This is not necessarily the fault of individual providers in the health care system — hospitals follow trends, they do not lead.  Physicians don’t have capital.  It makes sense that these are not the areas to look to for change and innovation.  The consumer and the gaming industry and the Web industry are the places to watch for glimmers of the health care delivery future.  However, even mighty GOOGLE tried out health for awhile and backed away.  (I hope you know that your GOOGLE Health account now needs to be ported over to a thumb drive — Google, “the cloud,” and your health information are no longer connected!)

If you want to follow some of the trends, the philosophical, and functional analysis behind what is happening in m-Health, seek out PWC and their definitive survey reports on the subject.  Note:  This is a lot more than simple ”tele-health” or whatever you want to call the connectivity of a patient to a doctor in real time over a CISCO router.  This is cell phone and consumer tech at the “app” level and on smart phones with a lot of smart employers becoming the first to innovate in this important segment of consumer services.

Integration has been a buzzword in the industry for decades, and we still don’t know what it means, but the new question may not be “How integrated are you?” but rather “How much bandwidth do you have?  Get the PWC report here.

1.  The hospitals and health care planning cycle is accelerating, and there is a renewed interest in access.  This is partly due to the emergence of the proposed health care changes at the Federal level and partly due to the fact that midlevel providers and retail medicine are becoming more prevalent in the marketplace.

2.  Employers who are managing their own health care “spend” are now more focused on what is beyond the primary care event.  Value-based contracting, narrow networks, select specialty networks, etc., are now being discussed at the employer level with increasing frequency and fervor.

3.  The vendors are sensitive and some see a ready opportunity for collaboration.  With payers like Cigna, Aetna, and United entering the picture, the vendors see opportunities to broker additional value in this space by managing the employer-hospital relationship.

4.  There are any number of benefits consultants and brokers who operate in this space, who see this opportunity, and are trying to exploit it as on-site clinics emerge and then move from a great idea to a great program.  They will make the connection and assist hospitals in their process of developing existing resources into viable solutions for employers.

5.  Programs are maturing and the second generation of vendors are emerging.  These vendors include many of the first generation, but they are now seasoned and they have been working with local health care resources to craft partnerships.  However, in some cases, they have also trained some of their own competition in the on-site industry.  We have to remember that most hospitals have ambulatory care services and many times these are remote and well-run.  They just have not figured out that they could be at a plant site or a school district rather than at a freeway intersection or in a suburb.

6.  The hospital-oriented literature is now reflecting that this is an idea that health care systems have to know is being pursued by employers and that they can either get in the game – or watch from the sidelines.  We have provided information to a dozen publications over the past few months about trends in this industry, and these articles will be filtering out to the industry pretty soon.  When they do, hospitals will feel more comfortable (and more compelled!) to seriously work with employers in their own region to augment on-site health care services.

Summary – predictions have three dimensions.  I know that one of these is the basic predictive, content and thrust.  I am sure that we have the idea down and that you will see other health care systems following; i.e. St. Elizabeth (Cincinnati), Wheaton Franciscan (Milwaukee), HCA (all over the country), and the Carolinas Health Care System, as they lead with their own employer programming.  When they do, you will find a well-capitalized and well-connected partner entering the RFP spin with unpredictable results.

Oh yes, the other two dimensions in a trend would be timing (When will it happen?) and scale or scope (How much of an impact?).  The answer to the former question is that it is happening right now, and the answer to the latter is that it all depends on your locale and regional market penetration.  If the health system in your primary market is emerging as a competitor, you have a significant amount of contingency planning to do.

Mike La Penna

We don’t know what the scientific difference is between “medication possession” and adherence, but the presumption is that if the patient has the medication, he/she is taking it.  Overall, the change in “possession” rates would seem to indicate that pharmacy counseling has a meaningful impact on compliance, and compliance is ultimately the goal in controlling the disease with the help of medications, right?  Those on-site clinics which have pharmacies included in their offerings may use this study to add or reinforce existing counseling services.

This is truly a groundbreaking study providing data on the 306 hospital regions in the U.S. and comparing data between and among them on a variety of issues.  It points out the vast variation from one region to another, which makes us all shake our heads and wonder how this could be.  Those of you with multiple plant/service locations throughout the United States have probably already experienced this as you evaluated what to do for each location with regard to healthcare services you provide, how you contract for them, and with whom.  We encourage you to, at the very least, skim through the report – even the most knowledgeable among you will be surprised by some of the data presented.

