my "educated guess" in figuring out an answer to this very timely and important question. Therefore, I contacted (on behalf of our readership) several such experts. I will pass their ideas and opinions on to you in future columns. On another issue, we watch physician comp pretty closely since we work with many health care clients and health systems. If you are in the business of self-funding and you are watching your costs go up (and up), you might note that AMGA (the American Medical Group Association) is reporting that compensation increased for almost 70 percent of specialty doctors in 2010. This matches profitable years for the insurance industry and, in some areas of the country, record margins for hospitals.
Finally, we have added several conferences to the sidebar. We will continue to highlight meetings as they come to our attention. Let us know if you have an educational event that would be of interest to readers of this newsletter. |
Hospitals are trying to get in the game -
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Our impression has always been that hospitals would watch the incursion of on-site clinics into the direct provision of primary care in their marketplaces and eventually reach out to employers directly. This is happening (although slower than we thought might have been the case). Our firm worked for awhile with a big Chicago health care system (they will go unnamed since the project is still on their planning docket, where it has been for three years), and we have encountered hospitals vying for contracts with the rest of the vendor community, generally without much success. The best example of a major hospital coup was the VW America engagement of a local health care system (Erlanger) in competitive and fierce bidding wth HCA's program offerings.
Now, a major institution (North Shore Long Island Jewish) in the New York area is in the race, as reported by the Health Care Editor at Crain's Business, Barbara Benson, highlighted with commentary on our Web site (read more here). They recently reported that they would be providing care for employees of Cold Spring Harbor Laboratory, incorporating this service within a department that they have called "Population Health"). More importantly, this was described as a "new" strategy. The article also noted that another major medical center in the area, Montefiore, was likewise entering the game.
North Shore-LIJ has capital and talent (and so do its competitors). They have powerful allies in the employer community, and they will launch a program that is complemented by their broad array of specialty services. In a previous post, I used the phrase "vendors beware" which elicited some spirited comments. I repeat the warning for vendors in the NY area that think they have a market presence, or want one. There is a new kid on the block.
Look for other major hospitals and health systems to join in the next round of RFP competitions. As noted previously, this is a trend which we anticipated and which is finally surfacing.
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PBMs, Pharmacies, and Employers Collude and Collide
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The relationship between employer, pharmacy, and pharmacy benefit management firm is one that has significant implications for the on-site clinic and the beneficiaries of the services there. In any case where pharmacy is an issue (this means any case where the employer covers pharmacy costs), the talk immediately turns to generics, the formulary, AWP, and 90-day prescriptions. Discussions can include mail order and retail (if the pharmacy is on-site). Rebates and transparency come into the discussion. Sometimes, the meetings include topics such as patient compliance and adherence. Sometimes the meetings are just about raw cost of product.
This is all an on-going dialogue, and it is complex enough when the PBM and the pharmacy are aligned. However, recently, many employers were caught off-guard when Walgreens and Express Scripts parted ways. If these are your service providers (one or both), there are issues that will be defined by beneficiary confusion. Simply put, when your clinic has two partners in the management of a significant component of your health care "spend," and they are no longer cooperating, then the confusion over pharmacy will take a bad turn.
This is an emerging story and one that is being watched by the investment community, big pharma, and the government. It is one that should be on your radar screen, as well, if you have on-site services. |
| Interesting Historical Content / Kaiser | |
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Dr. Strange and other Kaiser pioneers, ca. 1950
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If you want to dig deeper into the history of on-site programming, wellness, managed care, prevention, evidence-based medicine, etc., you can't do much better than looking into the rich traditions at Kaiser.
They have their own archivist and historian and they have it all on a terrific Web site: http://www.kaiserpermanentehistory.org/
Those of us who are sometimes asked to prognosticate on the future will often simply restate what has happened in the past. This is the Frank Tiedemann concept that we have quoted before - "Health care strategies are just like a Ferris Wheel - wait for awhile and they will come around again." That being said, here is a place to look for the germ of the next great idea.
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Go to our Web site for more information about the NAWHC. Here is a quick summary update.
We are reaching out to various other business/health care coalitions to assure that the membership is broad and representative of all aspects of the employer community. We have also drafted a considerable amount of material for review by the charter board, and we are contacting physicians to sit on a Medical Council that will address any issues that may arise which are focused on matters of quality and patient care protocols.
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ON-SITE CLINIC NEWSLETTER
