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Greetings!
This is from the "I've been wrong before" collection. I have to admit that there are a couple of predictions that I have missed regarding on-site clinics that are big right now and which will continue to be important - telemedicine and retail medicine. They are both trends that are probably going to become an integral part of most on-site programming, but for different reasons.
On the retail medicine front, the numbers just continue to grow. This is more than just a few national drug store lines playing with mid-level providers next to the pharmacy. Now, we see hospitals getting into the act and exploiting their market positions in the retail space, and we see pharmacies growing their business into direct management of disease states. Consumers are responding positively, and the conjunction of patients, retail giants, and health care systems in this space means that it is here to stay.
Video medicine is now being regulated and reimbursed. Eighteen states have some kind of regulation in the works and twelve already have rules in place. Medicare pays for video-visits. When regulations chase providers and the reimbursement agencies start to pay for care in a medium that has newly emerged, it is on its way to mainstream.
Integration is a key to success in health care, and neither of these trends seem to be very integrative in nature, but that will also change as people continue to channel their care along lines that are complementary to their lifestyles. I am now going to have to reconsider some of my thinking on personal medicine and the medical applications in the world of smartphones. These are pretty cool and they are probably the next big platform for care. They are already consumer-accepted, and now we just need to connect some kind of Medicare reimbursement. PayPal?
On another note, sometimes we have to remind ourselves that on-site clinics are really supposed to be all about the patient. It's an important core concept, and yet we do lose site of it. We get bogged down in the data, the planning, the day-to-day operations, and forget that the focus has to be on the patient (your employee, his/her spouse, or children). So, we're devoting a portion of this issue to news about research, programs, etc. that demonstrate that focus.
Check out the conferences in the sidebar - everyone is going to be in Chicago this summer! This is a great opportunity to hear tales from the front lines of employer managed health care and on-site programming.
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Shared Decision-Making
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If there was ever to be a concept that reflects the "it's all about the patient" approach to medicine, "Shared Decision-Making" has to be it. Some of us are old enough to have experienced that time when a physician's word was tantamount to hearing God. Whatever your physician told you to do, you did it. And you didn't ask why (sort of the same way we responded to our parents!). There are still millions out there, we are sure, who feel that they cannot question their physician's treatment plans or decisions.
But, as we all know, the Internet has shaken that principle at its very foundation. And now studies are actually proving that involving patients in medical decision-making really does reduce costs and improve care.
Implementing shared decision-making in your clinic may be a new concept, or it may be that you need help figuring out how to improve an already in-place program. But others have gone before you, so that help is available. One of the support tools frequently used in shared decision-making is, naturally, written materials. Others include videos and on-line teaching modules. You don't need to go out and create these yourselves. Like every other aspect of life in a free economy, there are vendors out there who can help you by supplying the aids you need.
Don't sell this concept short. Studies have shown that offering solid shared decision-making options to the patient - especially those with chronic diseases or those in need of major acute care - can reduce costs, hospital length of stay, and the number of surgeries performed. (Those with "enhanced support" incurred 5.3% lower costs overall and had 12.5% fewer admissions to hospitals.)
These data findings are from a recent study, so check it out here at our link to Health Affairs, an online service that is a valuable source of information for those involved in the online clinic industry. |
How much can you afford to waste?
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Yes, that's right. We asked how much money you can afford to waste, and we're willing to bet your answer is either $0 or very close! But, sadly, a study produced by the Institute of Medicine reports that the U.S. wasted $750,000,000,000 (billion - we put all those zeros there for emphasis) on health care expense in 2009. (We can only hope we have become more cost-effective since then.) It won't surprise you in industry (where competitive forces cause you to take every expense item seriously) to read in their report that "If banking were like healthcare, automated teller machine (ATM) transactions would not take seconds, but perhaps days or longer as a result of unavailable or misplaced records."
What we found most interesting about this study (aside from the shock value of the numbers), was the IOM's description of a "continuously learning healthcare system." It would be one where patients and their healthcare providers work together as partners (shared decision-making anyone?), where monetary and other incentives are in place to reduce costs, eliminate waste, improve quality, and transparency is paramount (pricing? quality? outcomes data?).
The report shows that $210 billion was wasted on unnecessary services (those are the tests that are repeated because the results aren't available to all your providers, or were actually lost, or never read and followed-up on); and another $105 billion was wasted because prices were too high (transparency in pricing is still a huge issue). And, sadly, $75 billion was sucked out of the system by fraud.
For a specific example of overpricing and over-treatment, see the NY TIMES article on colonoscopies. This is an example of the type of a procedure that is out of control in most health care delivery systems, and which can be corralled by an on-site program that channels care and directs it to a thoughtful group of specialists who use it selectively and price it competitively. Ask your on-site provider how they handle this one referral process to get an idea of what level of sophistication they have in their secondary level of programming.
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| 2013 Employer Survey | | |
Some highlights: Stunning, we think, that only 26% of participants in the survey (583 employers with at least 1,000 employees) indicated that they were "confident that health care benefits will be offered by their organization 10 years from now." Average employer expense per employee are projected to increase only about 5.1% in 2013, the smallest increase in 15 years! Those identified as best performers by the survey had an increase of only 2.2% with a trend focusing on value. The survey also showed that there will be continued focus on "quality of care, efficiency, and health outcomes."
It is well worth your time to review the entire report.
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On-site and near-site programming is maturing with more business coalitions bringing their considerable economic power to the forefront. In future issues, we will address programming related to near-site clinics, referral networks, hospitals, and health systems, and we will be updating vendor and consulting lists. Ideas, innovations, issues? Let us know.
Sincerely,
 Mike La Penna The La Penna Group, Inc. |
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