Onsite Health Centers:

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Onsite Health Centers

• A Better Way for Health Care Delivery?
• June 13, 2007
• Tim Newman, M.D.
• Randy Abbott

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Todays Agenda

• Introduction
• Developing an effective health care delivery
  strategy
• Review of onsite health care models
• Defining the steps for successful development
• Fitting the onsite center into the medical
  ecology
• Summary

3
A Different Perspective
Onsite Health Centers
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Healthe Clinic Vision

• Healthe Clinic will transform the health care
  delivery process and experience through
  personalization and technology. It will achieve
  optimal health outcomes at a lower cost by
  empowering individuals to actively manage their
  own health using new tools and knowledge.

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Healthe Clinic Reception
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The Cerner Difference Today

• Appointment
• Schedule online/same day phone
• No waiting room
• Healthe card identification
• Health care experience
• Efficient employee centered service
• Healthe Pharmacy e-script
• Healthe card payment
• E-communication
• Personal Healthe record
• Secured messaging with provider

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Healthe Clinic Care Suite
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Healthe Clinic Preliminary Savings
First Year Savings gt 1 Million

• Medical Savings
• ER visits were reduced by 10
• Provider office visits decreased 6
• Outpatient visits were reduced by 30
• Overall 24 medical savings
• Pharmacy Savings
• Generic substitution rate of 97.3
• Overall 25 pharmacy savings
• Productivity Savings
• Average visit time of 30 minutes vs. 2.5 hours in
  the community
• Savings of approximately 300,000 in 2006

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Developing an Effective Health Care Delivery
Strategy
Onsite Health Centers
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How Do We Get to a ..

• Healthy and productive workforcewith employees
  that will be
• Engaged and accountable for their health and work
  with benefits and programs proven to
• Impact our bottom line costs and help our
  organization to be
• Competitive in the marketplace?

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Health Care ManagementA Changing Focus




























































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Emerging Trends for Delivery
Based on the Watson Wyatt/NBGH Staying at Work
Survey, onsite clinics ranked 1, among other
employer initiatives, in terms of controlling
health care costs and improving health.

• Productivity
• Lost time from work for health care
• Absenteeism due to illness/injury
• Health Care Costs
• Availability and access
• Quality of care
• Care Coordination
• Prevalent health risks/conditions
• Lifestyle health risks
• Acute and chronic illness/injury
• Employee relations
• Turnover and retention
• Employer of choice

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An Individual and Health Management Strategy

• A model center for delivery of worksite health
  care services, with focus on employee centered,
  personalized care
• Health care services primary, occupational, and
  preventive care
• Support services health coach, case manager,
  counselor
• Integrated with programs such as health
  education, preventive screenings, lifestyle and
  disease management, behavioral health
• Optional services pharmacy, physical therapy
  and radiology
• A health management strategy for employee
  engagement, to help achieve optimal health
  status and function
• Alignment with business strategy and company
  needs
• Organizational framework that includes
  communications, health plan design and incentives
• Establish measurement metrics and quality control
  process improvement

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Model Health Center
Employee, Family and Retiree Health Care Needs
Lifestyle Management
Health Education and Promotion
Preventive Health Screenings
DiseaseManagement
OnsiteHealthCenter
Health and Safety
Employee Assistance Services
EnvironmentalHealth
AbsenceManagement
Physical Therapy Services
PharmaceuticalServices
Radiology Services
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Comprehensive Health Care Services
Definition assessment, treatment, care
coordination or management ofhealth risks,
medical conditions or diseases, or medical
circumstancesthat impact employee health or
productivity
Primary Care
Occupational Care
Injury/Illness Care Wellness Examinations Preventi
ve Screenings Diagnostic Lab Tests
Injury/Illness Care Medical Examinations Injury
Prevention Occupational Tests
Health Care Coordination Disease
Co-Management
Health Advocate/Coach Case Manager
Behavior Health Counselor
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Spectrum of Integrated Services
Preventive Health
Disease Management
Lifestyle Management
Health Education

• Wellness assessment
• Cardiovascular
• Diabetes
• Cancer
• Musculoskeletal

• Asthma/chronic lung
• Cardiovascular
• Depression
• Diabetes
• Chronic pain
• Migraine

• Smoking cessation
• Physical activity
• Nutrition
• Resilience
• Substance abuse

