Improving America’s health, one patient at a time. Introducing Concentra TotalCare and Urgent...
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Improving America’s health, one patient at a time. Introducing Concentra TotalCare and Urgent Care: Solutions for Improving Health Care Accessibility and Affordability in New Hampshire Presented by: Joe Castorina, M.D., MPH Regional Medical Director Tony Silva, Regional Sales Manager
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Transcript of Improving America’s health, one patient at a time. Introducing Concentra TotalCare and Urgent...
Improving America’s health, one patient at a time.
Introducing Concentra TotalCare and Urgent Care:
Solutions for Improving Health Care Accessibility and Affordability inNew Hampshire
Presented by:
Joe Castorina, M.D., MPH
Regional Medical Director
Tony Silva,
Regional Sales Manager
Improving America’s health, one patient at a time.
Improving America’s health, one patient at a time.
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What we’ll discuss today…
Current health care environment in New Hampshire.
Understanding the current health trends throughout the country
Changing Behavior through a Worksite Health Improvement Program
How Urgent Care expands accessibility and affordability of care
How your employees can benefit from Concentra Urgent Care
Next steps.
Improving America’s health, one patient at a time.
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New Hampshire ranks well in several measures of personal health:
#2 in overall child health status
#7 in rate of personal exercise
#42 in rate of overweight/obese persons
#45 in rate of hospital admissions
#45 in rate of occupational fatalities
#47 in rate of motor vehicle deaths
Source: Kaiser Family Foundation, statehealthfacts.org, 2008.
The State of Personal Health in New Hampshire
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Perhaps one reason for better overall health in New Hampshire is a younger population than the national and New England averages.
Source: State Master, 2009.
Improving America’s health, one patient at a time.
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Illicit drug use #3
Cancer incidence #15
Cigarette smoking #18
High cholesterol #23
Source: Kaiser Family Foundation, statehealthfacts.org, 2008.
And even though overall health measures look good, there is still room for improvement—especially in regards to national ranking on:
Improving America’s health, one patient at a time.
7Source: Kaiser Family Foundation, statehealthfacts.org, 2008.
Achieving and maintaining good personal health is important in controlling future health care costs, because New Hampshire leads the nation in employer-paid health insurance coverage.
Improving America’s health, one patient at a time.
8Source: Kaiser Family Foundation, statehealthfacts.org, 2008.
New Hampshire employers pay more on average for health care than the national average.
Improving America’s health, one patient at a time.
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
1960 1970 1980 1990 2000 2003
Bil
lio
ns
of
Do
llar
s
Source: Centers for Medicare & Medicaid Services
Spending expected to increase from $2.3 trillion in 2007 to $4 trillion in 2015. Source: National Coalition on Health Care
Understanding the Current Health Trend
Rising U.S. Healthcare Costs
Improving America’s health, one patient at a time.
Medical innovation
Pharmaceuticals - Specialty/Biotech
New technology and specialized testingReimbursement and coverage
Increasing numbers of uninsured or under-insured
Cutbacks in Medicare/Medicaid reimbursementSystem issues
Inefficiencies and fragmented care
Medical errors and qualityPractice challenges
Defensive medical practice
Preventive care not valued
Understanding the Current Health Trend
What is Driving the Increase in Healthcare Costs
Improving America’s health, one patient at a time.
Aging population
Aging workforce
Lifestyle factors
Diet
Physical inactivity
Understanding the Current Health Trend
Other Drivers of Increased Costs?
Improving America’s health, one patient at a time.
Increases in health insurance premiums have ranged from 6% to 13% since 2000
Source: Kaiser Family foundation
Chronic illness (heart disease, diabetes, and obesity) account for 75% of health care costs.
Source: APHA
Source: Kaiser Family Foundation Employer Health Benefits Annual Survey (2007)
Total Inflation
0%
20%
40%
60%
80%
100%
120%
Cumulative Inflation Impact 2000 to 2007
114.11%
24.3%29.0%
Health Insurance Premiums
Overall Inflation Workers Earnings
Source: Kaiser Family Foundation Employer Health Benefits Annual Survey (2007)
Total Inflation
0%
20%
40%
60%
80%
100%
120%
Cumulative Inflation Impact 2000 to 2007
114.11%
24.3%29.0%
Health Insurance Premiums
Overall Inflation Workers Earnings
Understanding the Current Health Trend
Increasing Health Insurance Premiums
Improving America’s health, one patient at a time.
