A Broader Approach To Managing Health Care Risk

Brian Klepper

Posted 2/15/13 on Medscape Connect’s Care & Cost Blog

BK 711Health care’s purchasers crave certainty. But complexity – and therefore uncertainty – rules. Assurances are hard to come by.

The most common question asked by prospective clients of my onsite clinic/medical management firm is how much less their employee health benefits will cost if they deploy our services. They often expect that we’ll review their claims history and nail down what their health care will cost once we’re involved. Looking in the rear view mirror can inform the future, but it isn’t foolproof.

The Complexity of Health Care Risk

The challenge here is that so many different mechanisms contribute to the need for care, the ways care is accessed, the ways care is delivered, and the ways it is priced. Even mechanisms that, in isolation, are strong, often are inadequate in the context of larger cost drivers.

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Moving Beyond Merchant Health Care

Brian Klepper

Published 4/05/12 on MedPage Today

Another luminary-rich panel has been formed to make recommendations about how physician and other healthcare services should be valued and paid for.

The Society for General Internal Medicine launched the National Commission on Physician Payment Reform with funding from prominent healthcare foundations. The 13 commissioners represent a mix of perspectives: a former surgeon/senator, community physicians, academics, two healthcare mega-corporations, a think tank, a state regulator, and a reform-oriented advocacy organization. A group representing large employer purchasers has one seat.

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A Case Study Presentation of the Transport Workers’ Union Clinic in St. Marys, GA

Brian’s Note: As I’ve noted before, I am Chief Development Officer of WeCare TLC, a leading edge onsite clinic firm based in Lake Mary, FL . WeCare now has 15 clinics in 5 states, and typically produces savings of 18-30 percent in the first six months, net of the clinic cost, while measurably improving population health status.

With Will Montoya, the broker on the case, I delivered a 9 minute case study presentation in October 2010 at the Health 2.0 conference in San Francisco, describing the experience and performance of our clinic for the Transport Workers’ Union (TWU) in St. Mary’s, GA. The union members are tradespeople on the Kings Bay Submarine Base. The group is fully insured with Blue Cross and Blue Shield of Georgia, and has 310 employees and 800 lives.

Prior to having the clinic, TWU had loss ratios (i.e., claims/premium) that typically ran about 85 percent. Within 4 months of the clinic’s opening, their loss ratio had dropped to 42 percent, and it has remained below 55 percent since.

In January 2010, after one year’s experience, BCBSGA offered a 2 year, 7 percent premium reduction. Comparably sized groups in the regions were receiving 25-30 percent annual increases.

While TWU is one of our smaller clinics, the mechanisms in play are the same for all our clinics. We chose this group to profile because the performance numbers were developed, not by us, but by BCBSGA.

Clinics As Health Care’s Transformational Engines

By way of full disclosure, I am Chief Development Officer of WeCare TLC, a rapidly growing onsite clinic firm, with clinics in 5 states, that produces dramatic, measurable improvements in quality and cost for its clients. I have been writing about this model – which effectively incorporates the best health care lessons from the past 25 years and places them at the front end of the care delivery system, where they can get the most traction – for several years, and have become convinced that it is both the basis of a fully-realized medical home and will drive a great deal of positive change in the system.


Originally Published in the December Issue of Medical Home News.

The recent explosion of interest in onsite clinics – not just by employers, but by health plans, hospital systems, public health programs, and others – is anything but just another health care fad. At once, clinics’ growing popularity signals purchasers’ weariness with an intransigent, self-interested health system, as well as their guarded optimism about a better way.

Today’s best clinics are single-mindedly focused on what works best for the patient and purchaser within a competitive health care marketplace. They are a return to the hard-learned care management lessons of the last several decades. They look like what experienced health care professionals would develop if they could start fresh, without the perverse incentives that drive so much of health care today. But by leveraging new tools, programs and incentives, they also create a uniquely powerful, contemporary design for managing care and cost.

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Value Trumps Price in Onsite Clinics


Onsite health clinics are new territory for most employers. It can be difficult to sort through the different approaches used by different vendors. Worse, in difficult economic times it’s tempting to “get in” as cheaply as possible.

But like many purchases, you may get what you pay for with clinics, especially if you scrimp. Here are three reasons to favor value over price when considering an onsite clinic vendor:


  • An investment. Most employers believe their health plan expenditures are high enough already. For them, a clinic represents an additional expense, and only makes sense if it can provide a return on investment that lowers overall group health and occupational health costs. Ask vendors for data and testimonials that their clinics save money and improve the quality of care.
  • Many impacts. Properly configured, clinics do far more than reduce costs for office visits, drugs and lab tests. They can positively impact the chronic diseases that consume two-thirds of a health plan’s costs. They can influence specialty and inpatient care, which the Dartmouth Atlas shows have the highest concentrations of waste. And they can affect the five major areas of occupational health — workers’ compensation primary care, disability management, human resources testing (pre-employment screens, drug screens, Department of Transportation exams), retention/recruitment and lost work time — that, together, cost two to three times as much as a group health premium.
  • Total effectiveness results from a clinic’s component medical management mechanisms. Optimizing quality and cost within the complexity of health care requires assembling an array of tools and programs, each targeted to a specific health care problem. Each approach has dedicated costs, but most also produce savings that outweigh their expenses.

For example, incentives such as free office visits, laboratory tests and free standard drugs, mostly low-cost generics, induce employees to use the clinic and help the primary care staff gain more control over the care process. Physicians cost more than nurse practitioners, but are more likely to create a fully realized medical home and have a better chance of influencing downstream care.

Clinical analysis and decision support tools help identify patients with health risks or gaps in care that deserve attention. Onsite, face-to-face disease management programs have a far better chance of influencing chronic disease costs than call center programs.

Modern clinics are a powerful innovation in an employer’s benefits arsenal. But they must be robust to be effective, integrating a variety of proven mechanisms. With those properly in place, the results can be quantifiable improvements in health care quality, cost and employee morale.

In other words, a clinic’s cost may be important. But the value — the benefit you receive for the cost — should be the reason you implement a clinic. It will certainly be how you’ll judge your investment.