Ben Baker - MT\|SHRM · 2014-06-16 · Sample CM/DM Programs: ... • Mailers and Emails • Health...

transcript

Proprietary & Confidential

On-Site Health & Wel lness Centers

February 19 th, 2014

On-Site Health & Wel lness Centers

Ben Baker Chief Operating Officer, CareHere

Proprietary & Confidential 2

AGENDA

Background & History

Healthcare Reform & Self-Funding

Benefits of Onsite Healthcare &

Wellness

Data Analysis

Reporting & ROI

Implementation

CareHere History & Ownership

• Formed in January 2004

• Headquarters: Brentwood, TN

• 163 health centers, located in 22 states

• 850+ on payroll

• Medical services provided to 95,000+

employees nationwide

• Named the 6th Fastest Growing Private

Company in Middle Tennessee

(2013 Nashville Business Journal Award)

Public59%

Private

CURRENT ENTITIES • City, County & State Governments

• School & Utility Districts

• Manufacturers (Auto, Food, Equipment)

• Banking & Insurance Companies

• College/University

• Construction

• Transportation

Tier 1 supplier to Ford,

General Motors and Toyota

CareHere Clients

US Health Care

Reform

Insurance Reform

Delivery System

Reform

Coverage

Expansion

Individual

Mandate

Medical-Loss

New Org

Structures

Payment

Reform

Value-Based

Payments

Bundled

Payments

2010 U.S. Healthcare Reform

• PCMH = Patient Centered Medical Home

• ACO = Accountable Care Organization

Patient Centered

Healthcare

Benefits of a CareHere Health & Wellness Center

Reduce

Healthcare

Claims Cost

Identify/Treat

Chronic

Illness

Increase

Productivity

Improve

Employee

Morale

Save Money

With No

Co-Pay

Appointment

Wait Times

Access to

Wellness

Programs

Trust in

On-site Care

Providers

Employer Benefits:

Employee Benefits:

Benefits to the Provider

• Build Trust with the Patient

• Educate and Provide Treatment

• No Double or Triple Booking

• Not a Fee for Service Model

• No Daily Patient Quota

• Covered Medical Malpractice Insurance

• Care-Coordination with Specialist, Health Coaches, and Outside

Primary Care Providers

Specialist Referrals

• Referrals are made within the provider network

• Establishing a high performance network

• Outside provider access to the CareHere EMR

Specified EMR accessibility

Local Hospital Alliance

• Specialized Services at Contracted Rates

• Hospitalist Established

• Bypass the Emergency Room

• Avoid the cost of the Emergency Room

• 24/7 Service

• Provides a higher level of service and convenience to the

employee

Market Place VS. Onsite Health Centers

No relationship

between patient and

Provider

Co-Pays

5-7 minutes on average

with the Provider

Poor or No communication

between Providers

No Co-Pays

20 minute Appointments

Care flows through onsite

Provider

Access to integrated wellness programs

Market Place Onsite Centers

Profit Driven Patient-

Centered Approach

Personalized Cover Letter Summarized Lab Results

Color-Coded Health Summary

20-30 Core Report

Health Risk Assessments

On-Site and Off-Site Blood Draw for Employees

CareHere Coaches

Exercise Health Coach | Registered Nurse | Behavioral Health Coach

Pharmacist | Tobacco Cessation | Registered Dietitian

CareHere has 185 Case and Disease Management (CM/DM)

programs developed for 2014!

Sample CM/DM Programs:

•Weight Management

•Smoking Cessation

•Diabetes Management

•Beginning Exercise

•Basic Nutrition

•Grocery Store Tours

Provider Driven Wellness & Case Management

Wellness Tracking Application

Patient interaction notes are

accessible by:

• On-Site Clinic Medical Provider

• CareHere Wellness Coaches

• Telemedicine Provider

• 24/7 Nurse Line Providers

• Outside Providers

EMR Differentiators:

• Ability to share CareHere EMR notes with Outside

Providers

• Ability to separate occupational health/workers

compensation notes from primary care notes within the

EMR while maintaining HIPAA compliance.

• Transmission of eligibility and claims data in a fully

integrated 837 file.

Electronic Medical Records

“…Among employees

who are at low-

moderate risk for

Cardiovascular Disease

and adhere to an online,

interactive, web-based

Work Health Program,

significant reduction in

multiple Cardiovascular

Disease risk factors(…)

is attained within only 90

days.”

