Employer health plan sponsor invests in employee/member health in a manner opposite to high-deductible plan designs. Free primary care and generic drugs bring huge plan and employee savings! Spending $50 million funnels Pasco Schools (FL) to hire their own physicians!
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
The Health Finance and Governance project works with countries to improve health systems and expand access to healthcare. In Ghana, the project worked with the National Health Insurance Authority to make the National Health Insurance Scheme more sustainable and effective. This included developing dashboards to monitor enrollment and claims data, conducting research to examine challenges, and laying the groundwork for capitation payments to primary care providers. The project helped institutionalize processes for using evidence to guide decision-making and reform policies to strengthen Ghana's progress toward universal health coverage.
The USAID Health Finance and Governance project helps improve health in developing countries by expanding access to healthcare. Led by Abt Associates, the project works with partner countries to increase domestic health funding, better manage resources, and make wise purchasing decisions. In Nigeria, the project collaborated with government and partners from 2012-2018 to address challenges like underfunding, donor reliance, and weak governance. Key accomplishments included expanding an innovative mobile technology to improve TB response, increasing domestic funding for HIV and primary healthcare, establishing state health insurance schemes, and enhancing multisectoral collaboration around health financing reform.
The Link between Provider Payment and Quality of Maternal Health Services: Ca...HFG Project
This paper presents case studies of provider payment systems in the Kyrgyz Republic, Nigeria, and Zambia that link a quality improvement initiative with provider payment. It documents these programs’ experience with design and implementation and lessons learned for other health care payers seeking to improve quality at the point of care through redesign of a provider payment system.
Can community action improve equity for maternal health and how does it do soHFG Project
Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.
The document discusses CMS's Chronic Care Management program, which pays providers to coordinate care for Medicare patients with multiple chronic conditions. Key points:
- The CCM program pays providers $42 per patient per month to perform 20 minutes of care management and coordination activities outside of office visits.
- To qualify for CCM, patients must have Medicare fee-for-service and two or more chronic conditions expected to last over a year.
- Eligible providers must obtain patient consent and provide 24/7 access, care management, care coordination, and electronic care plans shared with other providers.
- The program aims to improve outcomes and lower costs for patients with multiple chronic conditions by encouraging coordinated chronic care management between visits
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
The Health Finance and Governance project works with countries to improve health systems and expand access to healthcare. In Ghana, the project worked with the National Health Insurance Authority to make the National Health Insurance Scheme more sustainable and effective. This included developing dashboards to monitor enrollment and claims data, conducting research to examine challenges, and laying the groundwork for capitation payments to primary care providers. The project helped institutionalize processes for using evidence to guide decision-making and reform policies to strengthen Ghana's progress toward universal health coverage.
The USAID Health Finance and Governance project helps improve health in developing countries by expanding access to healthcare. Led by Abt Associates, the project works with partner countries to increase domestic health funding, better manage resources, and make wise purchasing decisions. In Nigeria, the project collaborated with government and partners from 2012-2018 to address challenges like underfunding, donor reliance, and weak governance. Key accomplishments included expanding an innovative mobile technology to improve TB response, increasing domestic funding for HIV and primary healthcare, establishing state health insurance schemes, and enhancing multisectoral collaboration around health financing reform.
The Link between Provider Payment and Quality of Maternal Health Services: Ca...HFG Project
This paper presents case studies of provider payment systems in the Kyrgyz Republic, Nigeria, and Zambia that link a quality improvement initiative with provider payment. It documents these programs’ experience with design and implementation and lessons learned for other health care payers seeking to improve quality at the point of care through redesign of a provider payment system.
Can community action improve equity for maternal health and how does it do soHFG Project
Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.
The document discusses CMS's Chronic Care Management program, which pays providers to coordinate care for Medicare patients with multiple chronic conditions. Key points:
- The CCM program pays providers $42 per patient per month to perform 20 minutes of care management and coordination activities outside of office visits.
- To qualify for CCM, patients must have Medicare fee-for-service and two or more chronic conditions expected to last over a year.
- Eligible providers must obtain patient consent and provide 24/7 access, care management, care coordination, and electronic care plans shared with other providers.
- The program aims to improve outcomes and lower costs for patients with multiple chronic conditions by encouraging coordinated chronic care management between visits
Integrating HIV/AIDS in Vietnam’s Social Health Insurance Scheme: Experience ...HFG Project
The document describes lessons learned from integrating HIV/AIDS services into Vietnam's social health insurance scheme from 2014-2017. It discusses challenges such as HIV services originally being provided through donor funding and separate from the insurance scheme. The Health Finance and Governance project worked with Vietnamese government agencies to address barriers through technical assistance. This included integrating HIV treatment facilities into the public system funded by insurance, expanding insurance coverage, and shifting to local drug procurement. The project aligned with government policies and created evidence to advocate for sustainable HIV financing as donors transitioned support. Major lessons were the importance of working within complex adaptive systems and existing policy frameworks.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
Extending health insurance coverage to the informal sector: Lessons from a pr...HFG Project
As a growing number of low‐ and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria.
Strengthening Primary Care Through Performance - Based Incentive SystemHFG Project
The document summarizes the findings from two cycles of research on Indonesia's primary care incentive system under its national health insurance program. The research found that:
1) Health workers' incomes come from various sources, including government salary, capitation payments, regional allowances, and private practice, but the capitation system does not adequately motivate individual performance.
