Insurance Companies and TPA's are in the risk business and administration...Worksite Clinic manager's are in the provider business...we essentially run small family practice doctors offices at employer's sites. UHC, Cigna, Aetna, Humana, Blues etc. are in the business to help people protect themselves from risk and to administer benefits.
Risk is hard to manage because of the lifestyles and behaviors of Americans. The expense of high quality care that our institutions offer paying customers and non-paying customers also makes the health care dollar sizable. When you also consider the cost shifting of government programs, the individual and employer market have become quite expensive with regular inflation increases of 12% annually.
The insurance industry which has taken the heat for the misbehavior of the American people, government cost shifting, legal burdens and the ever increasing cost and redundancy of the provider community is in the middle, under pressure and attempting to retain and assist their customers and continue to bring innovative products to the table to help "manage" risk.
Most of the players have paid outside vendors from the provider side to "deliver" these valuable services. Over the last 30 years our industry has tried to convince the employer to shift more cost to the member (employee), since most employers have absorbed unfairly or at best disproportionally the renewal (inflation and utilization) increases.
In order to make members (employees) more responsible and better consumers (skin in the game), they have accomplished this by raising deductibles and co-insurance and co-pays and penalties and incentives. Those in the now.... know that the only way to lower cost is to improve behaviors and health and therefore lower costs. Thus the Wellness and Disease Management industry was born in the 80's.
Employers recognize the value and ROI on these efforts but until the 2000's dragged their feet since they essentially all thought members should be more responsible. (I.e. it's not our problem...eat right, sleep right, and exercise right...all the things Mom said)...the problem was/is...they forgot human nature...humans given the ability to shift the risk/burden will do so. In self-interest employers are now using Wellness and Disease Management programs to motivate people to change behaviors and improve health and lower cost.
It's enlightened self-interest. Win/Win Additionally, the shifting of more cost to the consumers, though logical has had one glaring un-intended consequence. By shifting cost to the member in higher out of pockets, the assumption always was that members out of self-interest would still get appropriate medical care when needed. I dare say we were wrong as an industry.
They are not getting appropriate care, they are not being responsible, entertainment and other consumer desirables are perceived to be of greater value and thus individuals are avoiding appropriate care now under the cover of being good consumers. This increases overall costs since they become future high cost "train wrecks" tomorrow.
Now the clinics.... The Value Proposition: Win/Win/WinHuman beings listen better to doctors and are more accountable in a trusting relationship with a doctor. Many Work-site clinic doctors spend 20 minutes of uninterrupted time with each patient, which increases the odds of trust being built and education taking place. The member is given more time then is normal in the retail world. This better experience has no economic barrier since all care provided in many of the clinics is free.... free.... free.
The employer can allow the clinic to be free since every time the member uses the clinic it saves the employer approx 50%. We also distribute some generic drugs and do some labs in our clinics at substantial savings, which also increases the appropriate use of care. It's all Free!Thus the member's do not avoid care as much for economic reasons.
They get more engaged with the doctors who are never forced to rush them out of the clinic since most managers rarely have more than one patient in the waiting room since no walk ins or double bookings are permitted. Everything is scheduled appointments...very efficient...with less than 2 minute waits on the average. One of the added benefits is that Primary Care doctors also greatly value this model and realize often that this model fits well in their original vision of how practicing medicine is supposed to be.
Plus this clinic platform is supplemented by telephonic nurse coaches who are integrated into the medical practice to interact and tutor folk using the same electronic medical record used by the doctor. It's a comprehensive integrated effort. It's the best Wellness and Disease Management platform in the marketplace.
Finally...the employer saves $.50 on every dollar by directing care to the clinic versus the normal plan. Then as wellness and disease management happens, overall costs go down on the entire plan. We are being told by employers who have done this for 3+ years that they are not only seeing lower inflation rates but also are seeing deflation in overall medical costs. Competition is everywhere now. These clinics are so hot that everyone is quickly going into market with the next best version of the product.
Some are offering much lower fees but are not being transparent. Some have clear conflicts of interests. Some are not so clear. It's a competitive marketplace and which offering is the best for the employer both short and long term is not obviously apparent. A wonderful service at 50% of market cost. The mission is to improve the health of the membership and to revolutionize the way Primary Care is done in America.
I think in a brief but wordy way...you now have an overview of the value proposition. If you would like more information...don't hesitate to ask.
About The Author
Mr. Crimmins (Bill) has a twenty-six year career marketing group health benefits and numerous ancillary support products primarily in the Health Management business. He is a pioneer in work-site clinics.
The self proclaimed Ambassador of Healthcare in America is a Ball State graduate in world History. He began his insurance career with the Prudential of the South, Pilot Life and served with Mass Mutual in the late 80's early 90's. He was an officer of CHUBB Life America prior to Chubb's exit from the health benefit market. Then he joined the TPA world in 1995 through the present.
Bill has very strong convictions regarding Healthcare in America. He believes that all parties must be responsible to do their part to enhance the compensation packages of all Americans. This should increase the possibilities of all Americans to be insured against financial ruin.
The parties include: Consumers, Employers, Consultants, Providers of Care, Insurers and Financial Institutions, Administrators, State and Federal Government
Crimmins believes that the factors of crisis facing Healthcare include:
Parties wanting something for nothing
Attempts to apply economic solutions to moral and ethical dilemmas
Lack of education
Temporary stopgap measures
Greed
Fear
Low Profits
Unqualified Labor
Blaming not cooperating
Over legislation
Ignorance
Bill plays the role of Ambassador, Herald and educator. He loves his work!
Bill and his wife, Professor Corcoran Crimmins live with their three boys in Greencastle Indiana.
Bill recently published an article on Health Reform. If you are interested in getting a copy let Bill know.
If you would like more information…don’t hesitate to ask. You can reach Bill at
765-720-039 or mailto: crimmins@link2000.net. Visit http://www.noviacareclinics.com/