American Heart Journal Mayo Clinic Study

Incentives/Disincentives

•Mandatory HRAs

•Biometric Benchmarks

•Wellness Program Participation

•Premium Differentials

•Reward Programs

•Contests

Clinic and Wellness Marketing, Tools

and Education

• Employee Presentations

• Free HRA Events

• Open House

• Wellness Groups

• Health Events

• Mailers and Emails

• Health Educator Presentations

• On-Site Flu Vaccinations

• Paycheck Stub Announcements

• Targeted Notifications/Reminders

Creating Employee Engagement

• Promoting the Health Center

• Educating the employees

• Incentives and Rewards

• Customized to the employer

Client 1 Client 2 Client 3 Client 4 Client 5 Client 6 Client 7 Client 8 Client 9

Negative Negative Positive Positive Positive Pos./Neg. None None None

70% 68%

19% 26%

19% 21%

2% 2% 0%

Count of Unique Patients/Engaged in Wellness Count of Unique Patients Assigned Programs/Completed Programs

Employer Incentive Impact

On-Site Provider Dispensing

• Zero-revenue venture for CareHere

• 30/60/90 Day Supply

• 150 to 200 Generic Drugs Stocked On-Site

• Pharmaceutical Mail Order Plan

Top 5 Comparison (Brand vs. Generic)

Name Brand Marketplace

Generic or

Equivalent

CareHere

Nexium $5.71 Esomeprazole

(therapeutic sub to

Pantoprazole)

Prilosec $1.02 Omeprazole $0.15

Protonix $1.17 Pantoprazole $0.08

Lipitor $5.00 Atorvastatin $0.24

Claritin $1.00 Loratadine $0.07

CareHere Differentiators:

“What should

this cost?”

With data analytics, you can:

• Control health costs

• Measure performance

• Assess risks

• Cholesterol Management

• Weight Management

• Pre/Diabetes Management

• Tobacco Cessation (COPD)

• Hypertension Management

High Risk

Moderate Risk

Low Risk

John’s Hopkins ACGs

Data analytics enables you to evaluate

the total disease experience of a patient

and predict cardio respiratory

failure/shock, among other conditions.

Disease Management Protocols:

Quality Care Delivery

Member Analysis

Preventable Conditions

Data Analytics: Regression

Regression: BMI/All patients - $9

Regression: BMI > 30 - $14

Regression: BMI $22 + HbA1C $133

Claims Trend and Savings Analysis

OVER $15 MILLION SAVED

Health Risk Assessment Condition Savings

Services

Medical & Health Services

• Primary Care

• Acute Care

• Episodic Care

• Patient Medication Adherence

• Pharmaceutical Dispensary

• Mail Order Medication

• Immunizations

• Sports Physicals

• Plan of Care Compliance

Wellness

• Case Management

• Weight Management

• Hypertension Management

• Addiction Intervention

• Pre-Diabetes Management

• Lipid Management

• Stress Management

• Nutritional Counseling

• CareHere Staffing

• Wellness Coaches

• Accounting

• Training

• Pharmacist

• Director of Client/Clinic Operation

• Care Coordinator/Case Manager

• Medical Staff Management

• Medical Provider Management

• Medical Provider Recruitment

• Medical Staff Recruitment

• Medical Malpractice Insurance

Technology

• Electronic Medical Record

• CareHere Connect

• Information Technology

• Online Appointment Scheduler

• Smartphone Application

• EMR Access & Integration with

Outside Specialist/PCP/ER

Support Services

• 24/7 Call-Center

• 1-800 Customer Support

• Education Tools

• Marketing

• Information Technology Support

• HRA Employee Events

Clinical Outcome

Services

• Reporting

• Purchasing Coordination

• Clinic Inventory Management

• Patient Survey Feedback

• Clinic Best Practices Sharing

• Integration of Services

• ROI Analysis

• Budget Adherence

Staffing

Workers’ Compensation • Medical Management of Work Related

Injuries/Illnesses

• Ergonomic Job Analysis

• Coordination of Care/ Collaborative

• Maintain Productivity

Restriction of Work Vs. Disability

• Integrated Disability Case

Management: Systems Approach

Understand Workplace Culture

Negotiate & Manage Referrals

Disability Management

• Understanding Clients Environment

• Control Costs

• Preserve Patient Satisfaction

Occupational Health Services • DOT Physicals

• Random Drug Testing Program

• Assist with Job Placement

• Hearing Testing

• Hearing Protection Training

• Hearing Conservation Program

Management

• Annual Fit for Duty (FFD) Exams

• Respiratory Fit Testing

• Spirometry Testing (Pulmonary Function

Testing)

• EKG Testing

• HazMat Physicals

• Lift Testing

• Breath Alcohol Testing (BAT)

Worker’s Compensation and Occupational Health

Implementation

Waiting Room

Nurse Triage

Exam Room

The appearance, design, content and graphics of this presentation are the property of

CareHere and are protected by applicable copyright laws and may not be copied,

used, reproduced, altered, distributed, or transmitted in whole or in part without the

express written consent of CareHere which reserves all rights.

Re-use of any of the content or graphics in any medium, electronic or otherwise, for

any purpose is strictly prohibited.

Any unauthorized use of the text, images, audio and video may violate copyright,

trademark, privacy and publicity laws and other civil and criminal statutes of the United

States and other countries.

INTELLECTUAL PROPERTY DISCLAIMER

Ben Baker - MT\|SHRM · 2014-06-16 · Sample CM/DM Programs: ... • Mailers and Emails • Health...

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