2) There is wide variation in health workers' incomes between districts and facilities based on local policies and patient volumes.
3) While incentive systems exist, they are often based more on attendance and processes rather than quality metrics or achievement of health targets. Respondents recommended revising incentives and indicators to better promote quality primary care performance.
The USAID-funded Health Finance and Governance project worked in Namibia from 2013-2018 to help the country strengthen its health system and progress toward universal health coverage. It did this by supporting the institutionalization of Health Accounts to track health spending, conducting studies to estimate costs of health services and assess quality across public and private facilities, and building the government's capacity to mobilize resources and make evidence-based financing decisions. This evidence helped Namibia explore sustainable domestic financing options and identify its total funding needs for achieving universal coverage of priority health services.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
Case study on establishing low cost hospitals in 4 states with low health ind...Shubhenduchakravorty
This Case Study was created for a specific purpose of exploring a model to establish and clarify operational details of Low Cost Healthcare Hospitals in the States of Bihar, Jharkhand, Chhattisgarh and Madhya Pradesh. The name of the Hospital and the base presumptions are fictitious. However, all data used in the Case Study and the Models are genuine and referred from various sources.
Peak Performance: States Promoting Patient Safetynashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Ann S. Torregrossa, Esq.
The document discusses the goals and services of the Georgia Regional Extension Center (GREC) which aims to help healthcare providers select and meaningfully use electronic health records to improve patient care. It provides an overview of meaningful use criteria and incentives for both Medicare and Medicaid eligible providers and hospitals to adopt electronic health records. It also addresses some of the challenges and opportunities around developing Georgia's healthcare information technology workforce.
This survey found that most organizations expect health care costs to increase in 2014 due to the Affordable Care Act. Specifically, 84% of organizations expect costs to rise, with over half anticipating a 1-10% increase. Most organizations plan to pass these increased costs onto employees. The survey also found that more organizations will offer coverage to part-time employees and reduce the minimum work hours to qualify for coverage in 2014. Finally, effective communication strategies will be important to explain 2014 benefit changes to newly eligible employees.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance to improve financing, governance, management systems, and universal health coverage monitoring. In Botswana specifically, the project worked with the Ministry of Health and Wellness to develop a new health financing strategy, update the universal health benefits package, create a blueprint for national health insurance, increase hospital outsourcing efficiencies, analyze HIV treatment costs, and design a framework for setting healthcare service prices.
Enrollment in Kansas Medicaid and CHIP grew 6.0% in 2014, nearly triple the growth rate of the previous year. Most of this growth was due to increases in enrollment of children and families (85.9%), particularly those eligible through Temporary Assistance for Needy Families (TAF) programs. This surge in children and family enrollment is likely due to policy changes like the implementation of the new eligibility system (KEES) and reductions in eligibility for cash assistance programs, as well as changes in Medicaid and CHIP eligibility for children under the Affordable Care Act.
The USAID Health Finance and Governance project works with developing countries to improve access to healthcare. Led by Abt Associates, the project helps countries increase domestic health funding, better manage resources, and make wise purchasing decisions. The project has activities in over 40 countries and collaborates with health stakeholders to expand services like maternal and child care, reduce financial barriers, and promote universal healthcare coverage.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Essential Package of Health Services Country Snapshot Series: 24 Priority Cou...HFG Project
The document summarizes findings from analyzing essential packages of health services (EPHS) in 24 priority countries. Key findings include:
- 23 of 24 countries defined an EPHS, though specificity of packages varied. Most included the majority of priority reproductive and maternal health interventions.
- Countries delivered EPHS through community health workers and public facilities. Some used EPHS to standardize private sector provision.
- Governments addressed equity through EPHS-related policies on populations and financial protection, though mechanisms varied.
- Priority setting for EPHS appeared limited, with most listing all services rather than prioritizing based on resources. EPHS purposes also varied between guiding service delivery,
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to improve health systems. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project provides technical assistance to over 40 countries in areas like improving health financing, governance, management systems, and measuring universal health coverage. In Mali, the project worked with the Ministry of Health from 2015-2018 to address challenges and strengthen the health system through activities like assessing the system, building stakeholder consensus on priorities, improving use of health financing data, and increasing public-private sector engagement.
HFG Democratic Republic of Congo Final Country Report HFG Project
The USAID Health Finance and Governance project works to improve health systems in developing countries. Led by Abt Associates, the project helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. In the Democratic Republic of Congo, the project worked with the Ministry of Health to strengthen governance and management under a decentralization reform. Key accomplishments included establishing and building capacity of new provincial health divisions, developing human resources standards and guidelines, and institutional strengthening of central directorates to support the reform.
The document summarizes the work of the Health Finance and Governance (HFG) project in Guinea between 2012-2018. The key points are:
1) HFG worked to strengthen Guinea's health system following political instability, economic challenges, and the Ebola epidemic which exposed weaknesses.
2) Some of the results include building institutional capacity at the Ministry of Health, improving governance, and strengthening human resources management.
3) Specific accomplishments include supporting health sector coordination, financial management, use of health research, and oversight from the National Assembly.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
The Evolution of Physician Group from Patient Centric Medical HomesVitreosHealth
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
- Parkview Medical Group participated in the Maryland Multi-Payer Plan (MMPP), a program that provided financial incentives for practices that improved care coordination and achieved savings through reduced hospital admissions and specialist referrals. For the first time in 2014, Parkview received shared savings payments through the MMPP.
