Presentation on theme: "Riverport CEO Round Table Luncheon Agenda November 2013 Item #1 Item #2 Item #3 Item #4 Program for November – Healthcare & Medical Analysis Clinics Company."— Presentation transcript:
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 Employers Providing Healthcare OBAMACARE / ACA / PPACA Affected vs. Not Affected (Non-Affected theoretically doesnt 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 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 NPs if you please Alternative healthcare delivery trending Weve 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 Workers 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.) Well men Exams (prostate digital, PSA lab work, etc.) Asthma and Allergy treatment – breathing treatment EKGs w/Basic Interpretation – Pre-Op – Annual Physical, etc.
Clinic Services (contd) 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 Emplo yer / 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 Workers Compensation Claims Reduced Lab costs Convenience and Accessibility Wellness We move the healthcare claims needle
Overall Claims Reduction by Targeting Primary Healthcare
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:$124,709.00 – Rx Cost Affected by Clinic Model (@ 25%):$ 75,000.00 – Wellness / Nurse Practitioner Expense:$ 86,000.00 – Pre-Employment Testing:$ 11,000.00 – Workman's Comp. Savings:$ - ? - – Total Affected Cost:$296,000.00 – Cost of Providing Medical Analysis:$226,380.00 (Priced @ $55/PEPM for 343 Healthcare Part.) – Projected Savings for All Healthcare Participants:$ 69,620.00
Claims Data Analyzed (cont.) Case Study #2 Jefferson County Stamping Company Example: – Primary Care CPT Code Claims Affect:$ 47,000.00 – Rx Cost Affected by Clinic Model (@ 25%):$ 42,000.00 – Wellness / Nurse Practitioner Expense:$ 60,000.00 – Pre-Employment Testing:$ 11,000.00 – Workmans Comp. Savings:$- ? - – Total Affected Cost:$ 160,000.00 – Cost of Providing Medical Analysis:$ 94,380.00 (Priced @ $55/PEPM for 143 Healthcare Part.) – Projected Savings for All Healthcare Participants:$ 65,620.00
Data Analytics Reporting Monthly Utilization & Clinical Reports Quarterly Cost Savings Reports Number of Visits Diagnosis Treatment Medication Dispensed Early Detections Work Loss Preventions HRA Bio Metric History BMI Cholesterol Lipids Glucose (customizable) Wellness Educational Classes Progress Tracking