ONSITE CARE: CAN THIS STRATEGY
CHANGE YOUR HEALTHCARE GAME?
March 20, 2014
HOUSEKEEPING
• Slide deck will be posted on hni.com
• Q&A at the end, but feel free to ask questions throughout
• Tweet @H...
THANK YOU TO OUR SPONSORS!
TOPICS COVERED TODAY
• Intro
• Who’s a Good Fit and How to Build an Onsite Program
• Cost Structure and Payment Methods
• ...
INTRO
Why are companies considering onsite care?
5
6
Employers are frustrated with the
amount of waste we’re seeing in
our health care system.
How big is it?
That’s…
33-52%
of a total health care spend of $2.6 trillion
8
WASTE IN THE US HEALTHCARE SYSTEM
THE CONSUMER
THE SYSTEM
HIGH COST OF ILLNESS
9
“Unscheduled absences can cost employers $3,600
a year per hourly worker, so helping your
employees...
10
REASONS FOR ESTABLISHING
AN ONSITE CLINIC
ADDITIONAL CONSIDERATIONS
11
• Experiencing High Absenteeism
• Low Utilization of Primary Care
• Quality of Local Provider...
INCREASED EMPLOYEE DEMAND
• Employees view this as a benefit!
• Clinics have become common in the workplace
• By 2015, ons...
PATIENT-CENTERED HOME
13
http://youtu.be/btsGDHO_4lU
Patient-Centered Medical Home via Spectrum Health
WHO’S A GOOD FIT &
HOW TO BUILD A PROGRAM
What types of companies can make onsite care work?
How does onsite care work, ex...
15
ONSITE CLINIC MODELS
16
• Traditional Clinic
o Near Site or Shared Clinics
• Direct Primary Care
• Limited Service Clinic
...
TRADITIONAL SERVICES
17
• Occupational Health
• Acute Care
• Preventive Care
• Wellness
• Chronic Care and Disease Managem...
18
ADDITIONAL SERVICES
• Physical Therapy and Chiropractics
• Radiology
• Dermatology, Orthopedics, Pediatrics
• Dentistry...
TRADITIONAL ONSITE CLINIC
19
• Hire third-party vendor
• Employ all clinic staff and management
• Hybrid — employ clinic s...
DIRECT PRIMARY CARE
20
It’s retainer primary care
practice. Basically, you get a
company doctor, and your
employees are VI...
DIRECT PRIMARY CARE
21
EXAMPLE
Characteristic Traditional Practice Direct Primary Care Practice
Panel size 2,000-3,000 < 5...
LIMITED SERVICE CLINIC
22
Nurse Practitioner or Physician Assistant
Photo via Wikipedia
MOBILE MEDICINE
23
Transporting the office to
the patients to diagnose,
monitor, and treat health
conditions.
DEFINITION
MOBILE MEDICINE
24
http://youtu.be/p8jbV1rugyc
UnitedHealth Group: Connected Care Telehealth Video
via Connecting Care
TELEMEDICINE AND KIOSKS
25
26
INTEGRATION
• Collaborate with other
health plan programs, e.g.
care management
• EAP
• Workers comp
• Safety (OSHA )
•...
COST STRUCTURE
& PAYMENT METHODS
How do we pay for onsite care?
27
28
ACCESS AND ELIGIBILITY
Who can use the clinic?
• Employees
• Dependents
• Limit to those in the health
plan
• Shared fa...
VENDOR PAYMENT METHODS
29
• Direct costs plus a management fee
• Per member per month
• Monthly flat fee
Photo by Andrew M...
START-UP COSTS
30
• None — Built into vendor fixed rate
• Small initial investment in an exam room
• Clinic build out
o 50...
OPERATING COSTS
31
• 70% to 80% labor
Family Practice Physician: $170,000
Nurse Practitioner; $94,000
Physician Assistant:...
EMPLOYEE INCENTIVES AND OUT OF POCKET EXPENSES
32
• Most have low or no copays to encourage utilization
• Services may be ...
HEALTH BENEFIT DESIGN
33
Core Plan
• Deductible - $3500 per individual
• Coinsurance
– Preventive Care – 100% (all provide...
HEALTH BENEFIT DESIGN
34
Choice Available
• Option 1:
– $1000 company contribution to Health Savings Account
– No access t...