- Parkview worked to achieve NCQA Patient-Centered Medical Home Level 3 recognition, requiring collaboration between administration, providers, and staff. After over a year of preparation, Parkview received Level 3 recognition in 2015.
- Parkview has enhanced access for patients by adding services and expanded hours. They launched an online patient portal in 2014 and are working to integrate behavioral health services and move towards more integrated "whole patient
Integrating HIV/AIDS in Vietnam’s Social Health Insurance Scheme: Experience ...HFG Project
The document describes lessons learned from integrating HIV/AIDS services into Vietnam's social health insurance scheme from 2014-2017. It discusses challenges such as HIV services originally being provided through donor funding and separate from the insurance scheme. The Health Finance and Governance project worked with Vietnamese government agencies to address barriers through technical assistance. This included integrating HIV treatment facilities into the public system funded by insurance, expanding insurance coverage, and shifting to local drug procurement. The project aligned with government policies and created evidence to advocate for sustainable HIV financing as donors transitioned support. Major lessons were the importance of working within complex adaptive systems and existing policy frameworks.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
Extending health insurance coverage to the informal sector: Lessons from a pr...HFG Project
As a growing number of low‐ and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria.
Strengthening Primary Care Through Performance - Based Incentive SystemHFG Project
The document summarizes the findings from two cycles of research on Indonesia's primary care incentive system under its national health insurance program. The research found that:
1) Health workers' incomes come from various sources, including government salary, capitation payments, regional allowances, and private practice, but the capitation system does not adequately motivate individual performance.
2) There is wide variation in health workers' incomes between districts and facilities based on local policies and patient volumes.
3) While incentive systems exist, they are often based more on attendance and processes rather than quality metrics or achievement of health targets. Respondents recommended revising incentives and indicators to better promote quality primary care performance.
The USAID-funded Health Finance and Governance project worked in Namibia from 2013-2018 to help the country strengthen its health system and progress toward universal health coverage. It did this by supporting the institutionalization of Health Accounts to track health spending, conducting studies to estimate costs of health services and assess quality across public and private facilities, and building the government's capacity to mobilize resources and make evidence-based financing decisions. This evidence helped Namibia explore sustainable domestic financing options and identify its total funding needs for achieving universal coverage of priority health services.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
Case study on establishing low cost hospitals in 4 states with low health ind...Shubhenduchakravorty
This Case Study was created for a specific purpose of exploring a model to establish and clarify operational details of Low Cost Healthcare Hospitals in the States of Bihar, Jharkhand, Chhattisgarh and Madhya Pradesh. The name of the Hospital and the base presumptions are fictitious. However, all data used in the Case Study and the Models are genuine and referred from various sources.
Peak Performance: States Promoting Patient Safetynashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Ann S. Torregrossa, Esq.
The document discusses the goals and services of the Georgia Regional Extension Center (GREC) which aims to help healthcare providers select and meaningfully use electronic health records to improve patient care. It provides an overview of meaningful use criteria and incentives for both Medicare and Medicaid eligible providers and hospitals to adopt electronic health records. It also addresses some of the challenges and opportunities around developing Georgia's healthcare information technology workforce.
This survey found that most organizations expect health care costs to increase in 2014 due to the Affordable Care Act. Specifically, 84% of organizations expect costs to rise, with over half anticipating a 1-10% increase. Most organizations plan to pass these increased costs onto employees. The survey also found that more organizations will offer coverage to part-time employees and reduce the minimum work hours to qualify for coverage in 2014. Finally, effective communication strategies will be important to explain 2014 benefit changes to newly eligible employees.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance to improve financing, governance, management systems, and universal health coverage monitoring. In Botswana specifically, the project worked with the Ministry of Health and Wellness to develop a new health financing strategy, update the universal health benefits package, create a blueprint for national health insurance, increase hospital outsourcing efficiencies, analyze HIV treatment costs, and design a framework for setting healthcare service prices.
Enrollment in Kansas Medicaid and CHIP grew 6.0% in 2014, nearly triple the growth rate of the previous year. Most of this growth was due to increases in enrollment of children and families (85.9%), particularly those eligible through Temporary Assistance for Needy Families (TAF) programs. This surge in children and family enrollment is likely due to policy changes like the implementation of the new eligibility system (KEES) and reductions in eligibility for cash assistance programs, as well as changes in Medicaid and CHIP eligibility for children under the Affordable Care Act.
The USAID Health Finance and Governance project works with developing countries to improve access to healthcare. Led by Abt Associates, the project helps countries increase domestic health funding, better manage resources, and make wise purchasing decisions. The project has activities in over 40 countries and collaborates with health stakeholders to expand services like maternal and child care, reduce financial barriers, and promote universal healthcare coverage.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Essential Package of Health Services Country Snapshot Series: 24 Priority Cou...HFG Project
The document summarizes findings from analyzing essential packages of health services (EPHS) in 24 priority countries. Key findings include:
- 23 of 24 countries defined an EPHS, though specificity of packages varied. Most included the majority of priority reproductive and maternal health interventions.
- Countries delivered EPHS through community health workers and public facilities. Some used EPHS to standardize private sector provision.
- Governments addressed equity through EPHS-related policies on populations and financial protection, though mechanisms varied.