Healthy People 2010 Targets vs. Current
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PapScreeningLast 3 Yrs(age 18+)
ColorectalScreening(age 50+)
MammogramPreceeding 2
Yrs
DiabeticHbA1c
Screening(annual)
Diabetic EyeExam
(annual)
BloodPressure TestPreceeding 2
Yrs
CholesterolTesting
Preceeding 5Yrs
Year 2000 Healthy People 2010 TargetSource: CDC
Understanding the Current Health Trend
Healthcare System Fails to Deliver Recommended Preventive Services
Improving America’s health, one patient at a time.
And, the problem is going to get worse without coordinated and effective action …
Understanding the Current Health Trend
Worsening Health Status of Population
Improving America’s health, one patient at a time.
Over the past 20 years…
Calories rose 22% from 3200 to 3900 per day
Snacks as portion of daily calories increased >50%
Proportion of food eaten away from home doubled
Food processing has replaced complex grains with refined carbohydrates and simple sugars
Portion sizes grown by 25 – 50%
Understanding the Current Health Trend
Changes in Dietary Practices
Improving America’s health, one patient at a time.
15 states reported obesity rates from 10% to 14%; none greater
than 14%
28 states reported obesity rates from 25% to 29%, and
three states > 30%
Understanding the Current Health Trend
The Growing Problem of Obesity
Improving America’s health, one patient at a time.
5
10
15
20
25
30
35
18-24 25-34 35-44 45-54 55-64 65+
Years
Pe
rce
nt
1998 2006
Source: CDC, BRFSS
Understanding the Current Health Trend
Obesity Epidemic Affects All Age Groups in U.S.
Improving America’s health, one patient at a time.
Understanding the Current Health Trend
It is Only Going to Get Worse
Improving America’s health, one patient at a time.
↑ 3 fold in 25 years
Source: CDC Nat’l Health Interview Survey and ADA 2007
Understanding the Current Health Trend
New Cases of Diabetes Among U.S. Adults- Age 18-79 Years
Improving America’s health, one patient at a time.
1994 2005
Diabetes prevalence rose from 3% in 1984 to 7% in 2004 among US Adults. Source: NDSS, CDC, NHIS and ADA 2007
Understanding the Current Health Trend
Proportion of Adults with Diagnosed Diabetes by State
Improving America’s health, one patient at a time.
Type II Diabetes
Stroke
Cardiovascular Disease
High Blood Pressure
High Cholesterol
Pulmonary Disease
Sleep Apnea
Respiratory Problems
Cancers
Acid Reflux Disease
Sources: Weight Awareness and the Centers for Disease Control and Prevention
Psychological/Social Effects
Gallbladder Disease
Bladder Control Problems
Uric Acid Kidney Stones
Gout and osteoarthritis
Reproductive Issues
Women – pregnancy complications, irregular menstrual cycles
Men - infertility
Musculoskeletal problems
Understanding the Current Health Trend
Obesity-related Illness and Disease
Improving America’s health, one patient at a time.
Associated with:
39 million lost work days
239 million restricted days
90 million bed days
63 million physician visits1
Major contributing factor in workers’ comp injuries
Accounts for >9% of the total costs of work absenteeism2
Costs U.S. companies $13 billion/year:
$8 billion attributable to health care
$5 billion attributable to sick leave, life insurance, disability insurance, absenteeism, and presenteeism3
Source: 1Obesity Research 1998 , 2JOEM 2007, 3NBGH 2006
Understanding the Current Health Trend
Obesity Impacts Health and Productivity Costs
Improving America’s health, one patient at a time.
Understand the Production of Disease: Identify health risks and prevent disease and complications
Identify Employees At Risk: Determine those with risks of becoming ill or contracting a disease
Intervene to Promote Healthy Behaviors: Assist employees to lower risk and improve outcomes
Effectively Engage Employees: Communicate health as a priority, build awareness and reinforce health
Health Promotion and Communication
Health Risk and Biometric Screening
Health Education, Coaching and Monitoring
Policies, Benefits, and Incentives
Changing Behavior through a Worksite Health Improvement Program
Worksite Solutions that Work
Improving America’s health, one patient at a time.
