Workplace Clinics and Employer Managed Healthcare: A Catalyst for Cost Savings and Improved Productivity »

"If there is one key idea to take from this book it is that the ‘on-site clinic’ is a catalyst that allows all other programming to ‘work better’ and to be more coordinated and internally complementary. … We are buying health care without any clear understanding of how to value health care. We need to take a step back and ask ourselves, as we have with many other production inputs, whether we can simply make it better than we can buy it. …

"Mr. La Penna’s book outlines the many aspects of how to think about an on-site program and how to implement one, once the decision is made. These features alone recommend the book as a valuable reference but there are other parts of the book which address important tangents and support programs which complement the employer sponsored on-site clinic. The underlying premise is that the employer must first start, as Toyota did, with planning and design. Hopefully, this book will give those who are embarking on this process a much needed road map."

—From the Foreword by Ford Brewer, M.D., Medical Director, Toyota Motor Manufacturing of North America

The advent of organizations considering an on-site approach to the delivery of health care services increases in direct proportion to the rising of health care costs. This volume is a how-to manual on the design and implementation of an on-site program and presents the challenges and benefits of such a system. Topics discussed include hospital and specialty contracting; employee choice concerns; cost control; ancillary services such as pharmacy, lab work, physical therapy; workers compensation; quality vs. value analysis; and other considerations. An extended case study follows the implementation of a program from inception to introduction.

Foreword ix

Preface xiii

Acknowledgments xv

1 Introduction: Workplace On-Site Healthcare as a Catalyst for Cost Savings and Improved Productivity 1

2 Company Planning for Healthcare and Employees' Participation in the Planning and in the "Plan" 11

3 The Myth of the Company Doctor 19

4 Components and Complements to On-Site Healthcare: Planning to Plan 27

5 The On-Site Program: What and Who are in and Out? Why? 33

6 Cost Savings, Cost Avoidance, and Confidence Levels 41

7 The Quest for a Dependable Return on Investment: Claims Analysis 49

8 The Quest for a Dependable Return on Investment: Key Assumptions and Drivers 59

9 The Quest for a Dependable Return on Investment: Benefit and Program Design 71

10 The Healthcare "Buy": Determine What to Purchase by First Figuring Out What Not to Purchase 81

11 Electronic Medical Records, Personal Electronic Health Records, the Medical Home, and the Medical Homeless 89

12 Legal Issues: Contracting and Regulatory Challenges 97

13 Working with Hospitals Rather than against Them 115

14 Utilizing Local Physicians as the Primary Care Anchors 129

15 Pharmacy, Pharmacy Benefit Managers, and Other Mysteries 137

16 Employees, Consumerism, and the Illusion of Choice 145

17 Ambulatory Care Nuts and Bolts: Site Design and Function 153

18 Workforce and Population Analysis: Prevention, Intervention, Wellness, Disease Management, and the Care Management Team 165

19 Special Situations and Some Solutions (Middlemen, Brokers, Third-Party Administrators, and Consultants) 175

20 Working with the Vendors: The Request for Proposal and its Application to the Development Process181

21 Political and Functional Barriers to Establishing an On-Site Medical Service 193

22 Involving Other Businesses as Customers of the On-Site Program 199

23 The Future of On-Site Services and the On-Site Industry 205

Appendix A On-Site References and Reading List 213

Appendix B Claims Request (Complete Listing) 217

Appendix C Pro Forma Example 221

Appendix D On-Site Provider Listing 233

Appendix E Workplace On-Site Program Consultants and Resources 245

Index 253

About the Author 261