The Status and Direction of Onsite Health Centers

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2 The Status and Direction of Onsite Health Centers Larry S. Boress President and CEO Midwest Business Group on Health October 27, 2011

3 Profile of MBGH MBGH is a Chicago-based, non-profit organization of Midwest employers whose mission is to promote leadership, collaboration and knowledge among employers to continuously improve the quality and cost-effectiveness of health care and the health status of their constituents. Founded in 1980, membership offers the collective experience and knowledge of more than 100 self-insured public and private employers, including Abbott Labs, Boeing, City of Chicago and Kraft Foods, that spend over $3 billion on health care for nearly 3 million lives. Employers are represented by those responsible for designing and managing health benefits, including: VP of HR, Director/Manager of Benefits, Medical Director and other professionals within the organization who are responsible for wellness, safety, risk management. 3

4 MBGH Activities Health Benefit Projects & Quality Initiatives Determining the Triggers and Barriers to Employee Engagement Taking Control of Your Health - a value-based benefit program involving waived drug co-pays linked with pharmacist counselors to increase patient compliance with treatments Smoking Cessation Programs and Assistance Specialty drug management and best practices Purchasing groups for Chicago HMOs and PBM services Learning Network Programs on best practices in health benefits and worksite wellness Pharmacy Benefit Academy Blues User Group Benchmarking surveys of health benefit designs and strategies 4

5 National Association of Worksite Health Centers A new national organization for employer-sponsors of onsite clinics, fitness and wellness centers Offering education, networking, group purchasing and advocacy activities Members to include employers, as well as consultants, vendors and suppliers that support worksite health benefits, clinics, fitness and wellness programs Created by MBGH in collaboration with The LaPenna Group. For more information contact lboress@mbgh.org or Mike LaPenna, mlapenna@lapenna.com Copyright (c) MBGH

6 Onsite Health and Fitness Center Surveys MBGH conducted a series of surveys of employer sponsors of onsite health centers and fitness programs to enable members to benchmark their programs Major areas covered: Objectives Staffing Services offered Defining and calculating ROI Sixty-nine respondents Copyright (c) MBGH

7 What is your industry sector? Wholesale services Technology Retail services 3% 2% 6% Manufacturing 56% Health care 18% Government Financial services 6% 6% Education Consulting 2% 2% 0% 10% 20% 30% 40% 50% 60% Copyright (c) MBGH

8 How many employees does your clinic program serve? ,000 19% > employees 16% <500 employees 3% % % % ,000 22% Copyright (c) MBGH

9 How many clinics do you sponsor? Not applicable 10% >10 22% 1 to 3 39% 4 to 10 29% Copyright (c) MBGH

10 What department do you work in? (Environment, Health & Safety professionals) Finance/CFO 1% HR/benefits Other 29% 13% Medical 57% Copyright (c) MBGH

11 What are your clinic program's objectives? Other 5% Reduce pharmacy costs 35% Improve integration of health management efforts (Manage accidents, Build morale, Compliance) Increase effectiveness of health promotion efforts Improve access to medical services Offer occupational health and safety services Improve worker productivity - reduce presenteeism -being on job but not being productive Reduce time off to visit medical providers/obtain services Improve worker productivity - reduce absenteeism Improve worker heatlh 65% 65% 68% 85% 85% 83% 89% 92% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100% Copyright (c) MBGH

12 What services are currently offered and planned for the clinic program? Physical/rehab therapy Prescription medication dispensing Infusion services, health coaching Health promotion services/screenings Primary care services for acute and episodic problems Immunizations Occupational/industrial services EAP services/mental health services Emergency/first aid care Plan to offer Currently offer Copyright (c) MBGH

13 Other Services Offered: Travel health Disability Massage Dietician Ultrasound Optical EAP Compliance, OSHA services Copyright (c) MBGH

14 What is the staffing model of your clinics? 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 31% 17% 43% 25% 17% Internal company staff Contracted staff Combination of internal and contract staff Outsourced program (Vendor; Faculty of Occup. Med. Dept.) Combination of internal staff and outsourced program Copyright (c) MBGH

