A Better Way To Manage Care and Cost

Brian Klepper

http://boards.medscape.com/forums?128@864.cQ5Savfkkqo@.2a59c1b3!comment=1 

Posted 10/10/12 on Medscape Connect’s Care & Cost Blog

When an employer sits down with his health care partners – broker, health plan, physician, hospital, drug and device firm, health IT firm – everyone but him wants health care to cost more, and each is typically in a position to make that happen.

Lynn Jennings, CEO, WeCare TLC 

ALP_H_BK_0010A new class of health care management organization is emerging that thrives by taking advantage of health care’s rampant and institutionalized waste. These firms mine the market dysfunction that has developed over decades, which will almost certainly yield enough fuel to drive a new way to manage care and cost.

The founders of these organizations have deep health care experience, and they understand the mechanisms of excess. More important, the ones I’ve met are mission-driven, with a deep sense of outrage that health care’s exploitation has become so pervasive and overt. So their businesses are purposeful.

Continue reading “A Better Way To Manage Care and Cost”

Care & Cost Merges Into The Doctor Weighs In

Brian Klepper

When I began Care & Cost in December of 2010, the idea was to aggregate consistently good health care writing, and to moderate the comments to ensure a courteously professional exchange on the site.

It has been a pleasure and even an honor to scour health care blogs of all types early each weekday morning. Wonderfully dedicated and thoughtful colleagues – Merrill Goozner, Kenny Lin, David Harlow, Wendy Lynch, Brad Flansbaum, Bill Bestermann, Jane Sarasohn-Kahn, Paul Levy, Jaan Sidorov, Tom Emerick, Bob Laszewski, Roger Collier, and many more – graciously allowed me to republish their work. The result, I think, has been a cornucopia of high quality insight and knowledge.

Being dedicated to the exercise let me build a faithful readership that included professionals of all political and philosophical persuasions, who vigorously disagreed at times, but always with respect.

Even so, my own schedule has intensified, and maintaining C&C has become more difficult day-to-day. I’m very involved in the development of WeCare TLC, a leading edge onsite clinic and medical management firm. I’ve helped to spearhead the campaign against the current structure of the AMA’s Relative Value Scale Update (RUC) and that organization’s corrosive relationship with CMS. I’m continuing to write, now as a Medscape columnist on Business of Medicine and Primary Care, as well as for other venues. And I’m devoted to the struggle to deal with my wonderful wife Elaine’s peritoneal (ovarian) cancer.

I’ve chosen to fold into The Doctor Weighs In (TDWI) for several reasons. Perhaps most important, it reflects approximately the same sensibility – and possibly a more expansive one – on the kinds of content that a good professional health care magazine should be running. TDWI’s founders and editors are my very close friends Pat Salber, MD MBA and Dov Michaeli, MD PhD, both writers and thinkers whose work I hugely admire. Over the past several months, we’ve often posted the same columns.

So I urge you to head over there and sign up for their morning email. I am deeply grateful and humbled that you chose to spend time with me trying to better understand the many complexities that have made American health care so interesting and vexing.

Thank you for coming. Let’s continue this conversation over at TDWI.

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.