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Worksite Clinics: Comprehensive Management of Employee Health and Cost. Brian Klepper November 12, 2007 Daytona Shores. This presentation is, in part, about our need for health care change, and why its a lot more likely to happen here :. And here :. Than here :.

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Worksite Clinics:

Comprehensive Management of

Employee Health and Cost

Brian Klepper

November 12, 2007

Daytona Shores


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This presentation is, in part, about our need for health care change, and why its a lot more likely to happen here:

And here:

Than

here:

The Unrelenting Crisis


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Source: care change, and why its a lot more likely to happen IBI Full Cost Benchmarking

Study - 2002 Benefits Data

  • The real cost of poor employee/family health is in lost productivity from:

  • Absenteeism

  • Presenteeism

  • Disability

  • Workers’ Comp

  • Turnover

The Dilemma: Benefits or Productivity


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Reno’s Employers Are Apoplectic Over HC Cost care change, and why its a lot more likely to happen

  • Employers only. No HC folks.

  • Only CEOs, CFOs, COOs.

  • Objective: Pool and mine claims data to identify problems and opportunities. Address them.

  • They agreed in 1.25 hours of a 2.5 hour meeting.

  • Employers are tired of haggling over HC. They want results right now. They don’t understand why the HC industry isn’t cooperative. They’re now taking action on their own.

Employers Are Tired OF HC


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Premium Growth


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$14,500 - Total employer-sponsored health care costs for a family of four in 2007. (Milliman)

$19,300/yr or less - 1/4 of US workers’ income

$36,000/year or less - 1/3 of families’ income (US Census)

It’s Very Difficult To Make This Work

HC Cost & Workers’ Earnings


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2004 - Earnings/EE Compared family of four in 2007. (Milliman)

To Avg Health Care Costs/EE

of $6,227 (Hewitt)

Here’s The

Retailer’s Perspective

HC Cost & Production


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“If [Medicare and Medicaid’s] costs continue growing at the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Peter Orszag, Director, CBO

Testimony to the Senate Committee on the Budget, 6/21/07

HC Inflation


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Health Care the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Plz Keep Lid On

Pricing &

Performance

Data!!

The Deepest Driver Of The Crisis

Lack of Consensus and Infrastructure for Data Sharing, Standards & Transparency

Can’t see problems in the system

Has cultivated an opportunistic culture.

Why Cost & Poor Quality


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A Century Later And We’re Still Waiting! the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

1920

Dr. Ernest Codman proposes

the “end result system

of hospital standardization”

“Hospitals [and surgeons], if they wish to be sure of improvement...must analyze their results, to find their strong and weak points, [and] must compare their results with those of [their peers]...[They should] make this information publicly known so that the future patients might make informed decisions.”


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Medicare Per Capita Spending the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

By Hospital Referral Region, 2003

Perhaps the most significant hallmark of the crisis is our inability to provide consistent care that adheres to the evidence and is independent of financial conflict.

Source: Dartmouth Atlas Project, The Dartmouth Atlas of Health Care

Practice Variation


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Source: the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.” Jerry Reeves MD, Culinary Fund Heatlh Plan, 2005

Practice Variation


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Insanity: the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

doing the same thing

over and over again

and expecting different results.

Albert Einstein

Self-Insurance

Reduced Coverage

Higher Co-Pays

Better Networks

Mailing Brochures for Patient Education

Telephonic Patient Mgmt

A Different Approach


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Worksite Clinics the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Comprehensive

Physician-Directed

Preventive/Primary/

Urgent/Walk-In

For Employees & Dependents

A Platform To Manage Downstream Care

Clinic As Platform


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Program Savings Areas the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Health Plan

Occupational Medicine

Workers Comp

Disability (STD and LTD)

FMLA, ADA

Pre-Employment Screening

Fitness for Duty

Productivity

Clinic As Platform


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The Clinic is the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”Separate From

And In Front Of The Health Plan

Patients Don’t Use The Plan

Until They Leave The Clinic.

Health

Plan

So It Can Be Implemented At Any Time and Does Not Require Plan Changes.

Clinic As Platform


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Employees may the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Wish to keep their primary care doctor.

Wish to access care away from the employer setting.

This is completely acceptable. Normal health plan deductibles and co-pays apply.

The Clinic Is NOT Mandatory

For Employees/Dependents

Clinic As Platform


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Feasibility Criteria the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Employer self-insured for health coverage.

