Wellness Coalition America
April 2014
Fully Integrated Solution
Today’s objective
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Our view of the world
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Clinic fundamentals (CSF)
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System needs to manage clinic
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Total population management process
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Identifying and stratifying risk
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Scope of care
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Our view of wellness
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Staffing model and staging clinic growth
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Behavioral health advantages
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Clinic management
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Patient management and member empowerment tools
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Reporting and keys to success
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Differentiators to look for
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Our view of the world
Challenges employees face
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Healthcare is expensive
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Access to care
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Over or duplicate utilization
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Lower health literacy
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Tend to defer preventative care
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Unidentified and/or unmanaged conditions
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Unhealthy lifestyle habits
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Limited support to manage conditions and lifestyle
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Need help navigating the health system
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Income challenges can alter diet choices
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…and employees are given
License to Spend
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Employers left to make a decision
Managing Expenses
Providing Benefits
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Super
size impact Health Benefits
Two Approach's
Plan Design:
• Cost shifting
• Deductibles
• Co-insurance
• HDHP
• Surcharges
• HSA
• Incentives & compliance
Clinical Solutions:
• On-site and near-site clinics
• Health coaching
• Direct access to primary care
• Screenings and health assessments
• Results based programs
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Clinic Fundamentals
• Clinical solutions based on the unique needs of the client
• Integration of plan design with clinical solutions
• Scope of care, state regulations and requirements
• Participation criteria
• Member engagement strategies
• Member incentives, compliance requirements and tracking
• Government regulations
• Program launch and clinic communication process
• Risk stratification and identification process
• Data findings and clinic initiatives
• Process and system utilization to track and measure success
• Cultural and philosophical alignment
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Clinic management system
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Total population management process
The integration of our Care Management System is the backbone of our business
model and supports our Total Population Management Process, aimed at
improving the health of your population and decreasing costs.
Data Gathering and
Analysis
Measurement of
Clinical, Behavioral,
and Financial
Outcomes
Measurement of
Condition Specific and
Utilization Compliance
Identification and Risk
Stratification
Program
Recommendations and
Rollout
Measurement of
Activity
Enrollment and
Outreach Strategies
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Managing risk
3.4%
Membership
50%
Plan Cost
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Member identification and risk stratification process
The MI2 report stratifies members from highest risk to lowest risk based on all
available data input sources, displaying:
Clinical
• Diagnoses
• Co-morbidities
• Rx adherence
• Labs
• BMI
Utilization
• ER visits
• Hospitalization
• Gaps in care
• Medical cost
• PCP Bonding
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Establishing clinic focus
Nurse Practitioner:
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Disease Management
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Assess, triage, diagnose, treatment
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Condition education
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Medication education
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Preventative education
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Compliance management
Acute Care
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Assess, triage, diagnose, treatment
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Occupational health
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First responder workers comp
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Patient advocacy – steerage
Medical Office Assistant:
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Scheduling and administrative
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NP medical support
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Patient advocacy – steerage
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Optimal wellness model
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Staffing model
Leveraging competency for optimal success
WCA
Company
Clinic Operations
WCA Clinic Staff
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Nurse Practitioner
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Nurse Coach
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Medical Office Assistant
Executive Buy-in
Medical and Clinic Staff
Oversight
HR Team Engagement
Strategic Direction
Strategic and Tactical
Recommendations
Plan Design and Incentives
Tactical Involvement - MOA
Account Management
Company
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Wellness Coordinator
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Clinic point person
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Human Resources
Clinic Staff
DM Focus
Acute Care
Ancillary
Health Advocacy
Provider Steerage
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Staging clinic growth
Clinic Launch
Nurse
Practitioner
MOA
Six Months
Eighteen Months
Nurse
Practitioner
Nurse
Practitioner/
MD
MOA
MOA
Health
Coach
Health
Coach
Vendor flexibility to accelerate and expand services has needed.
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Clinic management - strategic vision and tactical direction
Clinic focus
• Plan design
• Clinic access and visitation policy
• Incentive plan
• Compliance requirements
• Scope of care
• DM, PM, Acute Care, ancillary
Staffing model
• Recruitment
• Training – initial and ongoing
Clinic set-up and timeline
• Clinic launch
• Communication tools
Clinic initiatives
• Measures of success
• Engagement strategy
• New hire policy
• Quarterly meetings to review progress
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Integration of behavioral health
Behavioral Focused:
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Core competency
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Individual goal setting
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Overcoming barriers
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Health education
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Condition specific education
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Medication education
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Preventative education
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Compliance management
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Patient advocacy - steerage
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Clinical management system and tools
Clinical
• Health History
Electronic Medical Record:
• Conditions - compliance
• Screenings - compliance
• Rx - compliance
• Labs and vitals
• Stage of change
• Session activity
Utilization and Financial
• Referrals
• Type of services rendered
• Location of services rendered
• Cost of services rendered
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Member empowerment tools
Personal Health Record:
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Health history
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Personalized action plan
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Screenings – compliance
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Health alerts
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Labs and vitals
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Articles and videos
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Exercise log
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Member empowerment tools
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Health seminars
Walking programs
Group challenges
Weight Watchers
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Reporting and data
Standard reporting package document
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Keys to success
• Adhering to optimal clinic model
• High clinic utilization
• Proper balance of disease management, prevention
management, acute care and ancillary services
• Movement from uncontrolled to controlled:
• Medication adherence
• Condition specific compliance
• Gaps in care
• Primary care
• Labs and values
• Behavior
• Culture of health and wellness
• Intangibles: morale, productivity, employee satisfaction
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On-site Savings Report
On-site Clinic Savings Report:
Calculates ROI for the clinic based on savings associated with all
clinic activity and other proprietary factors. ROI drivers are:
• Direct office service savings
• Referral avoidance
• Service utilization
• Productivity savings
• Reduced absenteeism
• Screenings
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Differentiators
• Single vendor solution = easy of delivery
• Depth of services = quality control
• Proprietary software = platform flexibility
• Independent = control, mobility and continuity
• Passion and philosophy = aligned interest
Fully integrated services allow better quality control and
greater flexibility to meet your unique needs.
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Questions
Any questions?
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Contact information
Wellness Coalition America
Terrie Reeves, President and Founder
Terrie.reeves@wellnesscoalition.com
Wellnesscoalition.com
1-877-903-4726
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