• Self-care
• Maternal care
• Safety
• Work/Home
• Ergonomics
• Online health

Health Advocates and Coaches
Communications, Plan Design and Incentives
Integrated Data and Measurement
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Improving Health Care Delivery and Quality

• Michael
• 25-year-old male
• Computer Tech Support
• Health Conditions
• No major illnesses
• Seasonal allergies requiring prescription
  medications and regular allergy shots
• Health risks reports high stress and
  sedentary job
• Onsite Health Services
• Review generic medications
• Provide allergy shots
• Allergy prevention education
• Wellness assessment
• Health Care Plan
• Refer to EAP for stress/resilience management
• Refer to health coach (fitness) for exercise
  program

• Rachael
• 38-year-old female
• Administrative Assistant
• Health Conditions
• Migraine headaches
• Depression off and on problem
• Health Risks sedentary lifestyle, obesity (BMI
  gt 30)
• Family history of breast cancer and depression
• Onsite Health Services
• Promote periodic treatment for acute headaches
• Headache prevention education
• Depression screening
• Wellness assessment
• Health Care Plan
• Refer to lifestyle management for
  nutrition/exercise program
• Instruction on self-exam reminders for mammogram
  tests
• EAP referral for depression counseling program

• Ricardo
• 58-year-old male
• Warehouse services
• Health Conditions
• Lumbar disc syndrome/chronic pain
• Emphysema requiring hospitalizations
• Health risks smoker, inactive
• Family issues wife has early Alzheimer's
  disease
• Onsite Health Services
• Periodic treatment of medical condition
• Discuss smoking cessation
• Co-management assist with chronic
  pain/emphysema care
• Health advocate/coaching support
• Health Care Plan
• Refer to lifestyle management for smoking
  cessation
• EAP referral for wife/employee to work with her
  health issues
• Discuss vocational assessment for possible job
  transfer

Preventive care and health management
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Health Care ManagementCenter Potential




























































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Review of Onsite Health Care Models
Onsite Health Centers
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Onsite Healthcare Delivery Models
Standard LevelOnsite Center
Mid LevelOnsite Center
Retail Clinic
Advanced Level Onsite Center
BasicOccupational Clinic
Standard Occupational Clinic
Purpose Convenient, AffordableCare
Purpose Occupational Care,Medical Surveillance
Purpose Primary and Occupational Care
Prevention and Health Care Coordination
Population Requires gt 2,000
Population From lt 1,000 to gt 5,000
Population From 1,000 to gt 10,000
Provider(s) Nurse/Paramedic/Physician
Provider(s) Physician Assist/Nurse
PractitionerPhysician
Provider Nurse Practitioner
Services Primary/Occupational/Preventive
Care Preventive Screenings/Health
Promotion Primary and Occupational
Exams Occupation Tests to Radiology
Services Basic Lab Tests Reference Lab
Services Basic Medical ConditionsPhysicals,
limited Limited Lab/ Drug Screen
Services First Aid/Injury Care/Occupational
Care Occupational Exams Occupational
Tests,Limited Lab
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Comparison of Service Capabilities
Yes
Yes
No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
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Onsite Healthcare Company Capabilities

• Fixed cost with management fee
• Long term contract
• Performance guarantee

Contract Agreement

• Design/co-develop/ build
• Equipment/ supplies
• Identify staff model/services/ hours

Center Development
Healthcare CompanyCapabilities
Center Model

• Finalize center model
• Select staff, orient/educate
• Integrate services/programs

• Medical liability
• Medical confidentiality
• Compliance with regulations

Medical Legal

• Daytoday operations
• Maintain appropriate staffing
• Manage/coordinate health services

Operations /Management

• Track primary/occupational care services
• Provide outcomes cost and value
• Interface with data management

Data Info System
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Determining the Value of Investment
Onsite Health Care Medical cost avoidanceTotal
care managementControl center costsProductivity
gain
Current Health System Community health
careHealth care accessCare coordinationProducti
vity loss
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Total Medical Savings Work Loss
Based on Client ABC with 2,000 employees in one
location.
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Organizational Management
Onsite Health ServicesManagement Team
Communication Plan Benefit DesignProgram
Integration
Onsite Healthcare Company Administration
Clinical ServiceDelivery
Employee Satisfaction
Practice CareManagement
Clinical StaffCompetency
Outcomes Data/Metrics
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How Are the Centers Performing?

