in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare...

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The future in health care delivery solutions today! Partnerships that work

Transcript of in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare...

Page 1: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

The future in health care delivery solutions today! Partnerships that work

Page 2: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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

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• 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

Page 4: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

WeCare TLC Company Snapshot Flexibility In Our Model, Brings Maximum Results

Page 5: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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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Page 6: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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

Page 7: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

• 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

Page 8: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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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Page 9: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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

Page 10: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

• 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

Page 11: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

Global Pension Administrators

Our Partners in Employee Health and

Wellness Program Management

Page 12: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

About the Health Center

Opened October, 2011

Page 13: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

Clinic located adjacent to Athletic Facilities

Page 14: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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

Page 15: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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

Page 16: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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:

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“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.”

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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.

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Troup County Collaborative Shock Loss Impact

Page 20: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

Patient Satisfaction Surveys

Page 21: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

Patient Satisfaction Surveys

Page 22: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

Patient Satisfaction Surveys

Page 23: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

Patient Satisfaction Surveys

Page 24: in health care delivery solutions today! · 2016. 6. 17. · • 1 RN Clinic Manager (WeCare TLC’s Cost not LaGrange/Troup Cty) • 1 MD, Board Certified Internal Medicine • 1

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