Burns & McDonnell On-Site Clinic A Prescription for Financial and Productivity Success Fall 2013 Lockton Companies Company P r ofi le Engineering, architecture, construction, environmental and consulting services firm 2,100 professionals at world headquarters More than 30 offices worldwide 100 percent employee-owned Authors Tammy Quinn Senior Vice President Director Data Analytics As Burns & McDonnell has grown over the years, so have some of its challenges related to employee-owner health and well-being: Most employee-owners are billable, working long hours and Anne Gibson Consultant Health Risk Solutions dealing with high stress levels. Many clients are out of town, causing employee-owners to travel fairly regularly. Traveling employee-owners generally don t eat well and have little time for exercise. According to claims data, high blood pressure and cholesterol are common conditions for the company s primarily male population. Tight work schedules and gender stereotypes lead to a resistance to seeing a doctor for preventive care or illness. L O C K T O N C O M P A N I E S
INFOLOCK Employee Benefits Data Identifies: The health coach being here, at no charge, and being able to get in and out fast, allowed me to fit my appointment in around work and personal life. I otherwise would likely not have done it. Trends in chronic disease High-cost claims Care utilization patterns -Burns & McDonnell Employee-Owner The Burns & McDonnell data definitely showed promise for potential financial success. As an employee-owned firm, company profits are funneled back to employees. Therefore, as the benefits administration team evaluated the organization s rising healthcare costs and the health challenges facing its employee-owner population, it sought a creative solution one that would personally benefit individuals health while reducing costs for the company as a whole. That s when the idea of creating an on-site health clinic at world headquarters was born. Conducting a Feasibility Study As a first step, the benefits administration team at Burns & McDonnell turned to its Lockton Health Risk Solutions team for help in determining whether an on site clinic made good business sense. Lockton helped educate me on the many, many intricacies of establishing an on site health clinic, said Cheryll Pacey, Burns & McDonnell Benefits Administrator. This process really helped me when I approached senior leadership. Lockton reviewed and analyzed claims and InfoLock Employee Benefits data to understand trends and the prevalence of specific risk factors in the employee population. The team presented the results of the feasibility study to senior management, along with a recommendation to pursue the implementation of an on-site clinic. According to Tammy Quinn, Director of Data Analytics for Lockton, We used a quantitative process to help the client make a decision about the cost/benefit implications for a clinic. When the numbers look good on paper, that s the first indicator we have for potential financial success and the Burns & McDonnell data definitely showed promise. Assessing Employee Attitudes With assurances of executive support, the benefits administration team initiated a conversation with the company s wellness committee. Its members agreed to talk with their coworkers in a grass-roots effort to gather informal feedback and gauge employee-owner reactions. 2
Fall 2013 Lockton Companies In addition, individuals at all levels of the organization were selected to participate in informational focus groups. These employees shared their opinions, expressing some concerns about privacy related to having a care provider located in the workplace. The benefits team considered their feedback when developing messages that were later used in launch communications. Finding the Right Clinic Partner Next, it was time to identify a partner to help develop the clinic. Together, Lockton and the benefits team outlined a general scope of services. They agreed that the main focus of the clinic should be health coaching, with services geared more toward wellness than illness. The main focus of the clinic would be health coaching, with services geared more toward wellness than illness. Lockton managed the overall request for proposal (RFP) process on behalf of Burns & McDonnell by doing the following: Developing a comprehensive RFP. Recommending vendors to be included in the process. Reviewing all proposals. Scheduling and attending finalist meetings. At the completion of the process, Comprehensive Health Services (CHS) was awarded the business. Finding just the right partner for creating the clinic was going to be crucial to its long-term success, said Tammy Quinn. At the core, if employees do not buy in or trust the clinic, there is little hope for true impact. In our experience, cultural fit between a vendor and client is just as important as the vendor s clinical and administrative capabilities. We helped the team at Burns & McDonnell consider all of these factors before making their final selection. Positive Interventions Health center staff members have shared stories of their own about successes with employeeowners stories of unexpected illnesses diagnosed and health goals achieved. These anecdotes provide important early evidence of the clinic s success: A patient, age 32, came in for an annual physical exam. Upon testing, we noticed elevated blood sugar and added an HbA1C test (a test used to diagnose diabetes) for more information. It came back with a result of 6.6, which is consistent with diabetes. After reviewing the lab results with the patient, this individual admitted to not having a primary care provider (PCP). We initiated a referral for a new patient visit and forwarded the lab results for assistance in medication management, as needed. This patient was also set up with health coaching visits to work on new diagnosis education, plus diet and lifestyle modifications to help manage the disease process. 3
