Bill,
I'll try to answer the questions you raised:
Nurse Practitioners are used to staff onsite clinics and each NP is supervised by a physician. Yes, hours are pre-set and each location has a predetermined schedule that employees can count on. The hours are determined by the number of employees (or program participants, as spouse's sometimes also utilize the clinics). Our current fee for service system has to many built-in incentivs for overutilization. In order to control costs, one must move away from the mentality of getting more $ for more service. Contracting for a set, hourly rate eliminates $$ from the equation and allows practitioners to focus on medical delivery and quality, not how many patients they "produced" in a given hour. (this is key). The wellness program headquarters is responsible for monitoring that NP's are following the prescribed course of action, as well as making sure that program participants are COMPLIANT. What does that mean? = that each is doing whatever they need to be doing to keep their chronic conditions in check.
Onsite is important. We have found that CONVENIENT access is another key factor to success. Many employees don't seek help PRECISELY because it's very inconvenient to take 3-4 hours off for what's considered a "minor problem that might soon go away". The companies that are more likely to be able to take advantage of this have 250 employees or more per location (4-8 hours of clinic per week). There are other options to smaller groups, but a bit lengthy to go into here.
Another important motivator to program participation is that employees can access primary health care, get presecriptions filled, all at zero cost to them. Remember that traditional Managed Care organizations have been preaching LIMITING services as a way of saving money. Our belief is completely the opposite: making quality primary care available to those with chronic conditions is many-many times cheaper than waiting for them to hit an Emergency Room. There are multiple "tricks" to get the whole thing to work. Some of the elements are:
1) The program needs to be incorporated into the benefits structure of the company
2) Very specific protocols need to be outlined for the practitioners
3) Employees need to be strictly monitored for compliance - incentivized or disincentived to do so.
4) Clear reporting mechanisms need to be in place to keep management informed (HIPAA compliant, of course)
The problem with your ideas of getting free things here and there is that YES, one would think they make sense - but the bottom line is that few will use them and there is no control over it (standardization). Only by impacting a suffiently large segment of the chronic risk group will there be hope to make a sigificant impact on rising healthcare costs - just helping a few individuals here and there isn't enough.
RR
I'll try to answer the questions you raised:
Nurse Practitioners are used to staff onsite clinics and each NP is supervised by a physician. Yes, hours are pre-set and each location has a predetermined schedule that employees can count on. The hours are determined by the number of employees (or program participants, as spouse's sometimes also utilize the clinics). Our current fee for service system has to many built-in incentivs for overutilization. In order to control costs, one must move away from the mentality of getting more $ for more service. Contracting for a set, hourly rate eliminates $$ from the equation and allows practitioners to focus on medical delivery and quality, not how many patients they "produced" in a given hour. (this is key). The wellness program headquarters is responsible for monitoring that NP's are following the prescribed course of action, as well as making sure that program participants are COMPLIANT. What does that mean? = that each is doing whatever they need to be doing to keep their chronic conditions in check.
Onsite is important. We have found that CONVENIENT access is another key factor to success. Many employees don't seek help PRECISELY because it's very inconvenient to take 3-4 hours off for what's considered a "minor problem that might soon go away". The companies that are more likely to be able to take advantage of this have 250 employees or more per location (4-8 hours of clinic per week). There are other options to smaller groups, but a bit lengthy to go into here.
Another important motivator to program participation is that employees can access primary health care, get presecriptions filled, all at zero cost to them. Remember that traditional Managed Care organizations have been preaching LIMITING services as a way of saving money. Our belief is completely the opposite: making quality primary care available to those with chronic conditions is many-many times cheaper than waiting for them to hit an Emergency Room. There are multiple "tricks" to get the whole thing to work. Some of the elements are:
1) The program needs to be incorporated into the benefits structure of the company
2) Very specific protocols need to be outlined for the practitioners
3) Employees need to be strictly monitored for compliance - incentivized or disincentived to do so.
4) Clear reporting mechanisms need to be in place to keep management informed (HIPAA compliant, of course)
The problem with your ideas of getting free things here and there is that YES, one would think they make sense - but the bottom line is that few will use them and there is no control over it (standardization). Only by impacting a suffiently large segment of the chronic risk group will there be hope to make a sigificant impact on rising healthcare costs - just helping a few individuals here and there isn't enough.
RR