Minimum of 100 employees on site.

Clinic As Platform


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The Basics the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Total Costs - $50-$60 per month per employee.

Three year contract.

Pass-through build-out & operational costs plus management fee.

Invest in clinic; ROI in claims. Highly transparent. Continual performance feedback.

Extremely convenient and employee friendly. No co-pay or drug costs. Extended hours for dependants. Easy employee opt-out if desired.

Clinic As Platform


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What We’ve Learned the same rate over the next four decades [as they have over the last four decades, at 2.5%/year higher than per capita GDP], federal spending on those two programs alone would rise from 4.5% of GDP today to about 20% by 2050. That amount would represent roughly the same share of the economy as the entire federal budget does today.”

Most health industry professionals have a financial stake in promoting higher costs.

Care is highly variable within and across markets. Half of all care/cost is unnecessary or inappropriate.

Convenient, open access to care reduces the need for downstream services.

Primary care, health care’s entry point, provides the best platform to manage full continuum care/cost.

Chronic disease is responsible for more than half of cost, and can be reduced significantly with lifestyle counseling and management.

Data can be analyzed to identify physicians and hospital services that routinely get the best outcomes at the lowest cost.

Given tools, patients respond to incentives to manage their health.

Managing Differently


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Changes to Primary Care and the Drug Formulary pay for the clinic. Other services enhance the savings.

Typically, Before Clinic:

Primary Care = 22% of costs

Drugs = 18% of cost

Each drops by 50% = 20% of cost

How The Clinic At Least Pays For Itself

Managing Differently


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Data Analysis/Network Refinement* clinic. Other services enhance the savings.

Each is proven to reduce risk and cost.

(Onsite) Chronic/Acute Care Management*

Drug Dispensary

Primary Care Management

Open Access

Management Tools/Approaches

How It Works


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All doctors use Electronic Medical Records and follow Best Practice Guidelines, for better, more consistent care/outcomes.

Patients make appointments by calling, through the Web-based scheduler, or by walking in.

Better access and convenience and prevents conditions (and costs) from becoming worse than they should be.

Clinic doctors replace a primary care network where the care, referral patterns, and tools are often inconsistent and outdated.

Doctors don’t profit from care services. They have no incentives to over-utilize.

Patients pay nothing for clinic visits or for drugs prescribed through the clinic.

How It Works


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A refined, high performance “downstream” network is more efficient and further reduces costs.

Analyzing claims data and having all enrollees take a Health Risk Assessment helps us identify health issues and chronic diseases that should be managed.

Claims data also let us identify the specialists and inpatient services that consistently get the best outcomes at the lowest costs.

Nurses manage patients with chronic diseases and with complex acute conditions.

How It Works


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  • Works With efficient and further reduces costs.

  • Existing Programs

  • Open Enrollment

  • HR

  • Risk Management

  • Occ Med

Integrates With Existing Programs


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Pricing/Performance Transparency efficient and further reduces costs.

Provides Monthly Group Transaction Reports

and,

With Access To Complete Health Plan Data, Routine Performance Reports.

HOWEVER -

Data Is Crucial For Accountability and Mgmt!


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It Is In Patient’s AND Employer’s Interests That efficient and further reduces costs.

Identified

Patient Information

RemainInaccessible

To The Employer.

So Is Privacy & HIPAA Compliance


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Employer 1 efficient and further reduces costs.

After 2 years, total health plan costs were

$430,000 per year lower than expected because of the clinic.

Case Studies


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2005 Project Initiation efficient and further reduces costs. $6,181.08/year.

End of Year One$4,088.64/year.

End of Q1 2007$3,392.52/year.

This is a 45% reduction over 15 months!**

**Case Study reference available on request.

Employer 2222 employees (plus dependents)

Case Studies


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Employee Orientation efficient and further reduces costs.

  • Initially and Annually

  • To Help Employees Understand Clinic Rules and Uses

  • Conducted by WeCare Senior Clinical Staff

Getting Employees Comfortable


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Brian Klepper, PhD efficient and further reduces costs.

904.246.9643o, 904.343.2921c

[email protected]

www.wecaretlc.com

www.brianklepper.net

The Health Care Blog

www.thehealthcareblog.com

Health Policy and Market Review

healthpolicyandmarket.blogspot.com

The Doctor Weighs In

www.thedoctorweighsin.com


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