1) ImplementationProgram Design and Logistics
Communications Plan
Incentive Coordination
2) Know Your NumbersHealth Risk Assessments (electronic/paper)
Personal Wellness Profile
Biometric Testing
3) Education and CoachingEmployee Health Portal (web tools)
Health Coaching (Onsite/Telephonic)
Education and Coaching (Onsite/Web-based)
4) Manage and MeasureEmployer Web Portal/Reporting
Measurements
Executive Consultation Meetings
Changing Behavior through a Worksite Health Improvement Program
TotalCare’s Program Design Elements
Improving America’s health, one patient at a time.
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Average Family Coverage Premium per Enrolled Employee For Employer-Based Health Insurance, 2006
NH% NH$ US% US$
Employee Contribution 26% $3,298 25% $2,845
Employer Contribution 74% $9,388 75% $8,536
Total 100% $12,686 100% $11,381
The higher costs of health care in New Hampshire are borne by employers and employees with health insurance. New Hampshire health insurance premiums are the highest in the country.
Source: Kaiser Family Foundation, statehealthfacts.org, 2008, Public Policy Institute of New York State: http://www.ppinys.org/reports/jtf/healthinsurance.html
Improving America’s health, one patient at a time.
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One reason for higher costs is that New Hampshire ranks #12 in hospital emergency room utilization—indicating unmet consumer needs for accessibility and convenience.
Source: Kaiser Family Foundation, statehealthfacts.org, 2008.
Improving America’s health, one patient at a time.
Up to 75% of hospital emergency room cases could be treated in a lower acuity setting like Urgent Care—for far less money.
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Routine Illness:
Seasonal Allergies
Ear Infections
Sinus Infections
Colds/Flu
Rash
Urinary Tract Infection
Health Screenings
X-Ray Services
Minor Injuries:
Sprains/Strains
Cuts/Scrapes
Fractures
Back Injuries
Simple Lab Tests
Vaccinations
Urgent Care Services
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Care Option Co-Pay Retail Price Availability Visit Length
Doctor’s Office $20 $75 to $125 Days or weeks until an open appointment.
60 minutes
Urgent Care $30 $85 to $179 Walk-in service; no appointment necessary.
60 minutes
Emergency Room
$100 $350 to $800+ 24 Hours, 7 Days 3 hours or longer
Urgent care charges are comparable to that of a doctor’s office—with greater accessibility—and up to 80% less than emergency rooms.
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Urgent Care Benefits to Employees and Employers
Benefits to Employees:
Available when patients cannot get into primary care
Immediate medical attention for non-emergent conditions
Capabilities beyond a typical primary care office, including x-ray and procedures such as suturing
No appointment ever necessary—just walk in
Shorter wait times
Lower out-of-pocket costs
One consolidated bill
Benefits to Employers:
Reduced absenteeism from illness or caring for sick family members
Increased productivity from early diagnosis and treatment
Decreased utilization of hospital emergency rooms
Greater control over group health costs
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For patients with in-network insurance, Concentra will collect the co-pay and any patient financial responsibility at time of service, and
submit the claim directly to the carrier on the patient’s behalf.
Insurance Plans Accepted:
Aetna Integrated Health PlanBCBS NH InterPlanBeechStreet NPPNCigna PHCS/MultiPlanCofinity ppoNextEvolutions Preferred Network AccessFirst Health Prime Health NetworkFortified Provider Network Three Rivers Provider NetworkGalaxy TriCare HealthNetGreat West UniCareHarvard Pilgrim Health Plan United/PacificareHealth Management Network USA Managed Care Organization Humana
Improving America’s health, one patient at a time.
Posted Pricing for Self-pay Patients
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Improving America’s health, one patient at a time.
Concentra Concentive$
A solution for uninsured, out-of-network and part-time/seasonal employees, uncovered dependents, and for employees in the 90-day
new employee benefits waiting period.
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Improving America’s health, one patient at a time.
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Next Steps
Concentra’s management team, Tony Silva, is available for appointments to review strategies and options for your clients.
Concentra will help develop a communication plan to educate employees as to the availability and benefits of urgent care.
Concentra will provide collateral including maps, posters, flyers, and Concentive$ to support the communication plan.
