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Primary Care: Are You Busy Or Effective (or Both)?

May of 2018 we turned on dashboards on the Value of Care for a group of 400 providers. On the dashboard the scale of 0 – 100, a 70 was considered “good value,” below this there were significant opportunity for higher value care. The average score for our providers was 35.

Within hours the phones began to ring – “my care is better than this,” “my dashboard is wrong,” “your data is incomplete” – the general sentiment was “I am making a bigger difference that you are saying I am.”

Let’s look at the facts – they were busy – usually filling their schedule to 80+%, moving through the day giving 100% to each person sitting before them. At the end of the day going home feeling tired but sure of their contribution to their patients. They must be high quality, effective, and their patients are benefiting based on days, months, and years of committed work.

So why the relatively low scores? We set up teams to investigate. The ability to click down to a member level allowed the providers to see what was going on with their patients. Were the patient really theirs or not? An examination revealed YES! Then why weren’t their blood pressure, cholesterol, asthma, blood sugars, immunizations, and screenings not at goal?

Barbara was supposed to come back in but never did, Bob travels all the time, Suzie stopped taking her meds, but never communicated it, John’s son got ill and he missed his appointment and never came back in…. The list of reasons went on and on. But the reality did not change – we were confusing being busy with meeting the needs of our patients. Often, we were not seeing the patients that needed us the most.

This lead to new systems, new ways of proactive (and automated) outreach. Soon the right patients were in the right practice at the right time. Quality took a jump up. Providers knew they were doing the best thing for all of their patients, not just the ones in front of them.

Busy was now productive and we were adding years to the lives and life to the years of those we served!

Is your practice busy, effective, or both?

What Does Your Employee Health Balance Sheet Look Like?

By DrScott – Posted on January 21, 2014 on www.compassphs.com

What is the most expensive item on your statement of revenue and expenses every month? Employee payroll tops the list for almost every company, with health benefits landing in the second or third position depending on whether you are in manufacturing (raw materials often in second place), or a service industry.

Now, how carefully do you manage employee costs? Cost of raw materials? What about health costs? When I ask this question of most CEOs and CFOs the answer is consistent – on employees and raw materials they are meticulous, but they don’t feel like there is much they can do when it comes to health benefits.

Really? As we have examined in these blogs, there is A LOT that they can do. In fact, given the high cost of health benefits it would not surprise me if soon companies will not have to add “Employee Health & Wellbeing” to their Balance Sheet. How? Well, disease doesn’t appear in a person overnight – it takes years, and if detected early it can be cured or slowed dramatically. Why don’t we slow or prevent disease progression?

The “I Feel Fine” Syndrome lulls us into a false sense of security (as we discussed in the last 4 blogs). But this is not inevitable – identified and handled properly, costs stay down, employees stay at work, and families keep their mothers and fathers.

Smart venture capital firms like Blackstone have already figured this out and established companies like Equity Health to get control of this issue. Imagine buying a company, putting in place proactive solutions, and dropping the cost of your number 2 or 3 spend by 10 – 30% in the first 36 months consistently. Regardless of how much the rest of the company performs, you already have created significant shareholder value.

So what will the Balance Sheet say? No one knows exactly, but an educated guess includes:

Assets:

Employee Health (Assets = lower costs relative to average employee of $X)

  • % of Employees

Healthy Employees : $3,000/employee

  • 15%

Employees with Chronic Conditions well managed : $1,400/employee

  • 8%

Liabilities:

Employee health (Liabilities = higher costs relative to average employee)

  • % of Employees

Employees with poor physical fitness <$500/employee>

  • Unknown

Employee with unknown health status <$1,400/employee>

  • 57%

Employees with uncontrolled Chronic Conditions <$3,200/employee>

  • 14%

Employees with Serious Illness <$19,000/employee>

  • 6%

So let’s take a company with 1000 employees paying on average $5000 per year for health benefits. This calculation would be a net negative of <$798,000> on the balance sheet. Getting biometrics, age and gender screenings along with active primary care involvement would shift this from a net negative on the balance sheet to a break even on the balance sheet. It would also reduce health care costs by over $60,000 per month. This approach is logical and attractive both from a financial and employee well-being standpoint. However, it takes experience and competent systems to achieve.

