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Organizations, Conferences, & Meetings
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On-Site Employee Health Clinics 9th Annual Congress
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| Vol 31 No 1 | Date: Feb 26, 2013
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Greetings!
Sometimes there is an article that a writer reads and then sits back and says, "I wish I had written that . . . ." Actually, I often read something and wish I could write like that. As I was preparing this newsletter, just such an article appeared in TIME. I am referring to Stephen Brill's article on the whole health care mess. The article is a "must read" not only for its content but for the fact that it is being referenced in so many other publications, blogs, and columns. We, of course, have a discussion and more connections on our own Web site, www.onsiteclinics.org, but our coverage is not the reason to be aware of the content and the tone of the article.
 This is written for consumers - your beneficiary population. It is written in a style that takes the reader from idea to example, to outrage, and back again. Any provider of health care has to be chastened by the article because it covers a wide range of flaws, greed, and outright waste in the health care system at a time when consumers are already interested and engaged.
You should read this one, because many of your employees already have, and it is a great ice-breaker for discussions with your provider support network.
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Diabetes Intervention
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We're always a little concerned when we report on medical research. Not being physicians, we don't always feel qualified in providing summaries of the data, the study parameters, etc. So, pardon us if we're not as accurate here as your medical director would be.
However, when we do this, we generally feel that the study is of such importance that even if we aren't science reporters, those of you who do understand all the data will benefit from the ability to read a quick summary and find the study results yourself to mull over and use (hopefully).
So, here's the most recent study which caught our eye. Scientists from the Wake Forest School of Medicine recently reported in JAMA (December 19, 2013 issue) that "intensive lifestyle intervention" in patients who are pre-diabetic, or non-insulin-dependent Type 2 diabetics, can result in significantly more weight loss and "sustained remission for 2 years" as compared with those who received support and education only.
We all know that diabetes is on the hit list for every physician, public health official, and insurer in the nation. Each year, this disease costs millions/billions to treat and negatively affects longevity and lifestyle quality for hundreds of thousands of people; therefore, a study showing that intensive intervention can make a difference is important news.
The authors indicated that the study had its shortcomings (you can read about those for yourself), but the data for the intensive intervention group are so dramatically different than the other group, one can't help but be hopeful that this information, along with all the other studies and data out there, may lead the way to some extremely positive prevention and treatment options in the future.
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How Does Hospital-Physician Integration Impact the On-Site Clinic?
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We all know that a "narrow network" and value-based contracting are key components to reducing expenses and improving quality for your employees. But, what value does an integrated network bring to the table, and is there one near your on-site clinic? Well, we have some information and some thoughts on the first question. The second may be more difficult to answer at the national level, but your benefits manager and/or your medical director both either have or can find the answer for your region.
Back to that first question and a little background. The Affordable Care Act (ACA) has nationalized the concept of pay for performance (something you have probably been doing for some time now) and the ACO (accountable care organization). Hospitals have been buying up physician practices in even greater numbers over the past two years, often in an effort to create ACOs, because CMS intended that Medicare payments would be made to these fully integrated networks for episodes of care - one payment to a single entity which was then to be divided up however the entity chose among all the providers who participated in the patient's care - with bonuses for achievement of quality measures.
But, how are those integrated networks really doing? Again, back to that first question (we really are headed towards an answer, I promise). Some examples of success stories were described in a recent article in Healthcare Executive (JAN/FEB 2013 issue, pages 20-24; author Ellen Lanser May). In the article she reported results based on interviews with four integrated systems (Advocate Health Care, Illinois; Mercy Health in Cincinnati; the Billings Clinic in Montana; and Yale New Haven Health System). The results were positive all the way around, but all four systems reported working on their initiatives for significant periods of time to achieve the improvements in care and savings they had hoped for, so success isn't an overnight process (as you already know).
Specific results were reported for Advocate Physician Partners (APP), which has 4,000 physician members completing work collectively on 57 programs resulting in 158 measures that "address quality and costs associated with an entire episode of care." The article includes a breakdown of individual achievements for APP for 2011. Their asthma control rate was 17% better than the national average and saved $8.9 million (direct and indirect expenses) when compared to that national average - for one year. Their program for pediatric vaccination resulted in vaccine rates for rotavirus which were above the national average by 14% for HMO patients and 28% better than the rates for PPO patients. Savings? Estimated at $5.2 million in reduced hospital costs.
So, what is the future? What do we predict in this area? Well, with the current legislation, Obama's win in 2012, and more components of the ACA going into effect over ensuing years, we predict more of the same. Hospitals and physicians will continue to work more closely together, and pay for quality will march to pay for outcomes as well. Let's hope these systems become the new norm in the future, and that sooner, rather than later, there is one near your on-site clinic.
[Note, you must be a subscriber to Healthcare Executive to review the article, but we have pointed you to their Web site, above.]
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National Wellness Compensation Survey
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Welcoa (a tremendous source for information, data, ideas, etc.) recently published a " National Wellness Compensation Survey" as well as an Expert Interview on the results with Dr. David Chenoweth. For those of you with wellness staff, this compensation survey may be helpful in understanding how your pay scales line up with some national data.
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QuadMed Announces "Corporate Health Suites"
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Over the years, one of the recurring problems we have experienced when assisting clients is the difficulty (if not impossibility) of providing on-site clinic services to smaller employers, those with less than 1,000 or perhaps even 500 employees in a given geographic area. We knew that eventually some vendor would come up with a solution, and now QuadMed (a pioneering innovator in on-site services) has done just that!
Check out their Web site for more specific information about this, but they are using state-of-the-art technology, in a small space (500 square feet) to provide on-site mid-level provider services with connectivity for telemedicine availability - not only primary care but specialty services as well. We've seen the progression of on-site clinics, going from a few employers, with large employee bases, primary care services only, to multiple vendors with a wide array of services and joint ventures among employers. This is just the next logical step, making high quality, low cost medical care available on-site for even small groups.
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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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Many of the newest initiatives in on-site care are not technology but relationships. As the new players enter the fray, we see the traditional vendors and innovators continuing to move the bar. Some of the best include the QuadMed application of telemedicine in their new Corporate Health Suites, CHS merging with W Squared, and Cerner purchasing PureWellness. Add these trends to Carolinas Healthcare Systems linking services with CVS MinuteClinic and all that Walgreens is doing with Take Care Health Employer Solutions in their telehealth initiative with Blue Cross and Blue Shield (North Carolina), and you can really get a sense of change at warp speed.
Most of the news and progress can be referenced at our companion Web site where we try to put the news up as it happens (or as it is reported to us!). The real news is that all of the technological change in workplace health is occurring through the reconsideration of relationships and the reconfiguration of health care delivery models. These changes are happening at the employer level, and they are fostered by the many partnerships that are emerging which will drive the true goal of any self-funded program - population health management.
Take a look at some of the upcoming conferences, and if you attend them, you will note that many new faces are in the audience. This is not any surprise to those of us in the business. The new faces are welcome. They are not late-comers - they are the innovators that will take this process to the next level.
Sincerely,
Mike La Penna
The La Penna Group, Inc.
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ON-SITE CLINIC NEWSLETTER