KEYS TO ONSITE SUCCESS
How do I comply with regulations?
What are best practices?
How do I measure performance?
35
HSA RULES AND WORKPLACE CLINICS
• HSAs are tax-exempt accounts that must be linked to health
plans with high deductibles
•...
ERISA
• Narrow exemption exists for certain clinics
• Treatment of minor injuries or illness or rendering first aid
in cas...
ACA COMPLIANCE
• Must include clinic in the cost of coverage reported on the
W-2 if COBRA premium is charged
• Value is in...
ADDITIONAL REGULATORY CONSIDERATIONS
• State corporate practice of medicine laws
• Fraud and abuse Laws
• HIPAA
• Medical ...
AVAILABILITY BY EMPLOYER SIZE
40
# of Employees
Full Service
Onsite Clinic
Limited Service
Onsite Clinic
Mobile
Medicine
D...
SUCCESSFUL PROGRAM BEST PRACTICES
41
Essential
• Leadership Support
• Continual Communication
• Patient Medical Home
• Pro...
MEASURES OF SUCCESS
42
• Savings — direct and downstream
• Operational — attendance, wait times, etc.
• Satisfaction — emp...
RETURN ON INVESTMENT
43
• T&W — Over half do not track savings
• Not tracked because
o Complex
o No access to past claims
...
SUCCESSFUL PROGRAM OUTCOMES
44
• Coordinated Care
• Control Downstream
• Transparency and Consumerism
• Promote Wellness
SUCCESS STORIES
How have other firms made onsite care work?
45
SUCCESS – TRADITIONAL CLINIC
46
OUTCOME:
Integrated diabetes management program into
primary care model for 2.4 ROI.
MANUF...
SUCCESS – DIRECT PRIMARY CARE
47
OUTCOME:
The strategy yielded 9.2% reduction in first year
health care costs.
MANUFACTURE...
SUCCESS – LIMITED SERVICE CLINIC
48
OUTCOME:
Detected several serious health problems and
connected employees with primary...
QUESTIONS
THANK YOU!
Visit hni.com or call 800-236-4464.
50
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Onsite Care: Can This Strategy Change Your Health Care Game?

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Onsite care programs are rapidly gaining popularity, both as a mechanism to control costs and to increase the value of benefits offered to employees. Employees love onsite clinics for the convenient access to care they provide — and employers are eager to realize cost savings, enhance worker productivity, and tout the value of the offering to attract and retain talent.

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  • Grateful you shared this as I have been researching, attending focus groups and vetted vendors. You simplified a topic, comprehensive in nature. I am leaving the healthcare industry, but have tweaked it for my team. Excellent statistics!
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Onsite Care: Can This Strategy Change Your Health Care Game?

  1. 1. ONSITE CARE: CAN THIS STRATEGY CHANGE YOUR HEALTHCARE GAME? March 20, 2014
  2. 2. HOUSEKEEPING • Slide deck will be posted on hni.com • Q&A at the end, but feel free to ask questions throughout • Tweet @HNIRisk or using the hashtag #hniu to win some HNI swag! 2
  3. 3. THANK YOU TO OUR SPONSORS!
  4. 4. TOPICS COVERED TODAY • Intro • Who’s a Good Fit and How to Build an Onsite Program • Cost Structure and Payment Methods • Keys to Onsite Success • Client Stories 4
  5. 5. INTRO Why are companies considering onsite care? 5
  6. 6. 6 Employers are frustrated with the amount of waste we’re seeing in our health care system.