Tremendous opportunity to make very significant differences for your employee’s health and well-being exists. Designing systems that help your employees keep their Seven Numbers at goal will add years to their life and life to their years. Thank you for following this series. Please let us know if you have thoughts or stories of how you are accomplishing this in your companies.

How is Your New Year’s Resolution Coming? This Year it is Time to Succeed!

By DrScott – Posted on January 14, 2014 on www.compassphs.com

First in the How to Switch On Your Employees Series

What is your New Year’s resolution? If you are like most Americans, the resolution will be given up by Super Bowl weekend and things will be back to status quo. But what if things were different this year? What if you succeeded and lost that weight, got in shape, or saved that money? What if 2014 became the year to get things done in a way you have never experienced before? What would you have to do differently in 2014 compared to previous years?

The science of change management, which is what we are speaking about, has come a long way in the past 5 years and it’s time to incorporate these discoveries into achieving our goals.

Let’s start by asking: is knowing what to do enough? As a weight loss expert who has helped hundreds of people lose weight, it is clear that there are many patients who can literally recite encyclopedic knowledge on calorie balance, exercise, food labels, and the latest best seller’s strategy on effective weight loss, but they don’t lose a pound. They know what to do, but are not doing what they know.

Maybe the key is to create or overcome strong emotional issues. In the patients mentioned above, often a life event preceded the significant weight gain. When this occurs there is no question that getting in touch with “what happened” and re-framing the experience in a more empowering and less threatening way makes a difference. However, often there was no preceding trauma or the traumatic experience was resolved through beneficial and significant counseling but no weight loss occurred, suggesting that attention to emotional issues may not be enough by itself.

Perhaps the environment makes the key difference. One Compass client discovered their employees gain, on average, over twenty pounds of weight in the first year they are working in certain departments (and this is not muscle weight – it is good old fashion fat). Employees are not allowed to be out of their seats more than 5 minutes an hour, they are rewarded with food when they achieve performance goals, birthdays are celebrated corporately with large cakes and free soft drinks (there are over 500 employees – more than one birthday per day on average), and long work days are common, leading many to work 10 or more hours a day minimizing the time for non-essential out of work activities like exercise.

Challenging environments are not just created at work. At home, the refrigerator often contains soft drinks, cabinets contain potato chips and cookies are baked and shared as a sign of love. Nutritious food is difficult to find and more expensive than fast food. Unfortunately, many obese children and adults do not have the resources to access nutritious food. So perhaps the reason we fail so frequently is that we are not looking at the bigger picture. Some combination of these factors work together to block our change efforts. What are the results if you address two or three of these issues at the same time? In the next blog, we will look at the interaction between these factors and at what the research is telling us about making sure we win this year with our New Year resolutions!

How The “I Feel Fine” Syndrome™ Is Costing You Millions – Part 4

By DrScott – Posted on January 7, 2014 on www.compassphs.com

In the last blog we addressed specific occasions that prevent employees from knowing where to go for the right test at the right time, with the right provider, and at the right cost. In this blog we will examine specific strategies that companies use to overcome these barriers.

Below are six strategies that companies have used:

  1. Get and explain the importance of their biometric numbers. Biometric screenings can be done at work or at the doctor’s office.
  2. Make sure employees know where they are at risk and the need to act.
  3. Remove the cost of the screening test (now necessary with the Affordable Care Act).
  4. Give employees time off from work for their physical and testing.
  5. Reward employees for closing their age and gender appropriate gaps in care.
  6. Inspire employees to “do the right thing” for themselves, fellow employees, their employer, and their families.

If you are responsible for employees at a corporation you may be asking yourself why do all this work? Is it really a company’s responsibility to help cure the “I Feel Fine” Syndrome? From my perspective as a practicing doctor I would say to you: I cannot do it without you.

