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Greetings!
Well, we just made it through March. There was the proverbial "Ides of March," for basketball enthusiasts it was "March Madness," and to all you fans of the Kentucky Wildcats, "Congratulations!"
For mudwrestling enthusiasts, it is the height of the primary season, and for all of the rest of us, this is the month where the Supreme Court looked over the health care law and turned a conundrum into all-out confusion. Is it constitutional, and if it is, what parts can be parsed out to ruin it? Whether you are a Democrat, a Republican, an Independent, or just confused, you probably do not know any more after the health care, three-day legal rodeo than any of the pundits on public radio.
We think we are sure on a couple of things - either the bill will survive and become law, or just parts of it will survive, and some of those parts are already in place and being introduced in the marketplace. The most important of these for the employers who are taking an active role in managing their own beneficiary population is the ACO (accountable care organization). This is a hospital or health system combined with a number of physicians who are out there looking for contracts so that they can make promises about care, quality, cost, value, and all of those other things that health systems think they can accomplish. Maybe, the local ACO could be the contracting vehicle for a narrow network of specialty services for your on-site program. This is an area that many employers are going to be exploring in the next couple of contract cycles as they try to understand how to take their programs to the next level.
We are well into spring and at a time when we all begin to think of new things, new ideas, and new programs (in addition to fertilizing the lawn and spreading compost). There are a lot of new things for employers to consider as they refresh and revamp their on-site program service offerings. There has never been another season with so many changes in vendor relationships, PBM reshuffling, and new program entrants. It is hard to keep up, but if we missed your "new program offering," please let us know so we can report it here or add it to our Web site.
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Oregon and Medical Care Innovation
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Oregon has long been at the forefront of innovative health care ideas, including the passage of the right-to-die legislation and rationing of health care through prioritization of treatment protocols based on some sort of cost-benefit analyses. The latest news out of the state indicates that their legislature has passed a bill that would put Medicaid beneficiaries into "coordinated care organizations," (to manage medical care using medical homes).
A core component of the model used for on-site clinics is now a part of the structure to provide health care for Medicaid patients in an entire state. The law has gone to the federal government for review and approval. This is not a new concept, but it is new to have it mandated at the state level. Oregon governor (and physician), John Kitzhaber intends to have ". . . providers . . . paid for the quality of care provided rather than the volume of services." Predictions are that this legislation could save the state about $1 billion over a three-year period.
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Hospital Care at Home Saves Money
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Hospital care can be provided at home.
As reported in Hospitals & Health Networks (March, 2012 issue) and initially studied by Johns Hopkins School of Medicine, Presbyterian Healthcare Services in New Mexico has taken up the model and reports savings of up to $2,000 per episode of care by providing sophisticated hospital services in the patient's home. Daily physician visits are made, along with support services of a registered nurse, and even video monitoring around-the-clock are included. Overall, length of stay was shown to be reduced by as much as 1.5 days, patient satisfaction rates are in the 94-percent-plus level, and everybody benefits.
This could be something which could be an extension of the services an on-site clinic could provide. You have the professional staffing and the technology. The barriers are many, but there are local hospitals that would want to work with you and your Medical Director to come up with a solution.
If innovation in health care is going to be part of any overall solution, it will begin in the on-site clinic community.
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| OBESE NEED NOT APPLY | | 
Citizens Hospital in Texas Denies Employment to Overweight People
We are all used to "no tobacco" policies in hiring, but now a hospital in Texas is employing only people who can meet BMI standards. Of course, they are being sued for discrimination. Self-funded employers are paying for costs that are out of control, and this is one way to get a handle on the challenge of obesity. Also, employee engagement in weight-control programs is probably pretty high when your job is at stake. I remember one administrator at a hospital who said he was going to improve employee morale by "firing all of the people who complained."
In any case, many employers have simply said that they don't hire smokers, and now we have one that states plainly that they do not hire the overweight employee. You can read the original story in the Texas Tribune. |
Rationing or "Choosing Wisely?"
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You may have heard of the new campaign, "Choosing Wisely," that has a goal of providing scientifically-based information to all of us (patients, employees, consumers, employers, physicians, etc.) with better information so we can obtain and provide health care more efficiently, economically, and with improved outcomes.
The American Board of Internal Medicine (ABIM), in conjunction with nine other professional medical societies, has now compiled a list of 45 tests, treatments, or services which they believe should be more thoughtfully considered by the physician and the patient, together, before ordering. Why? Because these may not provide enough additional/new information to make the time, risk, and expense worth it. Some of the feeling is that a solid patient history and exam should sometimes allow physicians to avoid this overuse of the system safely, while preventing some potentially increased risk based on the procedure alone.
Estimates are that up to 30-percent of the cost of health care in the U.S. is "wasted" on over-utilized testing and services.
Check out the links above for the list, the article in JAMA, and where this whole new process may be taking us, as well as benefiting you and your on-site program. Medical Directors are all acutely aware of this breaking news and will likely be looking at ways to implement the list into your own best practices guidelines.
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Time to re-price everything! Savvy consumers are prone to price checking. The recent Christmas rush by AMAZON showed consumers that they could go to a retail store and simply use their Smartphone to check a retail price of a product against the AMAZON price to get a sense of the value of immediate consumption vs. mail delivery. Same product with a better price, and the only difference is immediate access.
How about prices on services and procedures? Try the The Health Care Blue Book to compare pricing. Also, 35 states have guides to the cost of health care for consumers. If you want pricing for pharmaceuticals, we found in the New York State guide that Flomax in Albany is in a price range from about $90 to more than double that cost on a prescription basis. The New York site allows you to package a number of drugs, and it gives you city-by-city comparisons for the ones that you, as a consumer, might need. Great service to add to an employee on-site program.
Vendor pricing can be checked. At the outset, it is done by perceptive employers as they develop, distribute, and proctor RFPs. The vendors get to see the employer information and bid their services across a broad range of objectives. Recently, some employers have experienced vendor retreat from programs that are not easily managed or cost effective from a vendor standpoint. We have seen three in the last couple of months, which means that this is more than a simple casual occurrence. If the vendors can reconsider their commitment to the employer, can't the employer inspect the relationship with the vendor? We have had many calls regarding the idea (and challenge) of program transition.
Lastly, we all know that the issue of "price" is often muddled by what we are buying. The AMAZON example is pretty simple. Why pay more for the exact same product. The same goes for the Flomax comparison. (Target is the best value reported by the New York State site for pricing on Flomax in Albany). However, I was at a major university medical center this past week, and we discussed "domestic medical tourism." They price some of their services already at a level that would compete with any local health care system, and they consider any request for concessions on "high end" services, such as organ transplants. This is not flea market medicine, this is a major medical center that has a national and worldwide reputation pricing services at a lower level than the downtown hospital where your employees are getting care. Value?...unquestionable. Price?...more competitive. Benefit?...better care and lower cost.
Total program integration from an on-site perspective demands that someone is taking the lead on each part of the "population spend." Who is in charge at your program to make sure there is value and cost comparison on all levels?
Sincerely,
Mike La Penna
The La Penna Group, Inc.
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