Transcript Slide 1

Corporate Healthcare Ideas:
Thinking Outside the Box with
Employer Sponsored Clinics
WAHU
John Neuberger
Vice President Operations
September 19, 2008
The Problem
Healthcare Cost and Quality
CRISIS
A Crisis in Healthcare
A Lack of Coordination & Integration
PCP
Specialist
Our Healthcare System
• Costs $7,000/person, twice as much as other
industrialized countries spend to cover every citizen
• 30% of dollars and up to half of doctors and nurses time
spent on paperwork
• Only 1/3 of time is evidence-based medicine practiced
• Healthcare costs to businesses up 140% in the last 10
years, 5x wage growth
• But primary care real incomes are down
A Crisis in Healthcare
Overstressed PCP
No Universal EMR
No Financial Incentives
No System Integration
Lack of Care Coordination
One Employer’s Solution to the Healthcare Crisis
Who is Quad/Graphics?
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Founded in 1971
The world’s largest privately held printer of magazines and catalogs
10 printing plants in 6 states
International partnerships with printers in Poland, Argentina and Brazil
More than 10,000 employees
$2.0 billion in annual sales
A Sample of Quad/Graphics Clients
Advertising Age
Cargo
Entertainment Weekly
Elegant Bride
Golf Digest
Health
JC Penney
Life
National Geographic
Newsweek
People
Self
Time Inc.
U.S. News & World Report
Victoria’s Secret
Williams-Sonoma
Why Is Quad/Graphics In The Health Care Business?
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Control costs by providing a full range of healthcare services
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Focus on wellness and preventive medicine
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Enhance quality through best practice guidelines
and Evidence-Based Medicine
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Offer benefits that attract, retain staff
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Maintain flexibility in benefit design
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Improve patient access with onsite facilities
Who Is QuadMed?
Quad Med – A Medical Subsidiary of Quad Graphics
• Opened first clinic in 1990
• Currently manages 8 clinics
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5 Quad Graphics
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2 Briggs & Stratton (2002 & 2004)
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1 Miller Brewing Company (2005)
• In 2007 Quad Med Provided
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120,500 Clinic Visits
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122,100 Prescriptions
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21,800 Dental Visits
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17,600 Rehab Visits
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230,000 Adjudicated Claims
Briggs & Stratton Health Center
Miller Health & Fitness Center
Comprehensive integrated on-site services:
Requires balance
Medical
Management
Risk
Management
OSHA
Reporting
Acute care
Injuries and
Illness
Disability
Management
Workers
Compensation
Health Transformation/
Population Management
Primary
Care
Absence
Management
Case
Management
Referral
Management
Wellness/
Prevention
Health
Advocacy
Chronic
Disease
Management
On-site pharmacy
QuadMed Strategy
• Provide onsite primary care & selected specialty care
• Focus on prevention and wellness
• Restructure the delivery of primary care
– Focus on patient centered care
– Salaried providers, not “production” based reimbursement
– Incentives based on quality – customer satisfaction, adherence to guidelines,
preventive services, collegiality, committee participation
– Provide ample “face time” with patients
– Provide resources supporting quality care
• Provide specialty care & hospital care through direct contracting
“Narrow Networks”
• Remove waste and improve quality - LEAN
• Integrate workers’ compensation into primary care services
The Power of Integration & Coordination
Workers
Compensatio
n
Occupational
Health
Pharmacy
