11/10/2015. Are Employer Based Health Clinics the Answer? Agenda for Discussion. The Aurora Health Care Journey. Marketplace. Outcomes.

Transcription

1 Are Employer Based Health Clinics the Answer? Scott Austin, CEBS, Aurora Health Care Patrick D. Falvey, Ph.D., Aurora Health Care Agenda for Discussion Marketplace Outcomes Scott Austin National Statistics Why should an employer consider a clinic? Things to consider Marketplace Success Criteria ROI 1

2 National Statistics A growing trend despite employer based health clinics having been around for 70+ years, there has been increased use over the past years, and even more so recently Offered by 23% to 30% of mid-sized and large employers (500+ employees) Why the Growth? 1. Concerns with rising health care costs 2. Competitive business climate (1) need for increased productivity; (2) increased competition for skilled workers (convenience/employee satisfaction) 3. In response to a failing health care system especially primary care 4. Impact of ACA National Statistics And the Results Are.. According to a 2015 Towers Watson survey, large U.S. employers with onsite clinics found them to improve employee health and productivity. Many are ready to increase their investment and almost 40% plan to add new centers over the next 2 years National Association of Worksite Health Centers (NAWCH) survey ( ) reports: 64% seeing a reduction in medical care costs 70% realizing reduced lost time 63% reduced use of ER Enhanced integration of health management services and higher employee engagement Why Employers establish onsite clinics According to 2012 Towers Watson Survey Enhance Worker Productivity Reduce Medical Costs Create a Center of Health to Better Integrate all Health Productivity Efforts Improve Access to Care Occupational Health and Safety Needs Other Source: Towers Watson 2012 Survey 2

3 Characteristics that increase likelihood of success Employer should have at least 500 employees concentrated in an area with easy access to the clinic Characteristics that increase likelihood of success: Older workforce Low turnover Above average health care costs High ER usage High absence and lost time for unscheduled medical services Primary care shortage or barriers to external care settings Low utilization of existing primary care, preventive, screening and condition management services 500-2,000 square feet of available space Things to Consider Key decision points in assessing the feasibility of an employer clinic Who should be eligible to use the clinic? Should employees be charged for services? What services should the clinic offer? How should the clinic be staffed and managed? Where should the clinic be located? Should it be a dedicated on-site facility or shared with other nearby employers? What are the benefits of an on-site clinic and how should they be measured? Onsite Clinic Characteristics Services Offered Most popular services offered: Preventive Services Wellness Services Acute Care Emergency First Aid Occupational Health Fitness Center 3

4 Onsite Clinic Characteristics Staffing and Managing Onsite Clinics Staffing Options: Wellness Coaches Registered Nurses Advance Practicing Professionals (Nurse Practitioners or Physicians Assistants) Physicians Other Clinical Staff Occupational Health, Chiropractors, Behavioral Health Most onsite clinics are open 40 hours/wk and follow normal work hours Onsite Clinic Characteristics Staffing and Management Depends on Clinic Types and Services Offered Minute/Quick Care Clinic NP and nurses provide limited care for minor illness and injuries Emphasis on convenience Chronic care management services not provided Urgent Care Center NP or Physician Provides more medical services for more complex issues Provides health screenings and test interpretations Does not provide ongoing care or chronic DM Primary Care Model NP or physician Provides most primary care, including DM Newer Trend - Limit care to high-risk and complex cases Physician-managed on-site DM The vast majority of onsite clinics are overseen by the HR/Benefits department Onsite Clinic Characteristics Where should the clinic be located? Where there are at least 500 employees concentrated in an area with easy access to the clinic Most onsite clinics have a size of less than 2,000 square feet On-site vs. Near-site Over 75% of onsite clinics are within the worksite 10-15% offer a site that is < 2 miles from worksite Next most frequent is within an industrial park with shared access Also consider partnering with health care systems that have under-utilized space 4

5 The Marketplace Size of Employers with Clinics < 500 8% % , % % 5,001 10,000 17% 10,001 25,000 24% 25, % Source: NAWHC Survey, The Marketplace Industries Using Clinics Manufacturing 30% Financial Services 12% Health Care Services 12% Government 8% Source: NAWHC Survey, Providers of Employer Clinics Wisconsin Examples Healthcare system based Aurora Health Care Bellin Columbia St Mary s Froedtert Health Holy Family Prevea ThedaCare National Providers Interra Healthstat QuadMed Activate Sensia Medcor Paladina 5

6 Successful Clinic Characteristics Lessons Learned Clinic providers need to understand the strategic plan Clinic providers need to understand and relate to the workplace and employer s culture Clinic activities need to be data-driven and integrated with all wellness programs and vendors Clinic management needs to be familiar with the employer s benefit plans Clinic s staff has to earn the trust of the employees in order to motivate them to follow recommendations, be compliant and make the needed lifestyle changes Clinic needs to be held accountable Must have a way to monitor results and make improvements Promote confidentiality and privacy Offer easy access to the clinic It takes time to move employees from long-established provider relationships ROI (or Value on Investment) Little quantifiable evidence demonstrating the value of onsite clinics, but 75% of employers with onsite health centers calculate their ROI up from 47% in 2012 however just 12% use an independent third party to perform the analysis Whether onsite clinics save money is dependent on the cost of care delivery compared to avoided claim costs An increase in utilization may initially push medical and pharmacy cost trends higher could be good: Could see greater incidence of preventive screenings and wellness activities Should ultimately be offset by lower inpatient and hospital outpatient visits Typically will see higher GDRs Towers Watson ROI is highly dependent upon employee utilization and staffing levels Using the center to refer the patient to a preferred network of specialists can lead to substantial cost savings It takes time to quantify the affect on managing chronic conditions and increasing employee engagement! Sources 1. Employers Plan to Expand Use of Onsite Health Centers Towers Watson, May 28, 2015, 2. Larry S. Boress, The Landscape of Onsite Health Centers, National Association of Worksite Health Centers, (2014) 3. Victor M. Brugh, II, MD and Mac McCarthy, Employer-Sponsored Medical Clinics: Much More Than Convenience Care, Benefits Quarterly, First Quarter Karl Dalal, Allan Khoury, MD, PhD, Steve Nyce, PhD, Demonstrating High Performance at an On-Site Corporate Health Center, Benefits Quarterly, Fourth Quarter