  7. 7. How big is it? That’s… 33-52% of a total health care spend of $2.6 trillion
  8. 8. 8 WASTE IN THE US HEALTHCARE SYSTEM THE CONSUMER THE SYSTEM
  9. 9. HIGH COST OF ILLNESS 9 “Unscheduled absences can cost employers $3,600 a year per hourly worker, so helping your employees stay healthy and on the job is smart business whether you have two employees or 200.” —Kaiser Permanente
  10. 10. 10 REASONS FOR ESTABLISHING AN ONSITE CLINIC
  11. 11. ADDITIONAL CONSIDERATIONS 11 • Experiencing High Absenteeism • Low Utilization of Primary Care • Quality of Local Providers • Needs of the Population Photo via Wikipedia
  12. 12. INCREASED EMPLOYEE DEMAND • Employees view this as a benefit! • Clinics have become common in the workplace • By 2015, onsite clinics are expected to serve more than 13 percent of the under 65 population in the US compared to 4 percent in 2008* 12 *Massachusetts Research Company
  13. 13. PATIENT-CENTERED HOME 13 http://youtu.be/btsGDHO_4lU Patient-Centered Medical Home via Spectrum Health
  14. 14. WHO’S A GOOD FIT & HOW TO BUILD A PROGRAM What types of companies can make onsite care work? How does onsite care work, exactly? 14
  15. 15. 15
  16. 16. ONSITE CLINIC MODELS 16 • Traditional Clinic o Near Site or Shared Clinics • Direct Primary Care • Limited Service Clinic • Mobile Medicine
  17. 17. TRADITIONAL SERVICES 17 • Occupational Health • Acute Care • Preventive Care • Wellness • Chronic Care and Disease Management
  18. 18. 18 ADDITIONAL SERVICES • Physical Therapy and Chiropractics • Radiology • Dermatology, Orthopedics, Pediatrics • Dentistry • EAP – Behavioral Health • Laboratory • Travel Medicine • Minor Procedures Photo by Joe Goldberg via Flickr
  19. 19. TRADITIONAL ONSITE CLINIC 19 • Hire third-party vendor • Employ all clinic staff and management • Hybrid — employ clinic staff but managed by contracted physician • Contract with local providers to operate the clinic • Shared clinics Towers Watson
  20. 20. DIRECT PRIMARY CARE 20 It’s retainer primary care practice. Basically, you get a company doctor, and your employees are VIPs (very important patients). DEFINITION
  21. 21. DIRECT PRIMARY CARE 21 EXAMPLE Characteristic Traditional Practice Direct Primary Care Practice Panel size 2,000-3,000 < 500 Provider incentive Volume-based Quality-based PT access to MD Through call center 24/7 access to MD cell phone/email PT appointment scheduling Weeks out Same day/next day guaranteed Appointment length Appointment times < 10 min Appointment times > 30 min Waiting room times Often > 1 hour No waiting Annual exam Brief, it at all Comprehensive with lab work Care Location MD office MD office, patient home, workplace, cell phone/email Care coordination Minimal Complete
  22. 22. LIMITED SERVICE CLINIC 22 Nurse Practitioner or Physician Assistant Photo via Wikipedia
  23. 23. MOBILE MEDICINE 23 Transporting the office to the patients to diagnose, monitor, and treat health conditions. DEFINITION
  24. 24. MOBILE MEDICINE 24 http://youtu.be/p8jbV1rugyc UnitedHealth Group: Connected Care Telehealth Video via Connecting Care
  25. 25. TELEMEDICINE AND KIOSKS 25
  26. 26. 26 INTEGRATION • Collaborate with other health plan programs, e.g. care management • EAP • Workers comp • Safety (OSHA ) • Onsite fitness • Pandemic planning Photo by Liza via Flickr
  27. 27. COST STRUCTURE & PAYMENT METHODS How do we pay for onsite care? 27
  28. 28. 28 ACCESS AND ELIGIBILITY Who can use the clinic? • Employees • Dependents • Limit to those in the health plan • Shared facilities with other employers • General public Hours of operation • Shifts of employees • Anticipated utilization • Flexibility of staff • Coordination with other providers = Photo by Enrico Donelli via Flickr
  29. 29. VENDOR PAYMENT METHODS 29 • Direct costs plus a management fee • Per member per month • Monthly flat fee Photo by Andrew Magill via Flickr
  30. 30. START-UP COSTS 30 • None — Built into vendor fixed rate • Small initial investment in an exam room • Clinic build out o 500 to 2,000 square feet o $50 to $100 per square foot • Start with basic services and add over time START
