Can healthcare break old habits and find new solutions for viability and profitability?
by Robert Mandel, MD, MBA,Dr. Mandel, MD, MBA, serves as the Eastern Region President for Activate Healthcare. He has extensive senior leadership experience in health systems, health plans, and for-profit health companies.
The thought of going to a doctor’s appointment may elicit an image of waiting 45 minutes in an uncomfortable chair with a bad selection of magazines, being ushered into an exam room, waiting another 15 minutes, and then maybe spending 10 minutes with the physician. After leaving the office, you realize you didn’t have time to talk with your doctor about a couple of issues that concern you.
Unfortunately, the current healthcare system makes this scenario all too real for many Americans.
Healthcare providers struggle to see as many patients as they can squeeze in to their daily schedules. They are rewarded for episodic care, not for managing the whole person and their care. Visits are often brief and don’t allow the provider time to engage in meaningful conversations about behavior, lifestyle and other causes of illness and chronic conditions—conversations that could make the difference in an individual’s overall health and well-being.
Given that 86 percent of all healthcare spending in 2010 was for people with one or more chronic conditions, it’s easy to see why healthcare costs continue to rise. There is no opportunity to support the patient’s understanding of their risks and to engage them in their own health. The healthcare system needs a different solution, one that allows primary care providers the time and resources they need to prevent or effectively manage chronic conditions and other serious illnesses so they can help keep patients healthy and avoid the downstream costs and complications of chronic conditions.
Engaging the Patient
When primary care providers can spend time with their patients, they are able to get to the root cause of problems. This helps with early diagnosis, which in some cases allows for the reversal of the disease process or reduces the risk of progression. The ability to educate, support and engage the patient in their health also improves the management of existing chronic conditions, minimizing their health impact. Ultimately, downstream costs are lowered because chronic conditions are prevented or proactively managed.
The idea of managing issues early in the process to avoid higher costs downstream is not new in the business world. Manufacturers learned this principle a long time ago. And the same principle applies to healthcare.
Some health care companies are taking heed and have created and are offering solutions that help reduce costs, improve overall health and well-being—and make the healthcare experience more rewarding for patients and providers.
Employers are buying: On-site/Near-site Clinics
Many employers are building their own primary care clinics that are staffed and managed by on- and near-site clinic providers. On-site clinics make care available to employees and their family members at little to no cost, are easily accessible, and release providers from the constraints of the current healthcare system. Medications can be dispensed onsite, when prescribed by a provider, and some labs can be performed in the clinic and others can be drawn and sent to off-site lab providers, further enhancing convenience for patients. Patients can typically schedule an appointment on the same or next day and experience little to no wait time once they arrive.
On-site health clinics reduce costs and improve employee health, productivity and engagement. According to a 2016 survey of 255 employers by the National Association of Worksite Health Centers, on-site or near-site clinics provide successful strategies in:
- controlling healthcare costs
- enabling easy access to medical services
- improving employee health
- enhancing engagement in worksite programs
- ultimately increasing productivity
Sixty-four percent of employers of all sizes saw a reduction in medical care costs when using an on-site clinic and 63 percent experienced reduced use of emergency room services among employees. In addition, almost 70 percent achieved a reduction in lost time due to employees leaving work to see outside medical providers.
Activate Healthcare’s experience confirms these impacts with the clinics we operate delivering substantial savings and important gains in reducing or controlling the risks of chronic disease.
Activate’s model helps organizations of all sizes get directly involved in lowering member healthcare costs by adding a new benefit. By partnering with one or more organizations to develop a clinic, Activate makes on-site/near-site healthcare clinics a viable option for employers that may not be able to sustain a clinic on their own. Each organization plays an active role in selecting the clinic’s staff and setting clinic hours to ensure the right fit with the organization’s culture and member health needs, helping garner meaningful results for the population. Recent results include:
- A county government achieving a nearly 100 percent employee participation rate and a cumulative ROI of nearly 135 percent over a five-year period.
- A transportation company experiencing lower premiums today than it did in 2010 with a healthier employee population.