- Priority setting for EPHS appeared limited, with most listing all services rather than prioritizing based on resources. EPHS purposes also varied between guiding service delivery,
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to improve health systems. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project provides technical assistance to over 40 countries in areas like improving health financing, governance, management systems, and measuring universal health coverage. In Mali, the project worked with the Ministry of Health from 2015-2018 to address challenges and strengthen the health system through activities like assessing the system, building stakeholder consensus on priorities, improving use of health financing data, and increasing public-private sector engagement.
HFG Democratic Republic of Congo Final Country Report HFG Project
The USAID Health Finance and Governance project works to improve health systems in developing countries. Led by Abt Associates, the project helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. In the Democratic Republic of Congo, the project worked with the Ministry of Health to strengthen governance and management under a decentralization reform. Key accomplishments included establishing and building capacity of new provincial health divisions, developing human resources standards and guidelines, and institutional strengthening of central directorates to support the reform.
The document summarizes the work of the Health Finance and Governance (HFG) project in Guinea between 2012-2018. The key points are:
1) HFG worked to strengthen Guinea's health system following political instability, economic challenges, and the Ebola epidemic which exposed weaknesses.
2) Some of the results include building institutional capacity at the Ministry of Health, improving governance, and strengthening human resources management.
3) Specific accomplishments include supporting health sector coordination, financial management, use of health research, and oversight from the National Assembly.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
The Evolution of Physician Group from Patient Centric Medical HomesVitreosHealth
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
- Parkview Medical Group participated in the Maryland Multi-Payer Plan (MMPP), a program that provided financial incentives for practices that improved care coordination and achieved savings through reduced hospital admissions and specialist referrals. For the first time in 2014, Parkview received shared savings payments through the MMPP.
- Parkview worked to achieve NCQA Patient-Centered Medical Home Level 3 recognition, requiring collaboration between administration, providers, and staff. After over a year of preparation, Parkview received Level 3 recognition in 2015.
- Parkview has enhanced access for patients by adding services and expanded hours. They launched an online patient portal in 2014 and are working to integrate behavioral health services and move towards more integrated "whole patient
The Entity chosen was Baptist Healthcare South Florida for years 201.docxtodd701
The document outlines a course project that requires students to analyze the financial operations of a healthcare organization using three years of financial statements and metrics. It provides details on the expected case study format, including sections on background, issues identified, analysis using ratios, recommendations, implementation plan, monitoring methodology, and references. It also includes a sample analysis of Baptist Health South Florida that was done as part of the project, focusing on its statement of operations, balance sheet, statement of cash flows, and key financial ratios for 2017-2019.
A Case Study forBecky Skinner, RRT, BSSpecialized Care Coo.docxevonnehoggarth79783
A Case Study for
Becky Skinner, RRT, BS
Specialized Care Coordinator
University of Iowa Hospitals and Clinics
May 30, 2013
UIHC Human Capital Strategies to Comply and Thrive Under The Patient Protection Affordable Care Act Regulations
Table of Contents
Mission & Vision 3
History of the University of Iowa Hospitals & Clinics 4
Fiscal Year 2012 Facts 4
Statement of Problem or Challenge 5
Research and Background Data 7
Implications PPACA Has on UIHC Human Capital Management 11
Resolution Proposal 14
Summary and Conclusion 17
Appendix A: SWOT Analysis 19
Appendix B: Corporate Parenting Strategy 27
Appendix C: Portfolio Analysis 35
References 45
History of the University of Iowa Hospitals & ClinicsVision:
World Class People.
· Building on our greatest strength.
World Class Medicine.
· Creating a new standard of excellence in integrated patient care, research and education.
For Iowa and the World.
· Making a difference in quality of life and health for generations.Mission:
Simply stated, our mission is: Changing Medicine. Changing Lives.®
University of Iowa Health Care is changing medicine through Pioneering discovery
· Innovative inter-professional education
· Delivery of superb clinical care
· An extraordinary patient experience in a multi-disciplinary, collaborative, team-based environment
University of Iowa Health Care is changing lives by
· Preventing and curing disease
· Improving health and well-being
· Assuring access to care for people in Iowa and throughout the world
In 1873 The University of Iowa began providing medical services when it reached an agreement with Sisters of Mercy to operate a small hospital in the area. It began with two wards, one for women and the other for men containing four private rooms and a surgical amphitheater. In 1865 this agreement was terminated when the Sisters of Mercy moved across town and opened up Mercy Hospital. Today, the University of Iowa Hospitals and Clinics is a public -teaching hospital affiliated with the University of Iowa and a Level 1 trauma center. It has 711 beds including a 190-bed UI Children’s Hospital (About Us, n.d.). On an average day, there are close to 9,000 individuals providing care to patients, including employees, students and volunteers (About Us, n.d.). Fiscal Year 2012 Facts
There were 32,000 patients admitted to the hospital for in-patient care with 59,000 emergency room visits. In the 200 outpatient clinics of the UIHC, 977,337 clinic visits were counted. In addition to the 1,300 volunteers of UIHC, it employed during FY2012:
· 1,548 physicians, residents, and fellows
· 8,221 non-physician employees of whom 1,845 are professional nurses (About Us, n.d.)
Since U.S. News & World Report began to rank hospitals in 1990, UIHC has made the list as one of the best and has over 271 physicians ranked as “Best Doctors in America”.
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A Healthcare Worker Shortage Action Plan Short-Term Wins and Long-Term StrategyHealth Catalyst
U.S. health systems will have a projected deficit of 200,000-450,000 RNs by 2025. Meanwhile, hospital labor costs have reached almost 50% of an organization’s overall expenses. Now more than ever, leaders need a data-driven labor management strategy that ensures the most cost-effective, high-quality care.