• Productivity
• Most consistent reported positive impact
• Reporting calculations/methods vary
• Health care cost avoidance and ROI
• Projections vary greatly based on location,
  population demographics, clinic model, scope and
  quality of services, and utilization
• Utilization tied to company communication plan,
  benefit design incentives, and program
  integration
• Overall performance
• Positive indicators of satisfaction, health and
  productivity gains
• Additional data and standard measurements needed
  for accurate financial impact

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Defining the Steps for Successful Health Center
Development
Onsite Health Centers
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Steps for Successful Center Development
I. Determine the Preliminary Plan
II. Conduct Business Needs/ Data Analysis
III. Create the Business Case
IV. Determine Final Model and Plan
V. Vendor Selection and Implementation
VI. Create Ongoing Outcomes Process
4
0
1
2
3
9
12
Time Line (months)
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Determining a Preliminary Plan (I)

• Is an onsite health center in alignment with your
  companys business goals?
• How can the center be integrated into your health
  and productivity strategy?
• How would an onsite health center make an impact
  on health costs? (i.e., cost, trends high
  utilization)
• Is our productivity walking our the door? (i.e.,
  health care access, absenteeism)
• Should the center be made available to employees
  and families?
• Who would be the appropriate onsite health care
  company and what services should be offered?

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Conducting Business Needs/Data Analysis (II)

• Identify organizational factors
• Evaluate human capital strategy
• Review health and productivity barometer
• Identify key stakeholders and level of support
• Determine readiness to change
• Analyze required workforce data
• Employee demographics
• Medical claims history/pharmaceutical usage
• Prevalent health risks, conditions, and chronic
  diseases
• Absenteeism rates

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Creating the Business Case (III)

• Outline the guiding principles for success
• Communication a critical fulcrum point of
  success
• Identify key company and culture issues focus
  groups
• Analyze the feasibility
• Identify health care costs/utilization of
  services of defined population
• Identify potential healthcare company for
  partnership
• Center model/services
• Center costs and projected savings

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Determining Final Model and Plan (IV)

• Approve final center model
• Outline operational logistics
• Clarify type of vendor partnership
• Identify management responsibilities
• Analyze the financials
• Five year proforma
• Unify the plan across business units
• Communication strategy
• Implementation timeline

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Selecting a Healthcare Partner Integrating the
Services (V)

• Assess and select healthcare vendor
• Match capabilities, costs with company needs
• Negotiate contract
• Develop communications plan
• Educate employees to new concept healthy center
  
• Build consistent messaging/branding
• Create the employee healthcare experience
• Simplify processes
• Integrate all health services
• Integrate health and productivity programs

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Creating an Ongoing Evaluation Process (VI)

• Design key metrics for assessment
• Employee participation, satisfaction, turnover
• Healthcare costs, absenteeism
• Monitor process and progress
• Track metrics of center performance service
  delivery, practice care management
• Healthcare management interface with company
  programs

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The Bigger Picture Medical Ecology
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Value-Based Competition

• The focus should be on value for patients, not
  just lowering costs
• Competition must be based on results
• Competition should center on medical conditions
  over the full cycle of care
• High-quality care should be less costly
• Value must be driven by provider experience,
  scale, and learning at the medical condition
  level
• - Michael Porter, 2006

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New Model of Family Medicine

• Team care
• Risk/condition management
• Redesigned office systems
• Electronic technology
• Quality improvement

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Summary Benefits to Company

• Medical Services
• Improve health care access and quality
• Facilitate better health care management
• Health Care Costs
• Reduce primary and occupational care costs
• Productivity
• Reduce lost work time and absenteeism
• Enhance workforce health and work availability
• Organizational
• Facilitate healthy culture
• Improve employee loyalty and retention

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Summary Benefits to Employees

• Improved Quality of Care
• Access to convenient care
• Complete approach to medical,physical and
  behavioral health
• Cost reduction (copays)
• Focus on Prevention
• Identify health risks that contribute to current
  diseases
• Facilitate access to wellness programs, health
  screenings and lifestyle management programs
• Provide health information to facilitate good
  health care decision making

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The first wealth is health
- Ralph Waldo Emerson
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Thank You!
Randy AbbottSenior health care
consultant 781/283-9280randall.abbott_at_watsonwyat
t.com
Dr. Tim NewmanSenior consultant/clinician 216/9
37-4056tim.newman_at_watsonwyatt.com