Workshop A Effective Onsite Health Clinics: Design Elements & Credibly Calculating Impact

1. Workshop A Effective Onsite Health Clinics: Design Elements & Credibly Calculating Impact Brian Klepper

2. What We’re Talking About Comprehensive Primary Care Fully Realized Medical Homes Medical Management Platforms • Significantly Reduce Cost • Improve Population Health Status

3. Effective Onsite/Near-site Clinic Characteristics • Outside FFS, So No Financial Conflicts, Incentive is for Appropriateness • Comprehensive Medical Management Platforms That Incorporate Other Key Mgmt Approaches and Influence Care Throughout The Continuum. • Strong Incentives For Participation. Free Visits, Drugs, Labs. Capture Them, Engage Them, So You Can Manage Anywhere In The System. • Provable, Significant Savings. Based on hard data, not soft, productivity estimates.

4. Operational Pillars • Outside Fee-For-Service Reimbursement • Physician-Driven Clinical Practice • Empowered, Collaborative Primary Care • Employee Incentives That Drive Their Clinic Use • Rx Step Therapy

5. Operational Pillars • Web-Based Health Information Technologies • Onsite Face-to-Face Health Management • Data-Driven, High Performance Networks • Low Cost, Highly Efficient Physical Plant • Creative Purchasing Arrangements • Transparent, Accountable Client Relationship

6. Modular HIT Management Structure • Rx • e-Prescribing • Drug Interactions • Allergy Alerts • Drug Adverse Effects • Alternative Therapy • Pharmacy Alerts • PBM • Routes Prescription • PBM History • PBM Formulary • Rx Mgmt • Drug Inventory Control • Dispensing Compliance • Patient Education • Accounting • Accounts Payable • Accounts Receivable • Marketing • Marketing-Sales • Project Mgmt • Recruitment • EMR • Web-based Scheduler • Health Risk Assessment • Patient Portal • Decision Support • Lab • Electronic Results • Web-Based Order Entry • MIS Trips • Issue & Incident Tracking • Programming Requests • Admin DB • HR Database • Claims Data Storage • Med Mgmt • Risk Stratification • Disease LifeStyle Education • Goals & Outcome Tracking • Analytics • Client Dashboard • Predictive Modeling • Campaigns • Member Portal • Claims Analysis • Reporting Integration

7. Online Patients Tools (Patient Engagement, Self-Management) Online Scheduling Personal Health Record Patient Education Materials Recommended Content & Social Networking Sites

8. Clinicians Tools Population/Personal Care Mgmt Analytics ID Risk/Referrals Electronic Health Record Clinical Decision Support External Data Lookup/Processing

9. Client & Clinic Manager Dashboards • Clinic Use • How Often Is The Clinic Used By Employees/Dependents ? • What Services/Products Are Being Provided? • Status of Drug Inventories & Other Operational Requirements? • Cost • What Did The Client Spend? What Savings Have Accrued? • Quality • What Is The Group’s Health Status? How Has It Changed? • Staffing • How Productive Is Each Staff Member?

10. Major Savings Areas • Replace Higher Network Costs With Lower Clinic Costs • Aggressively ID/Manage Chronic/Acute Care Opportunities • Collaborate On & Influence Downstream Care & Cost • Occupational Health: Workers’ Comp, Disability Mgmt, HR Testing, Retention/Recruitment, Lost Productivity

11. Predicting PerformanceRequires Data • Confidently estimating savings levels requires access to past med/surgand Rx claims data.