15 How important are these indicators in evaluating clinic program performance? No importance Some importance Important High importance Most important Other Clinical outcomes, such as blood pressure, HEDIS effectiveness of care metrics Participation in disease management programming Reduction of community health care services (ED, Comparative cost of clinic care to equivalent services in Pharmacy services (conversion to generics, mailer Reduction in health risk factor prevalence Ancillary utilization Employee/patient satisfaction Clinic utilization 6% 0% 2% 10% 2% 29% 19% 23% 13% 12% 32% 38% 20% 15% 18% 15% 16% 23% 33% 11% 23% 20% 12% 17% 6% 24% 0% 25% 12% 38% 20% 38% 12% 17% 3% 32% 20% 14% 23% 20% 15% 22% 14% 20% 12% 35% 24% 44% 22% 2% 44% 37% 37% 32% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Copyright (c) MBGH

16 Most important performance indicators Employee/patient satisfaction Clinic utilization Reduction in health risk factors Clinical outcomes Comparative cost of clinic care to outside equivalent services Copyright (c) MBGH

17 Other indicators of performance: Workers comp mgmt Improved productivity Hospital utilization Out-patient services utilization Specialty utilization Procedure code utilization Copyright (c) MBGH

18 How important are each of the following items to you in determining your ROI? No importance Some importance Important High importance Most important Pricing advantage in contracted specialty and hospital support Lost time savings due to elimination of need for off-site travel 8% 8% Co-pay revenue for clinic use WC lost time duration cost reduction WC medical cost reduction Short-term disability duration cost reduction Health risk reduction Employee retention Avoidance of duplicative testing Presenteeism reduction Reduced cost per unit relative to outside purchase of 8% Reduction in pharmacy costs Reduction in emergency department use Reduction in hospitalization 13% 5% 8% 2% 11% 11% 3% 12% 5% 25% 20% 17% 12% 17% 40% 10% 21% 25% 20% 26% 61% 17% 14% 23% 17% 28% 20% 35% 27% 34% 21% 27% 29% 31% 45% 34% 35% 38% 22% 42% 18% 19% 27% 30% 28% 31% 9% 18% 20% 14% 38% 36% 23% 29% 7% 11% 16% 26% 7% 10% 8% 8% 10% 17% 2% 12% 0% Copyright (c) MBGH

19 Top ROI Indicators Workers comp lost time duration cost reduction Workers comp medical cost reduction Health risk reduction Reduce cost per unit versus outside services Reduction of emergency department use Copyright (c) MBGH

20 What tools are used to track clinic program performance? (Liability cost saving; CPT ICD coding) Other, please specify Ancillary utilization Specialist referral rates Quality improvement (HEDIS measures) Compliance rates Utilization rates Patient satisfaction Productivity measures Cost savings - medical trend Medical Group Management Assoc. measures Data warehouse, ie, Ingenix 10% 5% 8% 8% 2% 33% 32% 33% 54% 71% 78% 0% 10% 20% 30% 40% 50% 60% 70% 80% Copyright (c) MBGH

21 Other benefits considered Contract elimination and reduced referrals Cost avoidance related to pre-placement assessment Cost avoidance w/outside-inside costs Health plan cost reduction Cost/EE/Year Cost per $100 payroll Cost per EE per day Copyright (c) MBGH

22 When clinic program was first proposed, was there an expected "pay-back period? Yes, 4-6 years payback period 5% Other 8% Yes, 1-3 years payback period 22% No 65% Copyright (c) MBGH

23 80% 70% Do you have financial penalties or rewards tied to the clinic program's performance? 69% 60% 50% 40% 30% 20% 10% 0% 2% We have financial penalties 14% We have financial rewards 8% We have financial penalties and rewards We do not have financial penalties or rewards 3% Don't know 5% Other, please specify Copyright (c) MBGH

24 ROI Difficult Without Setting Objectives ROI metrics actually tracked: Patient satisfaction Clinic utilization rate Cost per unit relative to cost of outside services Savings in lost time from eliminating need for outside service Cost trend, savings in WC medical cost Performance objectives not tracked: Improve worker health, reduce risk factors and improve outcomes Improve worker productivity reduce absenteeism & presenteeism Increase effectiveness of health promotion/disease management efforts/compliance efforts Improve integration of health management efforts Improve access to medical services

25 For more information on this topic, MBGH or NAWHC: Larry Boress President and CEO Midwest Business Group on Health