Southcoast Health partnered with consulting firm Cammack Health in 2010 to reduce costs of its employee health plan and improve member health. Through strategies like population health management, domestic steerage, and personal health management programs, Southcoast achieved the Triple Aim of improved health outcomes, better patient experience, and lower costs. After 4 years, Southcoast saved over $17.2 million compared to national trends, employee contributions remained stable, and members showed positive health changes like reduced ER visits, hospital admissions, and improved management of chronic conditions.
The FMBHP is a collaboration among frontier/rural healthcare communities; Mineral Community Hospital’s Interdisciplinary Medical Education Center; iVantage, an industry leader providing comprehensive hospital evaluation tools; Mayo Clinic’s Practice-Based Research Network (PBRN); and the Appalachian Osteopathic Postgraduate Training Institute Consortium (A-OPTIC). The FMBHP will partner with CMS, IHS, Veteran Administration and other private insurers to develop a seamless and sustainable model of patient-centered and community-based healthcare that produces better outcomes cost-effectively.
The document is a newsletter from Mike Wojcik discussing rising healthcare costs, the impacts of the Affordable Care Act, and strategies for controlling costs. It notes that a new study projects healthcare spending to grow faster than GDP over the next decade. It also discusses provisions of the ACA like expanded preventive care coverage for women and guidelines for employer health subsidies in 2014. The newsletter provides updates on legislative actions and profiles initiatives by healthcare organizations like Blue Shield to reduce costs and improve care.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
This document discusses strategies for healthcare practices to improve financial viability through increased transparency and improved front-end collection methods. It recommends defining costs and billing upfront to set clear patient expectations. Practices should invest in tools to check insurance benefits and eligibility in real-time. Staff should be trained to educate patients on their financial responsibilities. Providing cost transparency builds trust with patients and increases referrals through positive word-of-mouth. Overall, transparency can lead to higher profitability through reduced bad debt and improved revenue cycle management.
The document discusses key strategies for hospital success, including establishing the business case for health information technology, redesigning processes around new technologies, and using technology to extend patient-centered care beyond hospital walls. It also covers best practices like incorporating evidence-based design principles in construction, including stakeholders in the design process, and designing flexibility into buildings. Additional topics include promoting economic viability, the benefits of electronic medical records, achieving patient-centered care, comprehensive care planning, and using social media and marketing.
Employees are facing increased healthcare costs as premiums and out-of-pocket expenses rise. Research shows that as deductibles increase, individuals are more willing to shop for lower cost healthcare. Those with high-deductible plans are especially likely to consider price. Analysis of user data found that people with higher costs engage more with tools to learn healthcare prices. However, many people still lack confidence in their ability to compare providers and costs. Providing tools that educate and empower consumers to make value-based decisions can help control costs and improve health outcomes.
Organizational AnalysisErika N. AguilarSouth Universit.docxvannagoforth
Organizational Analysis
Erika N. Aguilar
South University
Dr. Mary Naccarato
11/13/2019
Organizational Analysis
History of Universal Health Services (UHS), Inc.
Universal Health Services Inc.(UHS), is one of the nation’s largest hospital management companies, with more than 350 acute care hospitals, ambulatory centers, and behavioral health centers within the U.S., Puerto Rico, and the United Kingdom, based in King of Prussia, Pa. Chief Executive Officer, Alan B. Miller, and a team of executives he worked with at American Medicorp, funded the organization with investments from venture capitalists, along with $750,000 put up by himself and several former American Medicorp employees who followed Miller into his investment. Four hospitals and management contracts were acquired by UHS within four moths time. The company has continued to grow since its start up, attaining more facilities and stock trading.
Universal Health Services, Inc. Introductory Statement
Universal Health Services, Inc., a health care organization based in Pennsylvania, has exceled over the past thirty years, with 46 of its’ facilities being recognize in the last 5 years by The Joint Commission as top performers on Key Quality Measures. They have been recognized for Leapfrog excellence, recognizing their hospital safety, quality, and efficiency along with receiving Fortune’s World’s Most Admired Companies for the ninth year in a row, and ranked #293 for the 9th year in a row on Fortune 500’s list of America’s largest corporations by revenue. . over the last ten years in quality and safety and performance measures. The corporation strives to provide quality healthcare services that patients recommend to family and friends, physicians prefer for their patients, purchasers select for their clients, employees are proud of, and investors seek for long-term return (Uhs Inc, 2019).
The Focus on Quality Healthcare, changing lives, and transforming delivery of healthcare.
Universal Health Services has a focus on providing responsive and compassionate care. Patient centered care takes place in a team focused and driven environment focused on shared governance and teamwork. UHS has strived to put the patient first for many decades by employing those who have personal compassion, competence, and commitment to provide quality patient care. Staff are encouraged to voice their opinions and ideas to improve patient care (Uhs Inc, 2019).
Universal Health Services, Inc.’s Mission, Vision, and Values
Universal Health’s mission is to provide “superior quality healthcare services that: patients recommend to family and friends, physicians prefer for their patients, purchasers select for their clients, and employees are proud of, and investors seek for long-term returns” (Uhs Inc, 2019). By provided superior quality care, staff and administration embody the mission. With its large growth and expansion throughout the years, as well improvements in technology, patient c ...