- A trade union health fund attaining over 70 percent participation in its clinic, saving more than $8 million over two years and receiving overwhelmingly positive feedback from members thanking them for providing easy access to care.
The Technology Advantage
Some on-site clinic providers are taking advantage of technology to raise the bar for comprehensive, proactive primary care. The integration of medical claims history and patient data from electronic medical records creates a more comprehensive view of patients and helps providers more effectively manage the whole patient. The ability to analyze this more comprehensive set of information with predictive modeling software permits the identification of high-risk patients and allows the care team to be more proactive in addressing their needs.
Equally important is the convenience and access that an on-site/near-site clinic provides as well as the patient experience that can be created that allows the team to reach many patients who have not accessed the health care system in years. This enables earlier identification of previously hidden problems that would likely not be identified until there is a crisis.
Engaging the patient at every encounter
Sustained patient engagement is the critical element underlying the impact that preventive, proactive primary care can have on improving patient well-being, reducing the risk of future disease, and successfully managing and minimizing the impact of existing disease. Every clinic interaction provides an opportunity to support the patient’s journey. It is tremendously helpful when the entire care team is trained in engagement strategies and techniques. This ultimately allows for the patient and the care team to collaboratively develop a set of goals and an action plan to achieve those goals.
Sophisticated, app-based tools can enable patients to track progress quickly and easily on their mobile device or computer. Participants’ progress then is visible in real time to both providers and patients. In addition, the provider and patient can both communicate via messaging and videoconferencing in a secure manner. This enables the provider to provide near real-time support and guidance
The fact that the care team at an on-site/near-site clinic can be specifically recruited to meet the needs of a particular population and the culture of the organizations the clinic will serve allows this setting and these teams to achieve previously unseen levels of engagement and participation.
Happy employees create happy customers
Providers are enthusiastic about this model because it enables them to practice medicine the way they always wanted to—centered around the patient.
The fact that they “love” their job helps them create a different experience for their patients, one that encourages engagement and trust. Focusing on what is best for the patient makes them feel good about what they do. This translates into low provider turnover which in turn supports the kind of relationships that build engagement and trust.
Show me the savings
A significant advantage of an on-site primary care clinic is that only the clinic costs are capitated, yet organizations retain access to all other services offered by their medical insurance plans without constraints. Because visiting the clinic typically is no or low cost to members, they are more likely to rely on the clinic and only use their medical insurance plans when a higher level of care is necessary and recommended by their clinic physician.
For example, Activate Healthcare has seen its clinic solutions systematically reduce healthcare costs by 10 percent to 25 percent. For every dollar invested in an on-site clinic, organizations are getting back $1.50 from reduced costs downstream, typically in the same year.
Direct healthcare cost savings from clinics can be attributed to:
- Shifting primary care and some specialist care from community providers to the clinic – saving an average of 45 percent on primary care services per member per month.
- Actively guiding referrals to optimal in-network facilities for testing and procedures because there aren’t any ties to hospital systems that influence referrals.
- Decreasing utilization of high-cost care settings, such as outpatient emergency services.
- Decreasing utilization of inpatient services due to better preventive care and chronic condition management.
- Lowering prescription drug costs, with savings of 50 percent to 60 percent compared to retail prices.
- Lowering lab costs, with in-clinic labs generally costing 50 percent to 80 percent less than the same tests conducted in independent laboratory settings, and up to 95 percent less than those administered in hospital settings.
Technology lets organizations see their return on investment based on the cost of the clinic and total healthcare costs for the organization.
A better patient experience, a better future for healthcare
Envisioning the patient experience at an on-site primary care clinic is vastly different than what a typical patient experiences in today’s rushed and crowded physician’s office. Patients are greeted on a first-name basis, wait time is usually less than five minutes, they have as much time as they need with the provider and generally don’t pay for the appointment. And while there’s no guarantee there will be a good magazine selection, it doesn’t really matter because there likely isn’t time to read one, anyway.
This model of care saves costs for individuals and their organizations/employers and helps maintain a healthy, productive workforce. It’s easy to see why it’s becoming an increasingly popular solution for improving healthcare now and in the future.