in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare...
Transcript of in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare...
The future in health care delivery solutions today! Partnerships that work
www.wecaretlc.com
Lynn Jennings, CEO & Co-Founder • In 1981 formed Self Funding Administrators, Inc. (TPA)
• Financial success: Sold business after 5 years with over 1,000 employee lives under contract
• Innovation: One of the first TPAs in the US to adopt Utilization Review (UR) and Case Management
• 1985 served as President of Self Insurance Institute of America
• Created ESLU in 1988, merged with 2 MGUs to form Alliance Underwriters in 1997 • Sold this highly successful company in 2010 to concentrate on WeCare TLC. • Financial success: Grew start-up to $78M at its prime • Innovator in Industry Value Creation and Standards:
• Required CM to provide UR and CM Open Case • Measured Value of UR and CM vendors based on 18 quality measure and
created “Select” vendors from those measures
Origins of WeCare TLC
• Premier, Onsite/Near Site Clinic Company • 56 Clients, 35 Sites, in 5 States • 38,000+ Members • Book of Business Includes: Public, Private, White Collar, and Blue Collar
Industries • Independent & Privately-held company • 10 years old
WeCare TLC Company Snapshot
WeCare TLC Company Snapshot Flexibility In Our Model, Brings Maximum Results
Primary Care shortage has contributed to fragmented care
Unmanaged quality of care
Health care system rampant with waste and abuse
Inconvenient and inefficient access to care
Relentless growth of health care costs with little to no improvement in employees’ health
Unsustainable medical fee-for-service model
Overuse of Specialty Care and under utilization of Primary Care
www.wecaretlc.com
Growing Employer Demand For Primary Care Medical Homes
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www.wecaretlc.com
Worker’s Compensation Disability Management HR Testing and Screening
Primary Care “Lite” May Be ARNP Led Fevers/Cuts/Sprains Minor Ailments Single Site Offsite Care Management
PCMH, Physician Led True Chronic Care Management PBM Option/Added Cost Control Multi-Site, Multi-Client Cost Effective Rx Dispensaries
WeCare TLC Provides Cutting Edge Solutions
The Evolution of Employer Clinics
WeCare TLC’S Risk
Management Platform
Traditional Industry Model
Occupational Health
Client Funds All Start-Up Cost No Direct Contracting Offered Optional Rx Dispensary/Pharmacy No Benefit Design Assistance No Data Analytics No Proven Savings
WeCare TLC Funds Start-Up Costs Direct Contracting (Imaging, etc.) Data Driven Benefits Design Assistance True Reduction of Health Care Spend Proprietary CAT System: Data
Analytics
• Physician led model (can be supported by NP) creates quality needed for high risk members
• RN on-site focusing on DM & Care Coordination develops medical home & team based care
• Clinical data integration with Payer & PBM drives analytics for medical risk management decisions (patient & plan level)
• Transparency in health care pricing aligns us with our clients to drive utilization
WeCare TLC's Core Beliefs for PCMH
WeCare TLC Offers Diverse Market Solutions for Employers of all Sizes
www.wecaretlc.com
Two or more employers joining together to offer primary care at one or more locations, convenient to all employees. Potential benefits to this solution: • Allows smaller employers
to act as larger employers • More locations + more
hours = more access = higher ROI
Multi-Employer, Multi Location
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Single Site, Single Employer
Many employers in a community of 50k-500k residents, opening many sites (5+). Some benefits to this model: • Convenient to all
employees and dependents
• Allows for most robust risk management opportunities
Community Based Model
Traditional Model of onsite clinic offerings. WeCare TLC excels at this model by: Achieving Industry High,
65% Participation Year 1 Higher participation =
Increased ability to control referrals
Increased ability to control referrals = Higher ROI
CAT: Providing unlimited data analytics and reporting
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About LaGrange College
• Founded in 1831, oldest private college in Georgia • Location: 60 miles SW of Atlanta • Number of full-time employees - 200 (178) • Number of covered lives – 460 • 5-yr. avg. total plan cost - $1,302,291 • Number of enrolled students – 1,000, representing 17 states • Self Insured since 2005
• 3 yr. avg. total plan cost – $5,147,142 • Number of full-time employees - 450 • Number of covered lives – 1,100 • Self-Insured – changed TPA’s 2014
About Troup County Government
Global Pension Administrators
Our Partners in Employee Health and
Wellness Program Management
About the Health Center
Opened October, 2011
Clinic located adjacent to Athletic Facilities
Occupational Health
Convenience/ Urgent Care
Primary Care Medical Home
Rx Dispensary & Mgmt
Chronic Disease & Lifestyle Mgmt
Referral Mgmt
Direct Contracting
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Benefit Refinement
Utilization Review
High Performing Narrow Networks
Case Management
Carrots & Sticks
Stop-Loss Arrangement
Telemedicine
Centers of Excellence
Health IT
Management of Full Continuum
Health Care Clinical/Financial Risk
Comprehensive Primary Care Services • Episodic Care (Acute/Urgent Care) • Chronic Condition Diagnosis/Management • Minor First-Aid • Personal Hygiene Issues • On-Site Prescription Rx Dispensary • On-Site Labs
Imaging • X-Ray • Additional Services Available
Key Care Management Services • Care Coordination • Referral Management
Wellness/Prevention Services • Full Physicals (Including Well Woman Exams) • Wellness Program Oversight & Analysis • Health Risk Assessments & Evaluations • Biometric Blood Analysis • Wellness Prevention Lunch and Learns • Administering Vaccinations, Tetanus Shots, Flu Shots,
Etc. • Counseling for Stress-Related Issues • On-Site Targeted Total Lifestyle Counseling
Injections • Allergies • Depo • B12
Scope of Services
Total Space: 2,249 sq. ft. • 4 Exam Rooms • Lab • Dispensary: 100 Chronic and Episodic Care Rx
Clinic Staff • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1 Nurse Practitioner • 1 RN Lead RN and Nurse Educator • 1 LPN Dispensing Nurse • 1 LPN Office Nurse • 1 Certified Medical Assistant (Front Desk)
Hours of Operation • Monday & Wednesday: 8 am to 5 pm • Tuesday & Friday: 8 am to 3 pm • Thursday: Closed
More Health Center Facts:
“It’s like a real doctor’s office!”
“I used to go to the doctor when I was sick, now I go to the doctor to stay well.”
Troup County Collaborative Financial Impact Report
The per employee per month costs as of September 2013 of $927.09 as compared to September 2015 of $696.03 represents a 25% reduction over the 2 year period. This analysis is inclusive of all clinics costs for employees and students.
Troup County Collaborative Shock Loss Impact
Patient Satisfaction Surveys
Patient Satisfaction Surveys
Patient Satisfaction Surveys
Patient Satisfaction Surveys
How Can I Get Started?
1. Know Your Broker and Benefits of a Strong Relationship 2. Know Your Health Plan 3. Know Your Employees and the Medical Community 4. Know the Power of Partnerships