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Vol 36 No 1
| Date: April , 2015
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I know that it is with some suspicion that you are reading a newsletter that is dated the 1st of April, but I assure you that we don't have the energy or the talent for April Fool misdirection or misinformation. There is enough confusion in health care without having us add to it. Simply watch the events unfolding with the Affordable Care Act, and you will appreciate that the only humor in the health care realm is related to the process of bringing this legislation to life and then the efforts from the new Congress to kill it while it is yet in its infancy. I agree, if it is comedy of any kind, it is of the darkest sort. I have been to one meeting already today where the person has used the ACA with the rejoinder of April Fool!
This is not an editorial comment, only an observation. Our group has taken some time to study integration and the physician arrangements that are occurring nationwide. Much is happening in on-site clinics, however. The physician and provider communities are re-aligning, and we just finished a new book entitled "Medical Staff Integration - Transactions and Transformation." Admittedly, this is more in the hospital and physician practice space, but who can say whose space is whose with all of the vendors and on-site programs spreading into more traditional service models and with hospitals finally coming to understand the need to address employers with unique offerings. We think books of this nature make great wedding and graduation gifts, so be sure to remember this column when you are considering that new bride or new grad. (OK, April Fool! Please shop more seriously for your Spring and early Summer gift giving.)
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Direct Contracting and Benefits Design and Transparency
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If you want to get a sense of how much to pay for a procedure in Oklahoma City, one need only go up on the Web site associated with the Surgery Center of Oklahoma for an all-inclusive price. This means that the price for the surgery center, the surgeon, and the anesthesiologist is an "all-in-one" price for the consumer - or the employer. As an example, there is a body-guide where one can click on a body part and get the price. We clicked on the hand/wrist and found out that the cost for a carpal tunnel release was $2,750 "all-in-one" and that if we wanted, the Web site would direct us to the surgeon who was committed to the programming. Some employers are already using this service, and we can understand why.
We also read about a relatively new service in an issue of Employee Benefit Advisor (July, 2014, p36). A company called EmployerDirect is now offering a service, "SurgeryPlus+", which incorporates a network of pre-qualified physicians around the United States, and concierge service for employees (assistance in scheduling, records transfer, travel as necessary, etc.) to make scheduled surgery a seamless, easy-to-navigate process. They do this for a pre-negotiated price. Their goal is to make this new product (available since September, 2013) high-quality, patient-friendly, and less expensive (they say their bundled fees can be 30% to 50% lower than what might be considered "reasonable and customary").
Bundled fees? All-inclusive pricing? Steerage for cost and quality? All of these are concepts that seem to be emerging, but none is really new. What is new is the consumer need to optimize their co-pay and deductible strategy and their emerging dependence upon the employer to assist them with information and pre-arranged connections to care that is accessible and affordable. Consumers look at Consumers Reports before they buy a refrigerator, and they are going to be looking at something like that in the future before they go for their hernia repair.
Larger employers like WALMART and PEPSI have been leaders in the arrangement of specialty services, and we think this concept will be an important part of any employer-sponsored health service in the future.
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| ACA, NAWHC, AAAHC, JCAHO, and Other Acronyms of Importance! | | |
Larry Boress. the Executive Director of NAWHC, is wrestling with a number of issues of prime importance to members and to the readers of this newsletter. First and foremost is the matter of accreditation. One size does not fit all and traditional health care accreditation models do not have standards that can contain the well designed and well deployed health care site that serves employees. However, the vendors and employers do need to demonstrate that they can be certified and accredited. This is an attempt to show that they are "as good as" when some programs are actually better. See the next topic for information about QUADMED. NAWHC is presently working with several accreditation agencies to fashion a criteria set for what is happening in the on-site industry that actually fits the specifics of an on-site or near site offering.
On the ACA front, as many readers know. there has been a call for comments on the issue of how to design the so-called "Cadillac tax" that is referenced in the new legislation. As the readers know, sometimes the key part of any law is the regulatory guidelines that are written months after the law is enacted. NAWHC is formalizing comments to be submitted in this process to highlight the differences between on-site programming and employer managed health care from the standard issue insurance plan or provider based network of services. An association has much more clout than an individual and this is exactly what the NAWHC has been created to do -- to have clout and use it to advance the industry.
If you have comments on either accreditation or the ACA and the implications the law has for on-site programming, let the staff at NAWHC know. Better yet, join and make your voice part of the organized response. |
Awards, Accreditations, and Standards
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If you want to see what it takes to make the grade as one of the nationally recognized health and wellness companies, one cannot do better than to make the National Business Group on Health annual listing of award winners. Among the companies, one will find many of the early adopters of on-site health programming and some real pioneers in the provision of employer-sponsored health care programming. These companies are setting the standard for population health (there are something like 60 companies in the awards program), and there are ideas in their program descriptions that are worth considering. However, when it comes to actually adopting them, proceed with care. Just as one population and one region is different than another, companies are also unique.