Employees have to be engaged and encouraged. Doctors cannot do it without your support. With your support in health plan design, focused communications, and providing the right tools to your employees and their families, outstanding life-saving and cost reducing solutions are possible and corporations are winning the war on disease and disability.

This change in thinking is redefining what the Human Resources Department means to corporations. Always focused and concerned with the experience of the employee at the corporation, the HR department now has the opportunity to take the employee experience to the next level:

  • From “I always had health insurance” to “I am alive today because of the proactive programs my employer put in place”!
  • Teaming up with the insurance company and medical providers to create a system of care that helps employees get it done, as opposed to creating frustration and unnecessary expense!

As Karen Rogers, an insurance broker at Holmes Murphy & Associates in Dallas Texas said in her introduction to the book, The Seven Numbers, “When I started my career in the insurance industry, I never expected to be saving lives. Yet, 22 years later, as I consult with employers on their employee benefits strategy, it is what I do”. If you work in health benefits you are either saving lives, or allowing employees to remain at risk. Choose to save lives and appreciate the tremendous opportunity available to you today.

Missed The Window? It Is Not Too Late

By DrScott – Posted on December 19, 2013 on www.compassphs.com

In the first three Seven Numbers posts the natural history of the most important conditions to your healthcare spend were shared. But what do you do if you have missed the primary prevention window? Is it too late to control costs? So let’s say that the disease has appeared in the body – diabetes, heart disease, or cancer. It is not too late.

With cancer, for example, one cell becomes two, then four, eight, sixteen, thirty-two, and so forth. But the cells are localized, contained in one small area. They could easily be removed by a short procedure. It is not until literally hundreds of thousands of cells have appeared that the ability to completely cure the cancer is lost for many of the common cancers. Again, it is estimated that 3 to 5 years go by during which we could act and literally save our own lives. Which cancers could be diagnosed early?

  • Breast cancer (detected with breast exam, mammography, and breast MRI),
  • Colon cancer (detected with colonoscopy, occult blood testing and exam),
  • Cervical cancer (detected with an exam and pap smear),
  • Endometrial cancer (detected with a history, exam and a simple test) and
  • Skin cancer (detected with history, exam, and a simple biopsy).

For heart disease, diabetes, or hypertension, blood sugar and blood pressure gradually rise. Fat gets deposited in our arteries (LDL cholesterol for example) and begins to accumulate. No untreatable “end organ damage” in our heart, brain, kidneys, or other organs has occurred (if they had the employee would have had a heart attack, stroke, or kidney failure). With proper treatment these complications can be prevented or delayed for decades. But the window to act is closing.

How does your company make sure this occurs? Why don’t we and our employees act? Why do the majority of us allow these changes to occur in our bodies without acting? In the next Seven Numbers Blog we will explore the answer to this question.

Give Up Wellness Programs – It Is Time For Prevention

By DrScott – Posted on December 10, 2013 on www.compassphs.com

Catastrophic conditions, such as debilitating heart disease, diabetes, and cancer, don’t just appear in our body. They progress from having a predisposition passed on from your parents, to increased risk of the disease (for example when we gain weight or become overweight); to pre-disease, where the numbers we monitor like cholesterol and blood pressure begin to change; and to disease like diabetes, heart attacks, or cancer appearing in our body; to complications like strokes, amputations, and kidney failure, widespread in our body. Why is this important? Every step along this disease progression can be slowed or eliminated.

Most wellness programs try to attack this problem with lifestyle changes to reduce pre-disease – a good strategy if you are monitoring and targeting the appearance of pre-disease in your employees. How do you know if “pre-disease” is appearing in your employees? An effective program looks at the bio (life)-metrics (numbers) of your employees. If you don’t start with an understanding of the disease prevalence, time and money may be wasted.

Frankly, today the term “Wellness Program” encompasses such a broad range of initiatives, it has lost its meaning. Too often these programs amorphous well intended, information gathering and sharing efforts, devoid of actual metrics, and clearly defined next steps for the employee – point to a program that will fail.

In the next installment, we will discuss a proven set metrics to follow and why they are so vital to your company’s well-being.