7 Questions? Patrick Falvey Live Well Aurora focuses on several key areas: Employee Assistance Program (EAP) Occupational Health Onsite Nurse Navigators Disease Management Aurora System Wellness Aurora has been recognized as #1 healthiest large employer in southeast Wisconsin, one of the top 100 healthiest employers in America, and received 3 Annual Gold Awards from the Wellness Council of America. 1. Physical Activity and Healthy Weight : 2/3 of employees measured obese or overweight of which attributed medical and work-loss costs resulted in $17 million in costs & 2014: over 18 tons of sustained weight loss documented by 4,800 participating obese employees : 78% of covered employees & spouses were screened for BMI and 68.3% of those screened qualified for healthy weight credit (through BMI<30 or participating in alternative activities). 2. Tobacco Control - Percentage of health plan employees using tobacco have reduced from 14% to 9.8% (compared to statewide tobacco usage of ~20%) 3. Health Screenings and Immunizations - 85% of employees and 70% of spouses on health plan received HRA and coaching wellness credits. Literature suggests an ROI of ~2:1. - Effective 2011: mandatory influenza vaccines have resulted in 100% compliance 7

8 Employee Assistance Program (EAP) Aurora Employee Assistance Program Cost savings seen by our total book of business over the past few years: Overall savings = $12M; per dollar spent ROI = $ Overall savings = $12M; per dollar spent ROI = $ Overall savings = $13M; per dollar spent ROI = $8.67 In 2014, Aurora saw an average annual cost savings of $3.4M on the Aurora insurance plan, by offering EAP (estimated savings associated with keeping subscribers out of billable BH treatment) Occupational Health Employee Health department dedicated to our employees Pre employment physicals and drug screenings Injury prevention & treatment Exposure management Leave of Absence Assistance Vaccinations and TB Testing Blood Pressure checks Regulatory Compliance Onsite Nurse Navigators 2016 focus on Body Mass Index (BMI) and Diabetes in addition to a variety of Care Coordination Activities and Interventions: Sample Report: 8

9 Onsite Nurse Navigators Sample Report: Onsite Nurse Navigators Sample Report of Disease Management Disease Management Aurora Caregivers Defined Population Data & Benchmarks DEFINED POPULATION Initiative Measure Benchmark (national mean) Result Asthma Percent of defined asthma patients who use a controller medication for persistent asthma. 90.5% 94% Breast CA Screening Screening Rate NA 81% Cervical CA Screening Screening Rate 73.6% 81% Cholesterol in IVD Patients with LDL < 100 or filling a statin NA 85% Colorectal CA Screening Screening Rate 56.5% 76% Diabetes Screening Rate for A1C 87.3% 92% Diabetes Pts. w/ HbA1c under poor control (>9) 37.6% 21% Diabetes % patients with HbA1C <8 52.9% 67% Diabetes Patients with LDL < 100 or filling a statin NA 72% Updated 11/4/15 = Lower is better 9

10 Patrick Falvey Aurora Employer Clinic Testimonial Aurora Employer Clinic Outcomes Clinic Design Employer Services Experience A Testimony to Our Value Greendale School District A Testimony to Our Value Greendale School District Erin Green, Certified Administrator of School Finance and Operations, & Director of Business Services for the Greendale School District from Retired 10

11 Aurora Employer Clinic - Outcomes Primary Care Visit ROI Cost Aurora Employer Clinic services and basic supplies All inclusive hourly rate Average Reimbursement in Milwaukee Market Billed per office visit assume 4 visits/hr Savings through Aurora Employer Clinic For every $1 spent on the employer clinic, $4 saved in healthcare spend Aurora Employer Clinic - Outcomes Satisfaction Standards Quality of Care 91% Courtesy of Provider 93% Likelihood to Recommend 90% *Results YTD 2015 Aurora Employer Clinics Clinic Design One-stop medical care Convenient hours Dedicated care team Increased time spent with patients Efficient coordination of care High standards for quality of care Focus on health promotion and wellness Integration with employee s medical record 11

12 Aurora Employer Solutions Experience We Help People Live Well! This is what Aurora Health Care is all about and why we are in business. Aurora s Employer Solutions services help employees live well through the workplace and are designed to produce quality outcomes. The Aurora Employee Assistance Program has been serving employees since Occupational Health, Wellness, and Employer Clinic services have since become available through Aurora Health Care, Wisconsin s largest integrated health system. We re able to meet the needs of any employer. Ranging from manufacturing to school districts to law firms, employers have benefited from our locally managed wellness services made available to employees onsite and at convenient nearby locations. In 2014 alone, thousands of employees across Southeast Wisconsin have benefited from the variety of wellness services delivered by our trained and licensed professionals who are devoted to the health and wellness of each individual. Aurora Employer Clinics Visit Types Offering Acute and Primary Care Visits, Onsite Top 10 Acute Care Visit Types Allergy Bronchitis Dermatitis Otitis Pharyngitis Pink Eye Sports Physicals Sinusitis Wart Removal Common Primary Care Visit Types Asthma Diabetes Hypertension Medication Adjustments Thank you for your time. For more information: AuroraEmployerSolutions.org 12