If one were creating their own design of an on-site clinic and ambulatory care service for their employees, the standard that has been held up as desirable has been the Patient-Centered Medical Home - we have linked this reference to the American College of Physicians explanatory site that will allow a reviewer to go beyond the site to some of the accrediting bodies for the PCMH movement. PCMH has a lot to do with the management of a patient and his/her data as they move from one arena of care to the next.
Recognizing population management and patient management brings one to the next step -- facility and program management. Two areas of certification seem at the top of everyone's list - the one that hospitals use (The Joint Commission) or one that is generally more in use by outpatient services (The Accreditation Association for Ambulatory Health Care). The idea of licensing, certification, and accreditation loom large in the eye of the consumer, and this is an area where there is a great deal of status to be gained by vendors who might use the criteria to assure employers that their services are on par with those offered by other local health care providers.
Many vendors can meet a variety of the standards, but there is not much in the way of accreditation that spans a number of sites. The first vendor to achieve accreditation status in the new AAAHC Network category is QUADMED. Congratulations are in order. This marks an emerging trend for vendors to achieve some form of recognition as they move from simple staffing models to more robust delivery models. The question for employers might be which certification levels actually mean something and which are simply cost-additive. This comment takes nothing from the achievements of the vendors - it only suggests that some qualifications do not fit the employer models, and the industry should move carefully, hopefully in a partnership with NAWHC, to either establish its own standards or embrace standards that already exist.
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| Resolutions and Predictions | | |
It is probably too late for New Year's Resolutions, but if I were to make one, it would be "to not make any more predictions."
In the past, and in the distant past, I have made several predictions, but never any resolutions. I am batting about 50/50 in my predictions, but I can see that the only problem that I am having is that I think things will happen well before they actually occur. I often tell people that I want to be the type of person that makes long-term generalizations and not specific projections. The more specific one is, the harder it is to be correct. Long-term? Who will even be around when "long-term" arrives?
Predictions, however, are not projections. I do think that trends emerge in an industry, and there will always be firms that are in early and who set the trend for others. Maybe I should stick to predictions that are based on observations, and I can at least have a basis for my guesswork.
1. Mergers will continue and private capital will be a factor. Obviously, CHS, Walgreens, and Water Street set the stage for this with PREMISE.
2. Changes will occur at the top level of some of the major firms in the industry. QUADMED has led the pack for change in this regard.
3. Re-tooling will occur as providers re-think their priorities and markets. CareATC is one firm that has reorganized in a positive way to meet new challenges and delivery models.
4. Divestitures will erupt occasionally to demonstrate that not everything lasts forever - example: Humana and Concentra.
5. The firms that have demonstrated proficiency in a region or an area of expertise will only get stronger in their own zone and within their own area of proficiency - example: CareHere.
6. Hospitals may not seem like they belong in the world of employer managed health, but once they get the hang of it, they have staying power. One need only to reference Wheaton Franciscan as an example of local and regional success.
7. Once a firm demonstrates that it can do it for themselves, others will follow and often the on-site programming can be a base for additional business development. CERNER stands out.
8. Firms will continue to do it for themselves when necessary. Purdue, JM Enterprises and Pitney-Bowes are examples of do-it-yourself success.
9. Almost any size clinic will be able to prove its worth. If you want proof, ask HealthStat.
10. Brokers will continue to emerge as conduits between employers and providers. School districts in the West often turn to Webb and Greer for guidance and results.
Did I miss your example? Not on purpose. Contact me with your trend, and we will highlight it next month.
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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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There are lots of things that I might like to predict, but for which I have no real reference on which I can base the prediction. Actually, that has never stopped me in the past.
I think you can plan on more changes in pricing of contracts and more competition from physician groups. I wish I had examples to share, but I don't. Telehealth will be eclipsed by connectivity at the smartphone level. I became convinced of this the minute APPLE announced the I-Phone 6+. There will be a surge in medical information sharing that will be launched by consumers - not hospitals or health systems. (Read the NYT reference to the article by Steve Lohr at www.onsiteclinics.org.) Retail health will continue to move in a parallel track and will not replace on-site clinics, but look out for some impressive collisions and collusions as the on-site and retail health industries continue to define themselves.
Sincerely,
Mike La Penna
The La Penna Group, Inc.
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