The document discusses providing concise yet informative summaries of healthcare related news and legislation to clients. It aims to help clients understand challenges from the Affordable Care Act and determine solutions. The author will start a blog called "From the Desk of Mike Wojcik" to share healthcare market trends, legislative updates, and topics relevant to human resources challenges. The overall goal is to help the current healthcare model survive as more efficient, affordable and accessible to all.
Delivering value based_care_with_e_health_services.5Greg Bauer
The document discusses how value-based care requires new approaches to engage patients and improve outcomes while lowering costs. It argues that e-health tools can help by enabling better care coordination, remote patient monitoring, social support for patients, and customized care programs. These e-health disciplines are important for engaging patients in their care in new ways to support value-based models.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
How to Improve Healthcare Reporting Management System.pptxFlutter Agency
Here in this article, you will see the tips about the healthcare reporting management system. Read these top 8 tips to improve the Healthcare Reporting Management System.
Similar to How wise plan managers acted "outside-the industry box" to improve health while saving taxpayer dollars. Four year results! (20)
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
MYASTHENIA GRAVIS POWER POINT PRESENTATIONblessyjannu21
Myasthenia gravis is a neurological disease. It affects the grave muscles in our body. Myasthenia gravis affects how the nerves communicate with the muscles. Drooping eyelids and/or double vision are often the first noticeable sign. It is involving the muscles controlling the eyes movement, facial expression, chewing and swallowing. It also effects the muscles neck and lip movement and respiration.
It is a neuromuscular disease characterized by abnormal weakness of voluntary muscles that improved with rest and the administration of anti-cholinesterase drugs.
The person may find difficult to stand, lift objects and speak or swallow. Medications and surgery can help the patient to relieve the symptoms of this lifelong illness.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
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Name: Apollo Hospital
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Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
COPD Treatment in Ghatkopar,Mumbai. Dr Kumar DoshiDr Kumar Doshi
Are you or a loved one affected by Chronic Obstructive Pulmonary Disease (COPD)? Discover comprehensive and advanced treatment options with Dr. Kumar Doshi, a preeminent COPD specialist based in Ghatkopar, Mumbai.
Dr. Kumar Doshi is dedicated to delivering the highest standard of care for COPD patients. Whether you are seeking a diagnosis, a second opinion, or exploring new treatment avenues, this presentation will guide you through the exceptional services available at his practice in Ghatkopar, Mumbai.
3. Can data
analytics
deliver
health
solutions?
1
m
4 *
Acase study about a Florida
school district’s approach to
maintain health and wellness among
its employees under the pressure of a
rapidly growing community and
a tight budget.
Fasco County is located just north of
the Tampa-St. Petersburg metropolitan
region and is the state’s 12th most
populous county. From 2000 to 2010,
the county population increased 34.8
percent from 344,768 to 464,697, the
U.S. Census reports. This growth was
fueled by increases in housing and
jobs north of the Interstate 275 and
Interstate 75 intersection along the
state roads 52, 54, and 56. It’s esti¬
mated that the population is expected
By Dan Ross, Med-Vision, John Watson, Crowne
Clinics and Katherine Macrone, Deerwalk Inc.
9 October 2015 workspan | 51
4. Ifo tk& 2009-2010 the school board
created an Insurance Committee to meet with
consultants and identify programs to reduce health-care
spending and increase employee health and wellness.
to increase to 479,078 and to 527,000
by 2030. As more families move into
the county, increased service pres¬
sure is exerted on all government
services including schools.
Twenty-five percent of Pasco resi¬
dents are between the ages of 25-44
and another 26 percent between
the ages of 45-64. Families make up
67 percent of the population with an
average household of 2.7 persons.
The District School Board of Pasco
County (DSBPC) was, and continues to
be, the largest employer in the county
with 9,350 employees in 2010-2011
and rising to over 9,500 by 2015. High
school graduation rates have increased
from the baseline of 73.4 percent set
TV* Tuuire*
What is missing in medicine today
is a holistic approach authored
by consultants, employers and
led by physician-directed health
centers. In this model, doctors
are salaried and only worry about
their patient’s health, outcomes
and future good health.
“There are more than 9,000 billing codes for individual
procedures and units of care. But there is not a single billing
code for patient adherence or improvement, or for helping
patients stay well.”
— Clayton M. Christensen, “The Innovator’s Prescription: A Disruptive
Solution for Health Care."
in 2007 to 81.9 percent in 2010 to
over 90 percent by 2015.
County growth and demographic
trends are shifting from a rural
community to a more suburban
population with increased demands
for housing, schools, roads, entertain¬
ment, retail and other services. With
the collapse of the housing market in
2007-2008 and resulting recession, the
county saw a net property tax revenue
decrease over the same time period as
the population was increasing.
The annual budget of $519 million
spends 94 percent on direct student
services. Within this context of
increasing enrollment and flat budget
increases, it became imperative for
the district to review all expendi¬
tures that were not directly related
to student services. Faced with the
double hit of decreasing tax revenue
and increasing population, the DSBPC
needed to find a way to reduce
administrative expenses while main¬
taining student expenditures.
Starting in 2008, the DSBPC targeted
the annual trend of 10-12 percent
increase in its health care spending,
a major target for cost reduction.
As with all health insurance plans,
every dollar spent on claims was
a dollar less to spend on other
administrative areas such as facilities,
staffing, technology and pay.
