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Organizations, Conferences, & Meetings
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6th Annual Executive Summit on On-Site Employee Health Clinics
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| Vol 30 No 1 | Date: Nov 26, 2012
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Greetings!
The election is over, "Obamacare" is being rolled out, and we can all get ready for the changes required by the Affordable Care Act. No more nasty political commercials, but the in-fighting will continue at both the state and the federal level which will impact self-funded employers and the decisions that they are making about benefits. This might be the time for a quick check-up with your benefits team and your on-site management staff to see if there are any profound changes that need to be made and whether this is a potential "teaching moment" for beneficiaries.
If you don't have the answers to some of the questions below, you will soon have to find a place to get them:
Will there be any impact on our costs related to the "Cadillac" plan provisions? How do we account for the on-site clinic investments and patient services?
Can we expect any support for our wellness programming connected with this new legislative initiative and its provisions on preventive care?
Do the states in which we operate have insurance exchanges in the developmental stages, and do these have any impact on our planning processes?
Are any health systems in regions where we have benefits programming actively developing ACOs (accountable care organizations)? If so, how can we benefit?
One benefit about employer-managed healthcare and on-site clinics is that a lot of what happens in Washington, D.C. is just a distraction. Employers seldom wait for Congress to act when it comes to improving healthcare, reducing costs, eliminating unnecessary procedures, and waste, etc. However, this time the changes are so broad and there are so many moving parts that you might want to get your health care delivery team into a planning and reaction process to get out in front of any changes.
One last comment is that a strategy is especially important at this point in time since your employee population is probably wondering how all of this will impact them. The health care law revision is a sweeping national initiative that will be implemented on a regional basis, but each of us will be impacted on an individual basis.
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| Pay for Quality / Penalize for Problems - Does Either Work? | | |
Check out the Catalyst for Payment Reform ("CPR," clever acronym, huh?) Web site. Funded by a variety of employers and committed providers, they believe firmly in transparency in pricing and have a goal of getting that transparency by 2014. This is the holy grail of health care consumerism and reform. If they succeed, even with a small group of health systems, they will have accomplished something few have been able to do. Knowing the actual price of anything in health care, BEFORE it is consumed is a practical impossibility in most instances.
Specific contracts have been negotiated for some time now between employers and providers in an attempt to control specific costs. The news that Wal-Mart contracted with the Mayo Clinic for orthopedic services for its employees is just a recent example. Now, Wal-Mart knows the cost upfront and has an understanding of the anticipated quality/outcomes. Even CMS (The Center for Medicare and Medicaid Services) has turned to pay for performance. They started by penalizing hospitals and physicians for the last couple of years for inpatient treatment that results from a medical error by withholding payment for the treatment related to fixing the problem. However, it probably will surprise you to know that a study of this system sponsored by the Agency for Healthcare Research (yeah, that same one that some Senators and Congressmen want to eliminate), showed that the non-payment policy for hospital acquired infections and conditions has had no affect on improving outcomes (Modern Healthcare October 15, 2012 issue, page 8). Some say that the focus on reducing errors is coming from so many different directions that withholding payment alone ("small financial disincentives") just isn't enough. Others indicate that the providers have to "own" the problem first, then financial incentives or disincentives will just provide further support for improvement, but not the real motivation. What works and what doesn't (per these studies) may not be clear right now. But, what is clear is that pay for performance is in its infancy and that employers should lead the way. Confusion over pricing keeps us all in the dark about the economics of the health care event. If value is some kind of construct between cost and quality, and we cannot really understand quality, can't we at least know the cost?
Bravo for CPR and its goal, let's hope they achieve it by 2014 as planned - any improvement in transparency will help us all.
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| A Personal Contact with On-site Programming | |
Over the Thanksgiving weekend, I had a personal experience with on-site programming that drove home many of the points that I have been preaching. One of my relatives, a 22-year old whose father is covered in an employer-managed program, became suddenly and seriously ill. He went to the doctor's office on the eve of Thanksgiving and was immediately admitted to a local hospital where he was met by the Care Management Nurse. He spent Thanksgiving in the intensive care unit and was routed through a series of diagnostic processes. Eventually, he was diagnosed with complications related to a previously undiscovered diabetic condition.
Without going through all of the details, many issues related to program design became immediately apparent to the patient and his family. The purpose of this little patient care vignette is to ask how your program stacks up?
Do your employees and their dependents have immediate access to their primary care physician so they do not have to go to an ED or urgent care center?
Does your primary care provider have access to the patient medical record and related family history so that they can make an intelligent diagnosis and plan a treatment regimen quickly, accurately and cost-effectively?
Does your program have after-hours coverage that is coordinated with the primary care provider so that continuity of care is assured?
Is there a pre-defined access process for local inpatient services and specialty care that is coordinated on a value or quality contracting basis?
