Riverport CEO Round Table Luncheon
Agenda
November 2013
•
•
•
•
•
•
•
Item #1
Item #2
Item #3
Item #4
Program for November – Healthcare & Medical Analysis Clinics
Company Responses & Questions
Adjournment
Presented by Robert Price
Current Climate
For
Employer’s Providing Healthcare
•
•
•
•
•
•
•
•
•
•
•
OBAMACARE / ACA / PPACA
Affected vs. Not Affected (Non-Affected theoretically doesn’t exist)
Fully Insured vs. Partially Self – Funded / Level Funding
HDHP / Traditional PPO (Copays) / Bronze Level / Silver Level / Gold Level / Platinum Level
Mass Purchasing Power – Who Has It? Had It? Does it Still Exist?
Federal / State Exchanges vs. Private Exchanges – EXCHANGES PERIOD!!!!!
Oh!!! What about Wellness?
What the Face of Employer Funded Healthcare Looked Like - (“Mr. Burd Goes to
Washington”*)
“Reality Settles In!” – What has the ACA Truly Done?
What the next phase of “Employer Participation In Healthcare” looks like!
Providing True
Presented by Michael Dees
A Premier Health, Wellness,
Occupational Medicine and Pharmaceutical Plan
Exclusively Designed for
Employer Sponsored Healthcare Programs
Our story
Suzi Bogard CEO, and Dr. Douglas Leavengood, Medical Director, began their relationship in
February 2001 in the development and management of Health, Wellness, and Occupational
Medicine through an “on-site” clinic model for self-insured and fully insured corporations
and municipalities along the gulf coast.
Over the last 12+ years, Medical Analysis has grown to service corporations and
municipalities in the south central united states with on-site, near site, and or off site
clinics. Our vision is and always will be, to make health care more affordable and accessible
to employees and their households, while assisting corporations to decrease the spiraling
cost of health care, as we drive wellness within the workplace. Today we hold tight to
keeping our vision and continue to provide health care services that are Professional,
Informative, and Affordable, Providing healthcare “the way it should be!”
Our clinics
•
•
•
•
•
We do clinics and wellness.. well
On, near and off site options
NP’s if you please
Alternative healthcare delivery “trending”
We’ve been “trending” for 12 years
- 30 + industrial and municipal partners
- 100 + corporate clients
• “O” attrition
Clinic Services
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Office visits – All Associates and Eligible Dependents – 2 yrs and up
Primary Care - Acute Care – Urgent Care
Chronic Disease Management – Communicating with Primary Care Physician
Patient Referrals out into the community specialty physicians
Worker’s Compensation: Treatment of Injuries – Injury Prevention and Education
Physicals: Annual – Sports – School – DOT – Pre-Employment
Hypertension: Treatment – Education – Counseling and Monitoring
Diabetes: Treatment – Education – Counseling and Monitoring
Cholesterol: Treatment – Education – Counseling and Monitoring
Weight: Treatment – Education – Counseling and Monitoring
Smoking Cessation: Treatment – Education – Counseling and Monitoring
Stress: Treatment – Education – Counseling and Monitoring
Lab Capabilities (monthly calendar awareness labs free) and CLIA Waived Tests
Educational Classes: Fire & Home Safety, Child Safety, Disease Management, etc.
Well woman Exams (pap smears, breast exam, etc.)
Clinic Services (cont’d)
•
•
•
•
•
•
•
•
•
•
•
•
New Hire Hepatitis Class and HEP B injections (additional vaccinations available
at cost)
– Serums requested by client provided at cost
Flu/Pneumonia Vaccines
– Serums requested by client provided at cost
Health Risk Assessment / Health Fairs
Annual Bone Density Screening for Osteoporosis (Dexa Scan)
Eye Care – Vision Acuity
Colon Cancer Screening
Emergency Stabilization – Level 1 - Suturing – Splinting – Wound care
Level 1 Procedures (wart, skin tag removal, etc.)
Clinic Stocked with Convenience Meds / Generic Prescription Medications
We work to help decrease Emergency Room Visits
Monthly Calendar on Monthly Activity and Educational Classes
Non-DOT & DOT Drug/Alcohol Test
Taking Control
of
Diagnostic Laboratory Costs
• Costs associated with routine Lab work are included in our
PEPM fee, up to an expected allowable amount.
• Cost pass through can be customized.