Prepackaged
meds
Prevention &
Wellness
Fitness Centers
Health Plan
Design
Direct Contracting
High Performance
Networks
On-Site
Primary
Care Clinic
Data Warehouse
Electronic
Medical
Record
Physical &
Occupational
Therapy
EAP & AODA
Counseling
TPA
Case Management
Disease Management
The Savings of Employer Managed Healthcare
QuadMed Track Record
Average healthcare cost per employee
$ Thousands
11
10
9
8
7
6
5
4
3
2
1
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Midwest
Quad/Graphics
Actuarial Study
Quad/Graphics’ healthcare costs are consistently below the benchmark,
when adjusted for demographics and benefit design:
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18% below in 1998
19% below in 2000
17% below in 2002
26% below in 2004
32% below in 2006
Potential Savings for an On-Site Clinic and Pharmacy
Onsite care can provide the following
additional savings
Lab – 94% Savings
Rehab – 54% Savings
Pharmacy- 8% Savings
Direct Contracting – 11% Savings
Average Healthcare Cost Trend
2000-2007 per employee per year
4.9%
Briggs & Stratton Per Employee Cost Comparison
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
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Milwaukee (Salaried)
Poplar Bluff
Murray
FY04 (7/03-6/04)
$7,400
$7,096
$3,818
FY05 (7/04-6/05)
$8,537
$7,823
$4,222
FY06 (7/05-6-06)
$8,508
$6,936
$6,259
FY07 (7/06-7/07)
$7,417
$5,726
$7,398
Steinhafels Experience at Quad
400
$369
$343
350
$318
300
The Alliance Network
(Madison)
PHCS Network
250
200
154
127
150
Quad Med Network
100
50
21
0
Avgerage participation per
Month
Average Claim Cost per
Partipant per Month
PHCS VS Quad shows 16% savings per month per participant
Based on 2007 Data
The Health Plan
Power Of Benefit Design
Weekly Premium of $11 per single, $22 per couple, $32 per Family
Preferred
Network
Quad/Clinics
400 Specialists
9 Hospitals
$6 Co-Pay
$30 Co-Pay
$25-200 Co-Pay
98 Hospitals
6,650 Doctors
Nonnetwork
Providers
100%
84%
$300/500
$2,300 max
80%
9%
$400/800
70%
7%
Deductible/
Copay
Coverage
Dollars Spent
Quality of Care Measures
Quality of Care – Reporting Tools
• Satisfaction Surveys
– Patient
– Staff
– Provider
• Data Warehouse (Ingenix)
– Key Indicator Report – Comparative Activity Report
– Evidence-Based Medicine Report
– Ad Hoc Reports
• EMR/PM (GE Centricity)
– Focused EBM Reports – Individually Actionable
Key Indicator Report – National Experience
Metrics
Current
Norm
Difference
45.2
45
0.30%
3
3.8
-21.00%
15.5
16.7
-7.30%
Medical Average Length of Stay
3.3
3.9
-15.10%
Surgical Admissions per 1,000
10
8.2
22.10%
Surgical Average Length of Stay
2.8
3.5
20.60%
Maternity Admissions per 1,000
16.6
16
3.50%
2.4
3.1
-21.80%
Outpatient Surgeries per 100
Members
6.6
9
-26.90%
Physician Office Visits per 100
Members
236
305.3
-22.70%
X-Ray Services per 100 Members
57.4
76.7
-25.20%
Lab Services per 100 Members
276
353
-21.80%
Prescriptions per Member
5.1
6.2
-17.90%
Average Paid per Prescription
$38
$54
-29.60%
Inpatient
Admissions per 1,000
Average Length of Stay
Type of Admission:
Medical Admissions per 1,000
Maternity Average Length of Stay
Outpatient
Prescription Drug
Status
Evidence-Based Medicine Compliance
Ingenix Database
Condition
WI Compliance Rate
National Compliance Rate
Benchmark
Depression
84.4%
84.3%
88.7%
Diabetes Mellitus
74.1%
55.6%
56.0%
Epilepsy
82.4%
53.9%
69.4%
Hyperlipidemia
93.6%
71.3%
74.9%
Hypertension
89.2%
73.0%
75.8%
Obesity
75.5%
46.1%
46.1%
Quality of Care Analysis - EMR
Immunizations
Up-to-date on all immunizations at age 2
• QuadMed - 98%
• NCQA - 68%
Up-to-date at age 13
• QuadMed - 88%
• NCQA - 50%
In Summary
• QuadMed has developed a program that has been successful in
controlling cost and improving quality of care for QuadGraphics.
• The program focuses on:
– Patient Centered Care
– Empowered Primary Care
– Wellness and Prevention
– Practice of Evidence-Based Medicine
– True Integration of Healthcare Across Disciplines
• The program can be successfully implemented at a myriad of industries
and organizations with similar results.