Greetings! 

We are all anticipating the election and its impact on health care reform.  We believe that if the Republicans win, the news for on-site clinic development is very good, and if the Democrats win it, it will be even better.  Health care reform or its absence is not the issue -confusion and unpredictable costs and access will continue to drive employers to choose on-site and workplace health programming as their most valued asset.

Unfortunately, the old issues of confusion and concern for the way health care is being delivered will remain.  An employer-sponsored delivery model can address and resolve those concerns better than anything we will see coming out of Washington over the next four years.  The role of NAWHC will be to make sure that this important model does not get confused with the models that they are trying to fix.  Join the NAWHC and help in this effort.

We reported recently on the national Choosing Wisely campaign.  At that time, we also indicated that Consumer Reports was participating with the nine specialty medical societies as a vehicle for getting information out to everyday health care consumers.

The whole Choosing Wisely program is expanding and gaining momentum.  As an example, Consumer Reports is now working with Wikipedia to help them increase their information base on this important area of health information geared toward consumers.  

In addition, the National Business Group on Health has distributed the most often read Consumer Reports Health articles to its members.  From their latest newsletter:  "We remain focused on comparisons, good science, and great journalism, all focused on consumers and distributed to tens of millions of them.  Our goal next year is to reach 80 million people, and we are already well on our way."

You can sign up for the CR newsletter at this link, just like we did.   And if you haven't already done so, check out the Choosing Wisely Web site, as well.   This powerful effort  by respected organizations is yet another indication that reducing expense and improving quality in health care can be done. 

Employers with on-site programming, and the vendors who run them, should be supporting common sense and credible programs for patient and beneficiary access to information.  The glut of PHRs (personal health records - read the HHS background report here) and the hospital based information systems that package health care as part of a network will be eclipsed by solid inofrmation such as that offered by CR, and hopefully, employers will be the ones to make the best information choices available to their covered beneficiaries.

Recent news out of Milwaukee references a co-venture ACO between Aetna and Aurora Health Care that guarantees employers a 10% reduction in health care costs, using past claims as a reference point.  This is the home of one of the pioneers of on-site activity (QuadGraphics), and many may know that the original Quad model was a joint venture between the printing plant and a local health care system (Wheaton Franciscan).

Aurora is one of the largest and most successful health care systems in the Midwest, and Milwaukee is one of the most costly places that you can get health care in the nation.  An ACO (accountable care organization) is supposed to be something that can provide care in an accountable fashion, and a guarantee to employers of a 10% savings sounds like it is pretty "accountable."

The question for on-site providers will be whether a local health care system can team up with an insurer (or broker, or TPA) and offer a value proposition that knocks the on-site providers out of their contracted position.  If an employer has a $30 million dollar local "spend" and an on-site provider is putting up some sort of guarantee that puts their fees at risk, the threshold for comparison at 10% is three million bucks.

The Aetna/Aurora deal is only for the insured population right now, but sources who have inquired say that they have been assured that a self-insured option is on its way.  Aetna has also been known to respond to RFPs for on-site clinic service provision.  Will we see something like an Aurora/Aetna on-site proposal with guarantees on this scale?  Of course, we will, and that will be a game-changer.

At present, there is at least one very advanced health system that is working with a coalition of businesses around a value proposition that uses care coordination and medical management tools, combined with a narrow network, with the result being a ten percent guarantee of cost savings.  There is at least one business that is in the mix with an on-site program which will become part of the delivery system with the obvious implication that the management of that program will change.

We continue to hear of new vendors that are entering the marketplace and some very ambitious projects and ideas (see the reference to Aetna and the coalition activity in a previous panel). 

We once thought that the vendor community would be transitioning to become more full service and include things like TPA services, pharmacy, and rehab functions.  Some have done this; QuadMed is one example.  Of course, now we realize that size does matter and that a group like Aetna, or a health care provider like Walgreens, can enter the vendor space easier than a vendor can become an insurance plan or a pharmacy service.  This is probably a function of scale and capital.  Big companies can capitalize big ideas while smaller companies use all of their capital to expand so that they can be big companies, I guess.

In the future, we think that the "best in class" employers will have any number of options to link to a management team that provide real depth of experience along with access to resources and talent.  We hope as we see pharmacies, hospitals, and others get in on the action that the goals and objectives that originally inspired medical care in a workplace setting and under the direct stewardship of the employer are not forgotten.

Sincerely,