Taking Control
of
Pharmaceutical Costs
• We stock 50 to 100 of the most commonly prescribed
generic medications “on-site”.
• Pre dosed and sealed “ready meds”.
• Costs associated with these meds are included in our PEPM
fee, up to an expected allowable amount.
• Cost pass through can be customized.
Examples:
– $3 - $11 Antibiotics: Amoxicillin, Azithromycin, Cipro, Doxycycline, Bactrim,
Penn VK, etc.
– $5 - $10 Injectables: Celestone, Rocephin, Kenalog, Decadron, etc.
– $5 - $9 Hypertension: Ace Inhibitor, Calcium Channel Blocker, Beta Blocker,
etc.
Occupational Medicine
Comprehensive range of health services:
–
–
–
–
Prevention
Treatment
Follow-up
Communication with Employer / case management
Resulting in:
– Decreased costs in workers comp, through fewer claims and lower
experience rating.
– Improved communication concerning status of injured employees
– Timely treatment (WC injuries receive priority
status at clinic)
Prevention Services:
– Pre-placement and annual physical exams
(Including DOT)
– Ergonomic classes
Drug & Alcohol Screens
Pre-employment
Random
Reasonable Suspicion
Post Accident
•
•
•
•
•
Drug-Free Workplace Services:
– Drug and Alcohol Testing urine, blood, hair, saliva, breathalyzer
– Medical Review Officer Services
– Assistance developing drug and alcohol policy
– U.S. Department of Transportation drug testing (DOT)
Adulterant Tested
– Assists in detection of attempts to mask urine screening
Urine Negative Results Reported Same Day for NON-DOT
– On-site testing can quickly be achieved in the clinics and NON-DOT negative
results will be reported same day
Positive Results Report 24-48 Hours
Medical Review Officer (MRO)
– Contacts employee to report and verify the lab findings on a positive drug screen
by requiring them to produce valid prescriptions
Employer Benefits
•
•
•
•
•
•
•
•
•
•
Decrease in Healthcare Expenditures
Rise in Worker Productivity
Reduced Absenteeism
Reduced ER Visits
Reduced Pharmaceutical costs
Reduced Worker’s Compensation Claims
Reduced Lab costs
Convenience and Accessibility
Wellness
We move the healthcare claims needle
Overall Claims Reduction
by
Targeting Primary Healthcare
Total Primary Care Claims Pool
PRIMARY CARE
OTHER
Claims Data Analyzed
Preliminary Analysis Done for Clinic Feasibility:
–
–
–
–
–
CPT Code for Partially Self Funded Plans / Fully Insured If Available
Analysis of Pharmacy Claim Reports
Wellness Program Expenses (HRA / Biometric Costs, On-Site Nurse Expenses)
Pre-Employment Testing Relationships and Screening Contracts
Workman's Compensation History
Case Study #1
Jefferson County Manufacturer Example:
– Primary Care CPT Code Claims Affect:
– Rx Cost Affected by Clinic Model (@ 25%):
– Wellness / Nurse Practitioner Expense:
– Pre-Employment Testing:
– Workman's Comp. Savings:
– Total Affected Cost:
– Cost of Providing Medical Analysis:
(Priced @ $55/PEPM for 343 Healthcare Part.)
$124,709.00
$ 75,000.00
$ 86,000.00
$ 11,000.00
$
-?$296,000.00
$226,380.00
– Projected Savings for All Healthcare Participants: $ 69,620.00
Claims Data Analyzed (cont.)
Case Study #2
Jefferson County Stamping Company Example:
– Primary Care CPT Code Claims Affect:
– Rx Cost Affected by Clinic Model (@ 25%):
– Wellness / Nurse Practitioner Expense:
– Pre-Employment Testing:
– Workmans Comp. Savings:
– Total Affected Cost:
– Cost of Providing Medical Analysis:
(Priced @ $55/PEPM for 143 Healthcare Part.)
$
$
$
$
$
$
47,000.00
42,000.00
60,000.00
11,000.00
-?160,000.00
$ 94,380.00
– Projected Savings for All Healthcare Participants: $ 65,620.00
Data Analytics Reporting
HRA
Monthly Utilization & Clinical Reports
Quarterly Cost Savings Reports
Number of Visits
Diagnosis
Treatment
Medication Dispensed
Early Detections
Work Loss Preventions
Bio Metric History
BMI
Cholesterol
Lipids
Glucose
(customizable)
Wellness
Educational Classes
Progress Tracking