Do your employees have a care management system in place to assist them with the navigation of the health care system and its complexities?
Can your employees get tests and can their doctors get the results even on a holiday weekend?
Once a patient is discharged with a newly discovered chronic condition, is there a program that is coordinated with the primary care provider for follow-up and rehabilitative care?
Each question would have been answered positively in this particular case, and the health care was delivered over the holiday with diagnosis and testing on Thanksgiving, with therapy through the weekend and discharge on Sunday. In order to avoid any breaches of confidentiality, I am not divulging the location and providers, but I can tell you that this young man was a patient in a very mature program that is run by a vendor that "gets it," and where the employer covers employees, as well as dependents, in a patient-centered medical home model.
Costs for this type of a patient in a standard health care system model where everything would have been left to chance and the patient's own navigation of health care resources would have resulted in (I believe) triple the cost and (even more concerning) quadruple the hazard.
I hope your system works as well as this one did.
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Mississippi Baptist Contracts with MARATHON
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Mississippi Baptist (MBHS) announced a program for its own employees that is centered around services provided by Marathon Health. There will be a grand opening of a health care facility in January of 2013 according to the press release. The press release also restates many of the reasons that an employer might provide on-site health care for its employees. No need to recount them here. However, the president of the system (Mark Slyter) does point out that their employees are drawn from a population that is ranked "worst" in most categories when compared on a state-by-state basis. Marathon has its work cut out for it, and we hope that they are addressing some baseline measurements and on-going research to define their impact.
The reason this is news is not that hospitals are getting into the on-site clinic mix (they are), but that a hospital system that runs clinics, outpatient facilities, emergency departments, and all sorts of medical programs is using a vendor to implement programming for their own employee and dependent population. It shows that the employee-oriented programs are different and that the delivery of health care to a community and a marketplace (which MBHS does very well) is not necessarily the same as delivery to a specific employee population.
We would caution Marathon and MBH that they are not only operating in a state that is measured as the worst for many health indices, but they are working with a population (health care workers) that are among the highest cost and worst consumers of among many classes of bad consumers. If they can do it in Mississippi with heath care workers, it will work anyplace. Good luck to Marathon and to Mississippi Baptist!
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| The Problem with Research and Statistics | |
The Benfield Group LLC has any number of reports that detail issues related to employers and their attitude toward health plans and health programming. Most recently, they addressed Value-Based Benefit Design and commented that there are many barriers that keep employers from implementing VBBD.
They cite the fact that they (employers) often don't adopt value-based purchasing in their programs because there is not enough evidence that it can save their organizations money. Insufficient data to develop a business case and already high utilization rates are other common reasons for avoiding VBBD.
We like the Benfield team and value their research, but the issue with benefit design is that no one has any real data and program research. This same fact did not stop progress in disease state management - it only fueled a need to keep looking until the answers were found. It did not prevent pioneers like Harry Quadracci and Frank Perdue from implementing employer-managed programming. They went with their intuitive understanding of how things work, or are supposed to work. In the end, the statistics on their programs proved their point. Had they looked at the existing data, they would have gone with the mainstream.
Innovation does not come from statistics and research. Benfield research is probably correct that VBBD cannot be proven to save money. I get it. Maybe, we just all need to try harder.
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For assistance with your on-site clinic questions and support, we list a variety of resources on that site, and we welcome your suggestions.
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In our travels, we find a few places where the discussion turns to on-site programming, and there is sometimes an HR person at the table who says, "Oh, they tried that at _________ (Dow, Steelcase, wherever) and closed down the on-site program after a few years. It didn't work." I reflect on a recent LEGO challenge with one of my nephews whenever I hear that phrase. I was struggling with a complex set of wheels, blocks, and motorized components. When I complained that it all did not seem to work, he corrected me by saying, "You are doing it wrong - read the directions!" Of course, he was correct, I was pummeling along with intuitive knowledge and assumptions, and he was carefully following directions. That is one of the reasons that I wrote the book on the successful implementation of on-site programs. That is also a good reason to join the National Association of Worksite Health Centers or to attend one of the programs we have listed in our sidebar.
Anyway, while I am interested in the idea of firms that have tried it and succeeded, right now I am also interested in firms that have tried it and failed. Do you know of an example of a firm that has given an on-site program a try and then backed out of it after a few years? Do you know of a firm that has changed vendors or gone from self-management to vendor management (or vice-versa)? If so, I am looking for examples, and I would welcome your input. I have a great start on a list, but I want your input and ideas for an upcoming presentation on the subject of change at the workplace level. Give me a call or e-mail me with your ideas and references. I promise to credit you (or to give you assurance that I won't!).
Sincerely,
Mike La Penna
The La Penna Group, Inc.
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