PALADINA HEALTH ONSITE 2.0 THE EVOLUTION OF ONSITE CLINICS AND ITS IMPACT ON CLAIMS. Revolutionizing Healthcare for Employers

Transcription

1 PALADINA HEALTH ONSITE 2.0 THE EVOLUTION OF ONSITE CLINICS AND ITS IMPACT ON CLAIMS Revolutionizing Healthcare for Employers

2 Today s Agenda 2 Evolution of Onsite Clinics Incentives of an Onsite 2.0 Model Nuts & Bolts How Does This Work? Driving Maximum Results

3 3 I see a healthy bottom line in your future!

4 Onsite 1.0 Ahead of Its Time 4 Onsite clinics common for large employers, especially hospitals and manufacturing plants Companies also hired own physicians to take care of employees in remote areas Treat occupational injuries, urgent needs Minimize time away from work Executive perk for high-wage earners Many clinics closed in 1980s due to decreased manufacturing

5 Strategies to Manage Rising Costs 5 What s Your Experience? Redesign Benefit Plan Implement Wellness Initiative Deploy Onsite Clinic Model Self-Fund, HSA, HDHP Measurable results? Biometrics, incentives Measurable results? Primary care, trusted docs Measurable results?

6 Onsite 2.0 Reasons for Resurgence 6 Control overall health care spend by reducing: Specialist visits Non-generic Rx Avoidable ER visits and hospitalizations Unnecessary testing and procedures Improve population health with strong chronic disease management, wellness focus, and primary care services Reduce lost productivity/absenteeism Offer competitive benefit to recruit/retain employees

7 Onsite 2.0 Clinic Options 7 Management Models 1. Hire your own clinic staff and manage it yourself 2. Directly contract with private healthcare providers 3. Contract with experienced onsite/medical-home providers What Will It Cost You? Significant costs and risks Salaries, benefits, capital Capital costs, size of clinic Extension of private practice Fixed PMPM fees Capital costs dependent on provider chosen

8 Models in the Market Medical Homes On-Site Clinics Wellness Programs Staff Model HMO Traditional PCP Physicians compensated on quality & service 8 Concierge Access Convenient Clinics 24 x 7 doctor cell phone access Reduced panel size Experienced physicians Onsite Clinics at employer worksite Near-site clinics to serve dependents Provider invests their capital Primary Care Prevention & wellness Comprehensive Scope Care Coordination Urgent care On-site labs & pharma Occupational Health Price Transparency Cost Savings Accountability for use of outside system Physician guidance to high-value providers Claims analysis & ROI forecasting Risk-based pricing for qualifying clients Consistently available Sometimes/varies Typically Not Available

9 Today s Agenda 9 Evolution of Onsite Clinics Incentives of an Onsite 2.0 Model Nuts & Bolts How does this work? Driving Maximum Results Your Plan Design

10 Onsite 2.0 = Medical Homes 10 Key Features Include: 24/7 cell phone or access to your personal physician Primary, preventive, and urgent care Experienced primary care physicians Wellness coaching Chronic disease management Easy-to-use technology tools Convenient, modern clinics

11 Aligned Incentives of Onsite Employers Providers Employees

12 Aligned Incentives for Employers 12 Today s Challenges Tomorrow s Solutions High cost environment Lack of price transparency Uncertain exposure to ACA Prevalence of multiple chronic diseases Redirect care & eliminate Fee-for-Service (FFS) Tools to prioritize highvalue referral patterns Control provider supply chain with narrow network Systematic population health management for long-term cost containment

13 Aligned Incentives for Providers 13 Today s Challenges Tomorrow s Solutions Providers practicing on FFS volume-based treadmill Huge Patient Panels, typically 2,500 or more Lack of access, more barriers with exchanges Salaried providers with incentives focused on clinical outcomes & service satisfaction Dramatically smaller patient panels gift of time Vastly enhanced access with no barriers to care

14 Aligned Incentives for Employees 14 Today s Challenges Tomorrow s Solutions Productivity loss; time away from work Negative impact of cost shifting Low adoption of CDHP initiatives Low utilization of wellness or disease management programs Convenient access via text, s, phones; no waiting Benefits to enhance total compensation package High adoption through more carrots, less sticks High utilization and personal accountability through relationships

15 Today s Agenda 15 Evolution of Onsite Clinics Incentives of an Onsite 2.0 Model Nuts & Bolts How Does This Work? Driving Maximum Results

16 Onsite 2.0 Financial Incentives 16 For Employers For Employees Redirecting Spend Impacting Trend No co-pays or out-ofpockets costs Complements HDHP (lower premiums)

17 Onsite 2.0 Reducing Claims Primary Care Overall PMPM Current Costs Impact of Medical Home Increase scope of Primary Care Redirect expenditures out of costly settings Net claims reduction for employers Many clients see 5-15% net reduction in projected claims costs after the first year of the program.

18 Today s Agenda 18 Evolution of Onsite Clinics Incentives of an Onsite 2.0 Model Nuts & Bolts How Does This Work? Driving Maximum Results

19 A Tailored Clinic Solution 19 Onsite Clinics Excellent access point and convenience for employees Near-site Clinics Over half of individuals covered on most benefits plans are dependents Right level of convenience, access, and privacy to encourage high participation

20 Examples of Near-site Clinics 20 Near-site clinics can be located within the community or near a major worksite Comfortable & modern décor provide patients with a superior customer experience.

21 Recommended Plan Enhancements 21 A combination of carrots and sticks can be an effective way to maximize participation Examples Used by Employers Use of High-Deductible Health Plans ($1,500 or higher) Dramatically increased co-pays for off-site places of service (PCP, Specialist, Urgent/Retail, ER) Requirement of Comprehensive Physical Exam Premium reductions for participation metrics Give-aways or prizes for engagement metrics

22 22 Thank you for your time!