12. Differentiators • Business Model Assures No Financial Conflict • Most Advanced Full Continuum Medical Management • Financing For Most Startup Costs • Staffing for Convenience and Access • Fully Empowered Primary Care • Visits, Drugs, Labs Free To Patients (to encourage use) • Effective Drug/Lab Purchasing Arrangements • Rigorous Drug Step Therapies • ePrescribing with Surescripts Rx Hub

13. Differentiators • After Hours Call-In Service (with Data Exchange) • Use of High Performance Network • Local Oversight • Web-based (i.e., less costly) Health IT • Can Integrate with Existing Health Benefit Programs • Service Set Customized To Employers’ Needs • For non-Grandfathered plans, Use Clinic To Provide USPSTF Recommended Services • Risk Part of Mgmt Fee Against Cost/Quality Targets • Transparent/Accountable Business Relationship

14. Real Mission • Facilitate Better Patient Care • Protect Clients’ Financial Interest

15. Credibly Calculating Financial Impact • Principles • Repricing Overstates Impact. An effective clinic should restructure (and reduce) health plan utilization patterns. • Evaluate Full Continuum CostsPre- and Post-Clinic Implementation. • Normalize. Account for Shock Losses, Inflation, Census Changes.

16. Credibly Calculating Financial Impact • Add incurred medical/surgical and Rx claims costs associated with eligible clinic participants for the period in question post-clinic implementation. • Add incurred medical/surgical and Rx claims costs for the same group, and for the same months of the previous year, pre-clinic implementation. • To the post-clinic implementation period, add the costs associated with: • The clinic’s monthly operational costs • The startup amortization costs (e.g., buildout, furnishings, recruitment, training, inventory stocking) payable during that period.

17. Credibly Calculating Financial Impact • Remove catastrophic or “shock” losses – say, for claims over $25,000 - from the claims data for each period. There are random events that could not reasonably have been averted by the introduction of the clinic, especially in its first year. • Normalize average cost per employee by dividing the total costs for each period by the average census of eligible clinic participants.

18. Credibly Calculating Financial Impact • To account for the trend in premium inflation, multiply the previous year’s period by the premium inflation figures supplied by a reputable national research group, like the Kaiser Family Foundation (KFF) or Milliman. 2011 Family Premium inflation was 9.5% and 7.3%, respectively, for KFF and Milliman. • Subtract the total adjusted claims costs for the pre-implementation period from those for the post-implementation period to identify absolute and relative savings/cost increases.

19. Onsite/Nearsite Clinics – Financial Impact

20. Credibly Calculating Financial Impact

21. Onsite/Nearsite Clinics – Competitive Advantage Savings Grow Over Time, and Create Competitive Advantage Illustrative Only

22. Brian R. Klepper, PhD is a health care analyst and commentator. He is Chief Development Officer for WeCare TLC, LLC, an onsite primary care clinic and medical management firm based in Longwood, FL, and Managing Principal of Healthcare Performance Inc., a consulting practice based in Atlantic Beach, FL. An active author and speaker, Dr. Klepper has provided health care commentary to CBS Evening News, the Wall Street Journal, the New York Times, and the Washington Post. He has published articles on Kaiser Health News, Medscape, Healthleaders, The New England Journal of Medicine, Modern Healthcare, Business Insurance and newspapers nationally. In December 2010, he founded and now edits Care & Cost, an online professional health care magazine. He is a regular contributor to the Health Affairs Blogand other expert health care blogs. With his wife, he also maintains Elaine’s Journey, which details their struggle against Primary Peritoneal (Ovarian) Cancer. Brian serves on the American Academy of Family Physicians’ Primary Care Services Valuation Task Force, and is a reviewer for Health Affairs and The Journal of Ambulatory Care Management. He serves on the Board of the Consortium for Southeast Hypertension Control (COSEHC), dedicated to translational medicine for vascular disease.  He is an Advisor to the Lundberg Institute, the Patient-Centered Primary Care Collaborative, which advocates for medical homes, and the Center for Value Health Innovation, which helps business identify and implement approaches proven to improve quality while reducing cost. In January 2011, with David Kibbe MD, he began a campaign, Replace the RUC!, that focuses on the most important driver of inappropriate health care cost. That effort has resulted in a lawsuit by six Augusta, GA primary care physicians against the US Centers for Medicare and Medicaid Services (CMS) over its longstanding inappropriate relationship with the AMA’s Relative Value Scale Update Committee (RUC). Contact Brian at 904.395.5530 (o), 904.343.2921 (c), bklepper@gmail.com.