The Authors, Sherman and Fabius should be well known to readers of The Forum, as both have  long and storied careers in primary care, worksite health and workplace clinics.  Each has contributed significantly to the idea that worksite health services are more than a clinic and must be taken within the context of the whole health care “spend” and the total health status of the population being served.

In this most recent article, entitled “Quantifying the Value of Worksite Clinic Nonoccupational Health Care Services”, the authors point out that the computation of ROI (return on investment) is inconsistent from program-to-program and that there exists no standard for this measure that is accepted industry-wide.  They further state that the employers, in a rush to achieve near-term cost control over health care, are unable to demonstrate if this goal has been achieved.  They reference one program that has had some level of credible success and which has been studied on an independent basis using rigorous standards (QuadGraphics in Milwaukee) but they note correctly that this is the only long term analytic inspection of non-occupational health care services.

The authors suggest a framework for programs to consider and offer a number of observations concerning data, data collection and the qualification of results.  Essentially, Sherman and Fabius are reporting on an emerging industry with a lack of credible evidence to support the claims of the many vendors that are stumping from industry to municipality and back with promises of two-for-one and three-for-one ROI.

This article should be on the desk of any executive that is considering an on-site offering or reconsidering a contract for continued services in the workplace.  If there is an underlying theme, it is that employer understanding of existing community health care access and quality is critical and that basic on-site services do not necessarily perform in any optimum fashion unless they are crafted as part of an overall program.

Members of the Association will be afforded special pricing, and the sessions will be limited in their attendance in order to allow networking and discussion groups to be fashioned to give the attendees a peer-to-peer experience.  Interest in NAWHC is growing and the conference(s) will also be a time for members to collaborate on NAWHC programming.  To join NAWHC, go to their Web site.

They report that there are six vendors with bids of some $1M to $3M per year and that the clinic will serve 11,000 employees.  This shows that at least one state, Montana, seems to get the on-site clinic process.  Bidders that have moved to the final level of competitive review include some that you would expect and a couple that are new to the industry.  They include Take Care, CareHere, HealthStat, and Cigna.  The first three are naturals since they are all vendors that have strong offerings in a variety of venues.  Any one of them could provide fine service for the State.

The others are a bit unknown, and they would take some serious review.  Cigna has group practice offerings that would have fabulous statistics, and they boast a solid management infrastructure.  They would certainly understand population management, and they could bring some interesting ancillary benefits to the table with their knowledge of provider networks.  They already serve some state health care functions, so don’t count them out.  The others are “locals” (which counts for something).  They are: Cooperative Health Center (affiliated with Lewis and Clark  County, which already operates a Medicaid clinic in Helena) and MiCare of Montana (jointly owned by EBMS, the Western Montana Clinic, and Coordinated Care Partners).  MiCare is a regional provider that operates a handful of some workplace health clinics.

This is a local vs. national contest that should produce good theater as the State makes up its mind.  Insurance industry linkages vs. pharma-sponsored clinics and national vs. regional issues will all come to the forefront as the RFP scoresheets begin to fly.

Earlier, we reported that the Kokomo school district also instituted on-site services, so there seems to be an “epidemic” of clinic activity in the area.

The National Association of Worksite Health Centers (NAWHC) has already had exposure at the World Congress and through an on-line WEBINAR and is planning for the 2012/13 program year by scheduling coordination sessions, educational sessions and a variety of resources for its members.  Larry Boress, the Executive Director of both NAWHC and teh Midwest Business Group on Health, brings to the organization a wide array of contacts in the employer universe and he is negotiating with a number of other collaborative and complementary organizations to make sure that members have a lot of valuable channels open to them for access to all avenues of support functions for on-site clinics and employer managed health initiatives.

Look for additions and updates here and in our newsletter in the next few months.  The process of forming a national group dedicated to the advancement of the approach that was started by a handful of firms almost twenty years ago to change the way employees accessed health care is now entering a new stage.

Please note that anyone who has expressed interest in helping in this effort through this web site or through our related newsletter (you are signed up for the newsletter!) — will be contacted to become involved.  We certainly need all of the help we can get to maintain this organization as a key player in the workplace health movement.