When the clinic opened, employeeowners were invited in. Entrance to the on-site clinic at Burns & McDonnell Building and Staffing the Clinic Working closely with CHS, construction on the on-site clinic was completed in less than a year. The clinic was constructed using existing office space. The 1,800-square-foot facility included three exam rooms, two offices, a reception area with waiting room, and a nurse/communal area. During the construction process, CHS worked with the team at Burns & McDonnell to determine the clinical staffing model. Because of sensitivity to employee-owner concerns regarding health privacy, a decision was made that clinic staff would not be direct employees of Burns & McDonnell. The clinic was staffed with a nurse practitioner and a registered nurse who would also function as a health coach. Also on staff were a medical assistant and a full-time receptionist. Announcing the Burns & McDonnell Health Center To encourage high levels of engagement, an internal communications campaign was kicked off with an announcement by the Burns & McDonnell CEO at a company meeting. At the same time, the benefits team launched a page on the company s intranet that focused on the new Burns & McDonnell Health Center. When the clinic opened, employee-owners were invited to tour the facility, meet the staff, and learn what they could expect from the health center. In addition, they were directed to a new online portal where they could make appointments and communicate directly with clinic staff electronically. I am able to get the encouragement I needed to work on wellness issues, which has made me a better employee. -Burns & McDonnell Employee-Owner 4
Fall 2013 Lockton Companies Average Visits Per Day 25 20 15 10 5 0 18.9 21.1 19.7 Q2 2012 Q3 2012 Q4 2012 Immediate Adoption of the Health Center 894Unique patients seen in 2012. Since the health center opened in March 2012, its performance has exceeded leadership s expectations. Although it s typical for companies to experience a ramp-up period during which employees slowly begin to use a new workplace health center, the schedule for the Burns & McDonnell Health Center was filled nearly to capacity from day one. Average Visits Per Day The Cornerstone of Health Risk Management The health center has been fully integrated into Burns & McDonnell s overall Lockton Health Risk Solutions program. The skills of the health coach have been leveraged wherever possible. Each time a prevalent health issue is identified, whether through review of claims data or InfoLock Employee Benefits data, solutions are promoted through the health center. Early evidence shows signs of progress. For those employee-owners who engaged in health coaching, 24 percent had a 10 percent reduction in body weight. The other 76 percent maintained their weight. Four percent of obese employee-owners reduced their body mass index to overweight. With this shift, the organization anticipates an eventual reduction in other risk factors, such as cholesterol and blood pressure. Early Financial Indicators Although leadership was cautioned that financial success with an on-site clinic typically takes time, the health center began proving its value from a financial standpoint in its first year. Financial Indicators for Year One of Operation Hours Saved Per Visit 1.5 hours Total Estimated Productivity Savings $167,849 Cost of On-site Clinic Services $494,857 Total Invoiced Amount $549, 572 Net Value $113,134 Hours Saved Per Visit Average number of hours an employee saves by not having to travel to the physician s office, wait and then be seen by the physician. Total Productivity Savings An estimate derived from the number of hours saved by an employee staying on-site, total number of office visits, laboratory services, and average employee-owner pay. Cost of On-site Clinic Services Lockton valuates clinic procedure codes by reviewing the prior year community pricing based on the 50th percentile for cost of services or Medicare fee schedules. Total Invoiced Amount The amount CHS billed Burns & McDonnell for the operation of the clinic in year one. Net Value Calculated using this equation: (Productivity Savings + Potential Value of Services) Invoiced Amount. 5
The Evolution of the Health Center Although the Burns & McDonnell Health Center enjoyed success in its first year, the leadership team regularly considers potential enhancements. Currently, they are reviewing data and planning new services and features to match the needs of the employee-owner population. Partnerships with community healthcare providers in a variety of specialties may be I will get help when I feel ill or developed over time, based on employee-owner need. have a question. In the past I wouldn t have, to avoid missing Our health center has been a huge success beyond our wildest dreams, work. and none of this would have been possible without Lockton assisting -Burns & McDonnell us every step of the way, said Melissa Wood, Senior Vice President of Employee-Owner Human Resources at Burns & McDonnell. Our health center has been a huge success beyond our wildest dreams. -Melissa Wood Senior Vice President of Human Resources Exam room at the on-site clinic at Burns & McDonnell 6
Fall 2013 Lockton Companies Positive Interventions A patient with diabetes, along with high blood pressure and cholesterol, has been attending health coaching sessions since the Health Center opened. During that time, the patient has lost 32.5 pounds and followed up for the first time in three months with their PCP. The PCP was amazed by how much weight the patient had lost, the significant decrease in the patient s HbA1C, the decrease in the patient s blood pressure, and the decrease in the patient s cholesterol. As a result, the patient s cholesterol medication was reduced to a half pill daily, oral diabetic medication was reduced to one pill per day, and soon insulin will be reduced by five units weekly. A patient who was seeing me for health coaching visits was struggling with depression. I worked with the patient and even sat with the patient, who made a call to the company s employee assistance program (EAP) and Blue Cross to discuss benefits. The patient was able to use the EAP program and work with their PCP to get a prescription for an appropriate medication. Since starting medication, the patient has lost 21 pounds and decreased BMI from 26.8 to 24. The patient is not only physically healthy today, but mentally healthy, too. Since coming to the health center, I have lost nine pounds. The biweekly health coaching sessions motivate me to achieve the goals that I set when I visit. Also, the clinic has kept me from missing hours of work when I have caught colds or had bad allergies. I love this health center! The staff is great, and I would be very upset to lose any of them. -Burns & McDonnell Employee-Owner 2009 Feasibility study confirms potential impact for clinic. 2010 Leadership approves clinic proposal. Associate feedback sought to help shape messaging. 2011 2012 Clinic partner identified via RFP process. Construction begins. Clinic opens in March. Associate adoption is immediate. 2013 Staff is hired. Internal communications campaign is launched. Data analysis. New services are under consideration. 7
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