  31. 31. OPERATING COSTS 31 • 70% to 80% labor Family Practice Physician: $170,000 Nurse Practitioner; $94,000 Physician Assistant: $90,500 Registered Nurse: $65,000 Certified Nursing Assistant: $42,000 Physical Therapists: $83,000 • 20% to 30% supplies Immunizations Medications Minor Equipment Laboratory
  32. 32. EMPLOYEE INCENTIVES AND OUT OF POCKET EXPENSES 32 • Most have low or no copays to encourage utilization • Services may be provided at cost with no markup e.g. immunizations, minor equipment (crutches) • Equipment could be loaned COPAY NO -or- LOW
  33. 33. HEALTH BENEFIT DESIGN 33 Core Plan • Deductible - $3500 per individual • Coinsurance – Preventive Care – 100% (all providers) – All other services including Rx - 80% benefit in-network • Maximum Out-of-Pocket - $6350 per individual
  34. 34. HEALTH BENEFIT DESIGN 34 Choice Available • Option 1: – $1000 company contribution to Health Savings Account – No access to On-Site Clinic/DPC model for non-preventive care -OR- • Option 2: – $0 co-pay for primary (non-preventive) care at on-site clinic/DPC provider – Selection of Option 2 disqualifies access to HSA funding
  35. 35. KEYS TO ONSITE SUCCESS How do I comply with regulations? What are best practices? How do I measure performance? 35
  36. 36. HSA RULES AND WORKPLACE CLINICS • HSAs are tax-exempt accounts that must be linked to health plans with high deductibles • Under IRS rules, enrollees in HSA-eligible plans must pay full market value for medical care until they have met the entire deductible 36
  37. 37. ERISA • Narrow exemption exists for certain clinics • Treatment of minor injuries or illness or rendering first aid in case of accidents occurring during working • If the clinic does not fall within this definition, it is considered a welfare plan is needs to comply with ERISA • ERISA claims and appeals procedures • Plan Document, SPD, Form 5500, Summary Annual Report are all required 37
  38. 38. ACA COMPLIANCE • Must include clinic in the cost of coverage reported on the W-2 if COBRA premium is charged • Value is included in the cost of employer coverage when performing Cadillac tax calculations • Must comply with wellness rules • Other mandates such as 100% preventive care, emergency care, etc. • Additional guidance regarding ACA impact on on-site clinic would be welcome 38
  39. 39. ADDITIONAL REGULATORY CONSIDERATIONS • State corporate practice of medicine laws • Fraud and abuse Laws • HIPAA • Medical malpractice • Rules for nondiscrimination in favor of highly compensated employees • Accreditation and licensure 39
  40. 40. AVAILABILITY BY EMPLOYER SIZE 40 # of Employees Full Service Onsite Clinic Limited Service Onsite Clinic Mobile Medicine Direct Primary Care Mid-Size (<200) n/a X X x Larger (200+) X X x x
  41. 41. SUCCESSFUL PROGRAM BEST PRACTICES 41 Essential • Leadership Support • Continual Communication • Patient Medical Home • Providers that Fit BEST
  42. 42. MEASURES OF SUCCESS 42 • Savings — direct and downstream • Operational — attendance, wait times, etc. • Satisfaction — employer and employee • Utilization — physicals, visits • Clinical outcomes
  43. 43. RETURN ON INVESTMENT 43 • T&W — Over half do not track savings • Not tracked because o Complex o No access to past claims o Difficult to measure cost avoidance o Catastrophic events can skew results o Higher use due to incentives or lower costs • Hard ROI • Soft ROI • Most studies estimate the ROI between 2 to 3 years
  44. 44. SUCCESSFUL PROGRAM OUTCOMES 44 • Coordinated Care • Control Downstream • Transparency and Consumerism • Promote Wellness
  45. 45. SUCCESS STORIES How have other firms made onsite care work? 45
  46. 46. SUCCESS – TRADITIONAL CLINIC 46 OUTCOME: Integrated diabetes management program into primary care model for 2.4 ROI. MANUFACTURER WITH 1,000 EMPLOYEES
  47. 47. SUCCESS – DIRECT PRIMARY CARE 47 OUTCOME: The strategy yielded 9.2% reduction in first year health care costs. MANUFACTURER WITH 550 EMPLOYEES
  48. 48. SUCCESS – LIMITED SERVICE CLINIC 48 OUTCOME: Detected several serious health problems and connected employees with primary care physician. Photo via Wikipedia MANUFACTURER WITH 80 EMPLOYEES
  49. 49. QUESTIONS
  50. 50. THANK YOU! Visit hni.com or call 800-236-4464. 50

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