Employers as Change Agents – New Opportunities through Direct Relationships
Jan 12, 2016
Employers as Change Agents – New Opportunities through
Direct Relationships
THE HDP PREMISE
Employers are ready for cost containment solutions based on Patient-Centered quality care, with competitive pricing.
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SO….
WHAT’S THE
PROBLEM?
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“7 OF 10 CFOS AND OTHER TOP FINANCIAL EXECUTIVES RANKED HEALTH CARE AMONG THEIR TOP
BUSINESS CONCERNS FOR 2013.”
Bank of America Merrill Lynch Survey In USA Today, 7/23/13
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HOW MUCH HEALTH CARE COST IS WASTE?
PwC 2008* – 54.5%
In 2008 - $1.2 trillion
8% of 2008 GDP
Equal to income tax receipts
> The US’ 2012 Budget Deficit* PricewaterhouseCoopers’ Health Research Institute The price of excess: Identifying waste in healthcare spending
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TOP THREE CAUSES FOR $1.2 TRILLION WASTE OUT OF A $2.2 TRILLION TOTAL SPEND Defensive medicine –
including unnecessary test and procedures
Inefficient healthcare administration
Cost of care necessitated by preventable lifestyle driven conditions * PricewaterhouseCoopers’ Health Research Institute
The price of excess: Identifying waste in healthcare spending
AVG ANNUAL HEALTH INSURANCE PREMIUMS AND WORKER CONTRIBUTIONS FOR FAMILY COVERAGE, 2009-2013
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If health care costs tracked general inflation over the prior 15 years, in 2010 average family income would have been $8,410 (13.9%) higher ($68, 805 vs. $60,395).
Young and Devoe Family Medicine, Oct 2012
IMPACT ON FAMILY INCOME
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OccupationalHealth
Convenience/Urgent Care
WHAT THEY’VE BEEN DOING FOR YEARS HELPS – BUT DOESN’T SOLVE THEIR PROBLEM
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Rx Dispensary& Mgmt Chronic Disease
& Lifestyle Mgmt
Referral Mgmt
Benefit Refinement
Utilization Review
Case Management
Carrots & Sticks
Stop-Loss Arrangements
Health IT
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Primary Care Medical Home
High PerformingNarrow Networks
Telemedicine
On Site Clinics
NOW THEY’RE WILLING TO GO DIRECT, USE THEIR BUYING POWER AND EMPOWER MEMBERS WITH DATA
Centers of Excellence Centers of Excellence
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THE HDP PREMISE – REDUX
Employers are ready for cost containment solutions based on Patient-Centered quality care, while maintaining competitive pricing…. And here’s what’s
new….. they’re going direct and moving market share
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BASED ON THE TRIPLE AIM
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Old model –
Is care cost effective?
Are discounts best available?
New model –
Is care necessary?
Care most effective for the presenting patient?
Patient engaged and in agreement with approach and satisfied with care?
Are there good outcomes?
Is pricing in a format that assumes risk?
EMPLOYERS WANT CHANGE
In a word… VALUE
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Evidence-Based Integrated Care Delivery
Plus
Patient- Centered Collaborative Decision Making with an Integrated Team
Plus
Appropriate & Affordable Risk-Based Price
Healthcare Value Results From……
WHAT DO EMPLOYERS WANTIN DIRECT RELATIONSHIPS?
Take care of the patient (my member) first and foremost
Deliver appropriate, evidence-based care
Engage the patient as a critical member of a multi-disciplinary integrated team
Exercise team-based decisions on care
Create a timely and transparent process, holding everyone accountable
Charge a reasonable fee – preferably at a bundled rate
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Centers of Excellence/Domestic Medical Travel
Accountable Care Organizations, Medical Homes, Narrow Networks
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“DIRECT TO EMPLOYER” MODELS
Patient Centered Medical HomesPaul Grundy, MD, MPHGlobal Director of Healthcare Transformation IBM, President PCPCC
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DIRECT TO EMPLOYER MODELS
IBM Unleashes "Primary Care Spring"
“Utilizing a collaborative care model, the patient becomes a valued member of the care team – more than just a vessel for billing codes. Patients win. Physicians win. Employers win.” Dave Chase
8/27/2012
MERCER’S 2012 SURVEY ONWORKSITE MEDICAL CLINICS
Who is offering clinics…
37% of employers with 5,000 or more employees operate their own health clinics for occupational medicine and/or primary care
Increased from 32% in 2010
Another 15% - considering installing a clinic within 2 years
15% of companies with 500 to 4,999 employees have workplace clinics
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Our CLINIFIT® Program
Fully carved out domestic travel surgery program For frequent high cost surgeries:
Cardiothoracic surgeries Spine surgeries Joints – Hip and knee replacements Transplant management 1/1/2016 adding bariatric surgery
Currently with self funded Fortune 200 companies WalMart, Lowe’s, PepsiCo, McKesson, others Available to over two million lives
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WA
OR
CA
NV
ID
MT
WY
COUT
NMAZ
TX
OK
KS
NE
SD
NDMN
WI
IL
IA
MO
AR
LAAL
TN
MI
PA
NY
VT
GA
FL
MS
KY
SC
NC
OHINWV
NJ
CT
MA
ME
VA
NH
MI(upper pennisula)
RI
DEMD
ClinifiT ® Centers of ExcellenceVirginia Mason Medical Center
Mercy Hospital Geisinger Health System
Johns Hopkins
Cardiac
Spine
Joints
Southeast Center Coming in 2016
Kaiser Irvine Medical Center
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MEDICAL CENTER CRITERIAQuality – Components:
Published outcomes begin evaluation Demonstrated practice of patient-centered, evidence-
based medicine Systematic, formal, documented quality driven
management process (e.g., Lean, Six Sigma, Adaptive Design)
Comprehensive team approach to clinical decision-making, willing to work collaboratively and as partner
Closely managed transitions of care Support of patient and “caregiver” throughout the
process Demonstrated accountability and transparency
Price – competitive and comprehensive bundled pricing – Requirement for consideration.
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SAVINGS RESULT FROM Better outcomes with fewer complications Integrated care delivery with well managed
transitions Advanced care delivery techniques Commitment to totally patient-centered
approach – seeing everything through the “lens of the patient”
Patient engagement reduces cost; promotes better outcomes
Collaboration with other centers promoting best practices
Avoidance – HDP’s CoE experience Appropriate pricing & price structure (preferably
bundled)22
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BUT WAIT… THERE’S MORE
Other Critical Factors Creating Value… Employee return to
work
Employee disruption – lost work time
Presenteeism
Employee relations – my employer cares about me and my family
SECRETS TO SUCCESS FOR A COE? Commitment to integrated, patient-
centered care delivery Physician leadership committed to
quality, service, evidence, patient engagement, and transition of care
Commitment to transparency, collaboration and working as a partner with TPA, employers and other centers
Commitment of necessary resources
Commitment to communication and valuing the whole team
Ultimately – Seeing and delivering all care “through the lens of the patient”
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