Without broker involvement where commissions and fees may, and
in most cases have, become a primary driver of recommendations
for programs, the partnership between the employer, health and
wellness centers, and consultants can and will lower spend,
improve health, and save employees and employer’s money. Data
analytics are now available to pinpoint inefficiencies and excess
waste in health-care costs, and opportunities abound for both cost
savings to employers and employees as well as future good health
and quality of life.
Team-Based Approach
In the 2009-2010 year, the school
board created an Insurance Committee
to meet with consultants and iden¬
tify programs to reduce health-care
spending and increase employee
health and wellness. The group
consisted of Med-Vision LLC, Care-
Here Crowne, LLC, the school district
superintendent, and the school district
52 | workspan October 2015
5. Insurance Committee. Med-Vision is the
data analytics company that compiles
and then analyzes an organization’s
health and pharmacy claims data in
order to identify areas and activities
where excess spending can be reduced.
CareHere Crowne was formed as part¬
nership between The Crowne Group and
CareHere LLC and it administered the
employee health and wellness centers
for the district. The following areas
were identified where excess spending
could be addressed through a program
of wellness, big data and physician-
directed health centers:
1 | Moving pharmaceutical drug
spending from higher-cost brand
names to lower-cost generics
2| Engaging members with chronic
conditions such as high blood
pressure, high cholesterol and
diabetes in active manage¬
ment of those conditions
3| Identifying the mix of claim dollars
between preventive and reactive
payments for existing disease and
Claims data are taken direct into the
Med-Vision system and analyzed in an
easy to read and understand reporting
format. The platform utilizes the Deer-
walk Plan Analytics platform, which
uses the practice of Big Data analysis
where information is stored in data
“lakes” and can be searched and reported
on in real time, much like Internet
search engine’s return information. In
addition, data from over 18 million
lives is benchmarked against the data
from the organization based upon the
organization demographics in order to
compare organization results against
statistically validated norms.
The team was able to identify key
action items to reduce spend and
increase member engagement in well¬
ness. Team members then then used
those parameters to develop a program
driven by employer-sponsored on-site
health centers and real-time data
analysis feedback on the results:
1 | Implement on-site physi¬
cian directed health and
wellness centers for employee
and their dependents (members)
medical and pharmacy use.
2 | In exchange for no co-pays
for medical and lower to no
cost for many pharmaceu¬
ticals, member blood work
and biometric data feed
into the clinical systems so
that data analytics are able
identify high-cost expense
and high-risk population.
3| By identifying these
employees who were either
currently high cost or at
risk of becoming high cost,
steps are taken to reduce risk
by driving these employees
to manage their conditions
through on-site physician
and health teams coach.
4 | Move pharmacy benefit
management (PBM) from a
traditional PBM model to a
transparent PBM that operates
on a pass-though pricing model.
AWarJi/AccotaJeÿ &During 2014, Healthiest Employers, the
leader in employee health analytics best
practices and benchmark data, inducted
the District School Board of Pasco County
into the 2014 Healthiest 100 Workplaces
in America. The district school board
was also designated by the American
Heart Association as the Platinum Fit
Friendly Workplace.
In 2013 the Tampa Bay Business Journal
named the District School Board of Pasco
County as the healthiest employer in the
1500+ employee category and second
place overall winner out of 27 finalists
from the Tampa Bay area.
°Ru/ve
Rce
A Content-Rich Webpage
for Exec Comp Professionals
Articles Videos White Papers Upcoming Events
Sponsored by:
Partners’ Thoughts & Ideas on
Executive Compensation Pearl Meyer
Visit today! WorldatWorkwww.worldatwork.org/execcompthoughts The Total Rewards Association|
October 2015 workspan | 53
6. Physician Directed Health
and Wellness Centers
The health and wellness center model
offers medical visits with $0 co-pay
and prescriptions that are often $0
or much lower cost than through the
member health plan. By running all
claims from the health plan and the
employee health and wellness centers
through its data model, Med-Vision
is able to analyze the components of
savings and health from the health
center versus the health plan participa¬
tion in order to document savings and
target additional areas for savings.
As a physician-directed program,
every health center is staffed by a
board-certified medical doctor who is
a salaried employee of the company.
Each health center medical staffer is
able to spend 20-30 minutes with
the member, unlike most practices
where time is often limited to 5 or 10
minutes. In addition, there is a phar¬
macy doctor on staff to review and
monitor all prescriptions.
Since the health center inception
in 2011, employee participation has
grown to where currently 96 percent
of eligible employees use some type
of health and wellness center service.
Total appointment utilization increased
132 percent per member per year
since inception. Growth has been
robust that over the past four years a
total of five health centers have been
opened as of May 2015.
In 2014, 46,000 appointments were
made for medical treatment with
60-70 percent of these treating a
chronic condition and 30-40 percent
acute care. Ten thousand visits were
wellness based. Participation is
trending at 5,000 visits a month for
both wellness and medical visits.
Employee and Member
Wellness Program
The centers provide a critical link to
support the organization’s health and
wellness initiatives. After the initial
launch and strategic plan design,
teams were assigned to specific
goals and held accountable to imple¬
ment tactics, monitor results, assess
and evaluate programs and provide
feedback for program success using
data-driven analysis. Four strategic
initiatives were targeted:
1 | Communications — engage
all members
2| Wellness — physical, emotional,
financial, social, spiritual
3| Weight Loss — care health team
4 | Diabetes Management — medi¬
cation compliance, close care
gaps, reversal of disease
The wellness committee consists of
associates from all parts of the orga¬
nization —human resources, board
members, union members, teachers,
EAP specialists, school nurses, health
center employees and other admin¬
istrative employees. All members
of the health plan are part of the
wellness program, not just employees,
thus engaging all stakeholders
in wellness programs.
Cost Savings Medical,
Pharmaceutical, and
Workers Compensation
Since inception in 2011, medical and
prescription plan cost exclusive of the
health center expense has trended
upward only 0.5 percent over the
four-year time frame (essentially a
54 | workspan October 2015
7. r
Figure 2 | Health Plan Utilization: Inpatient Facility
A
350
300
250
200
150
100
50
0
ALOS:
3.5
Pre-Employee
Health Center
Opening
Jan10-Dec10 Jan11-Dec11 Jan12-Dec12 Jan13-Dec13 Jan14-Dec14
Inpatient Days/1,000 Members
90
80
70
60
50
40
30
20
10
0
81 79
Pre-Employee
Health Center
Opening
Jan10-Dec10 Jan11-Dec11 Jan12-Dec12 Jan13-Dec13 Jan14-Dec14
Inpatient Admissions/1,000 Members
‘Includes run-out medical claims
v j
( i
'
Figure 3 | Health Plan Utilization: Outpatient Facility
1000
800
600
400
200
0
0 percent trend). Contrast this with
average 4 percent to 12 percent
year-over-year trend and annual cost
increase over same timeframe for
benchmark organizations.
Facility Utilization Trend
Inpatient facility utilization decreased
15 percent since inception from 83
per 1,000 members to 70 per 1,000
members over a four-year period.
Outpatient facility visits decreased
10 percent since inception from
902 per 1,000 members to 816 per
1,000 members in the same time
frame. In addition, medical claims
per member per year decreased 10
percent over the four-year period.
Total number of claims processed by
the health plan dropped 16 percent
in the same timeframe.
Prescription Trend
Prescription drug utilization through
the health plan has decreased
17 percent since inception of the
health center pharmaceutical program.
As the employee health and well¬
ness center dispenses its drugs at
a much lower cost than the health
plan, this drives savings for both the
employee and the employer.
Jan10-Dec10 Jan11-Dec11 Jan12-Dec12 Jan13-Dec13 Jan14-Dec14
Outpatient Visits/1,000
The number of outpatient visits has decreased 10 percent since inception.
V
Workers’ Compensation Trend
The centers also manage all first
reports of injury workers’ compensa¬
tion claims since after the first year
opening. Expense from workers
October 2015 workspan | 55
8. compensation and occupational
claims have dropped 60 percent over
the reporting frame.
District and Employee
Savings Three-Year Results
Over the reporting period, the value
of the shifted utilization for the
district totals $24 million. Once the
employee health and wellness center
operating costs are included, savings
are $9.2 million over the timeframe.
Employee Savings Year Results
Over the past four years, members
have saved a total of $4.2 million in
medical and prescription co-pays alone
Figure 4 | Prescription Utilization: EH&WC and Health Plan
(Per Member Per Year)
A
Utilization through the Plan has decreased
Jan10-Dec10 Jan11-Dec11 Jan12-Dec12 Jan13-Dec13 Jan14-Dec14
Number of EHC Rx PMPY Number of Health Plan Rx PMPY
Figure 5 | District Savings
(Analysis by Health Plan Utilization Change)
Market Cost
of Medical
Claims
Avoided
Market Cost
of Rx Claims
Avoided
Total Market
Value for
Shifted
Utilization
EH&WC
Operational
Costs
‘excludes facility
related charges Net Savings
2011 $6,914,248
$1,171,000
($75.69 x 15,471)
$8,085,248 $3,856,189
2012 $4,579,215
$901,239
($37.63 x 23,950)
$5,480,454 $5,258,482
2013 $9,343,680
$1,062,987
($38.15x27,942)
$10,409,667 $5,612,988
Total $20,837,143 $3,138,226 $23,975,369 $14,727,659 $9,247,710
Despite High Cost Claimants in 2012, ROI = $1.63 : $1
by using the employee health and well¬
ness centers instead of the health plan.
The district is a large group with
over 9,000 members and the baseline
data set included three years of
claims information, which translates
to over 340,000 member months.
These data sets are large enough
so results are considered statisti¬
cally significant (within 2-3 percent
of margin of error).
Future Trends
Medical claims costs are being driven
primarily by high-cost claimants
in areas like cancer and multiple
sclerosis, along with a few cases of
trauma or premature birth. Pharmacy
claims costs are most recently being
driven by specialty medications to
treat conditions like Hepatitis C,
multiple sclerosis and cancer. Also
lower-cost/lower-risk members are
being moved out of the plan and
using the company plan as a single
coverage. Or, they are using programs
under the Patient Protection and
Affordable Care Act or Medicare
or Medicaid programs. Concerns
regarding adverse selection arise
if only the sickest members are
remaining in the plan. TO?
Dan K. Ross is president of Med-Vision LLC/
Med-View LLC in Tampa, Fla. He can be
contacted at dan.ross@med-vision.com.
John Watson is director of strategic
development at CareHere Crowne LLC. He can
be contacted at JWatson@CareHere.com.
Katherine Macrone is a client manager
at Deerwalk Inc in Tampa, Fla. She can be
contacted at kmacrone@deerwalk.com in
central Florida.
resources plus
For more information, books and
education related to this topic, log
on to www.worldatwork.org and
use any or all of these keywords:
I Wellness
I Health
I Benefits
56 | workspan October 2015