Discussion of the Cost+ Onsite Health Clinic Business Model This brief was prepared to share knowledge and answer questions about the feasibility of a CHI-built rendition of an on-site health clinic by outlining the business, clinical, and member experience models. Business Model The recent resurgence of workplace clinics has differed markedly from the first iteration of clinics. The focus has shifted largely to health promotion, wellness and an array of primary care services, rather than occupational health or convenience care. Indeed, the increased interest in onsite clinics is linked to greater demand for workplace wellness programs. Employees benefit from better access to acute and preventative care while employers save on health care …show more content…
For a dedicated on-site clinic, an employer typically needs to have 500+ eligible members. However, most workers in the U.S. work for smaller employers. Fortunately there is an option of a shared model known as a near-site clinic. These clinics are located off an employer’s property in an area populous enough to garner enough employer or public utilization to sustain a clinic. For near-site clinics, once a 500+ member “anchor’ is in place, employers of any size may be added (capacity increased correspondingly through additional staff), enabling small businesses and even individual members to …show more content…
The employer is all but guaranteed to save money because if the target isn’t met, the vendor will reduce their membership fee until the agreed target is met (up to the total membership fee). Payment Model The employer pays a "per employee/per month" management fee that may or may not include actual costs for staffing, generic prescription drugs, lab tests and replacement supplies depending on the model. The employees do not pay for the services or prescriptions dispensed from the clinic, nor are there additional co-pays or co-insurance fees. The benefits of the clinic the employee receives are in addition to the health plans offered. By utilizing the clinic whenever possible, employees will less frequently visit their PCP and outside treatment sources, therefore reducing the health care spend of the employer. Clinic Access The employer designates those eligible to use the clinic. In most instances, employees and their eligible dependents may use the clinic. However, since the clinic is separate from the employer's medical benefit plan and not subject to insurance guidelines, the employer may choose to allow others to also utilize the clinic, for example: part time employees, retirees,
This group is more focused on satisfaction, access and quality of care. Providers, or practitioners, are also key stakeholders within an organization. The term provider can encompasses not only physicians and surgeons, but also nurses, physical and occupational therapists, technicians, and other members of a clinical staff. Providers fall into two categories, primary, which includes hospitals and health departments and secondary, which includes educational institutions and pharmaceutical companies. Providers are focused on the best treatments for patients and are involved in delivering health services and products. The final element of the MCQ model is the employer who by far is the largest paying and purchasing stakeholder of an organization. The employers focus is primarily on their return on investment within an organization. Cost and quality is a focus for employers when choosing health benefits but are mindful that access is just as important. Within the Patient Healthcare model, MCQ explains the interactions between the four elements of employer, patient, provider and payer while the Iron Triangle focuses on the factors of cost, quality, and access. The Patient Healthcare model charges healthcare leaders with the task of balancing satisfaction with the stakeholder (employer, patient, provider, and payer) in relation to cost, quality and access. This may be very difficult since stakeholders may have competing priorities. Changes and variations made in how healthcare organizations operate may have profound effects on how stakeholders perceive the quality, access and cost. For instance, a patient may consider cost to be a top priority when seeking healthcare and at the same time the healthcare organization may consider raising costs and therefore devaluing access and quality. Patients who begin to incur high out-of-pocket costs may begin to perceive a financial
The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...
A simple comparison to the US system is difficult considering the multitude of insurance plans with variable premiums and the wide array of coverage depending on company size and other factors. Different from the French system, American employers do not buy insurance based on a percentage system and the money does not flow into a few National Health insurance funds, rather...
The Crowded Clinic Case Study (Colorado State University - Global, n.d.) discusses the issues of practice management as they apply to access to care. Access to care may be as inconvenient as lengthy patient wait times to issues far more serious that may have a profound effect on the health and well-being of a single patient or an entire cohort.
Access to healthcare provides financial stability by assuring people that they will not be financially destroyed by injury or illness. Additionally, when people can afford regular medical care they tend to avoid chronic problems and financial stress. In a study provided by the American Medical Students Association, researchers reviewed the costs and benefits of universal health care. They came to the conclusion, after reviewing other articles and statistics from multiple sources, that, “The annual cost of diminished health and shorter life spans of Americans without insurance is $65-$130 billion.” (Chua 5) This comes from people not having adequate health care and then losing their jobs because they...
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The cost and administrative burden of providing health care benefits to employees has grown rapidly in the last several years, and organizations have opted to cheaper means of doing this by resorting to CDHPs programs that are little bit cheaper when using deductible health insurance plans. This has led to the hope of healthier generation in the near future as the cost of health services would be manageable (Buntin, Damberg, Haviland & Kapur, 2006).
The steady rise of healthcare costs and the ever increasing cost of health insurance premiums are making it harder and harder for employers to pay healthcare premiums for their employees. In the past, it was almost a given that employers picked up the tab for health insurance coverage. The health coverage was usually exceptional with little or no money paid out of pocket by the individual for the insurance premiums. Those appear to be the “good old days”, with fewer and fewer employers shelling out money for health insurance premiums and demanding a larger percentage to be paid by the employee. Other employers are simply unable to financially provide healthcare coverage for their employees and have stopped all together.
Paul Fronstin, EBRI (2001). Workers and Access to Health Care: Consequences of Bing Uninsured. Retrieved February 27, 2012, from http://www.ebri.org/pdf/publications/Books/economic_cost_of_uninsured.pdf
Offering employee benefits is one way a company must competes in today’s marketplace to retain old employees and attracts new ones. These benefit packages may range from offering basic health insurance to additional discretionary and perk benefits such as vacation and retirement packages. Benefit packages are often a large portion of employee costs and Federal mandates require an employer to carry and offer certain benefits even if they offer nothing else. Federally required employee benefits make up approximately a quarter of the costs associated with employer offered benefit packages. Some of these mandated benefits include Social Security, Worker’s Compensation Insurance, and the Family Medical Leave Act.
The main advantage of the Affordable Care Act is that it lowers health care costs overall by making insurance affordable for more people. First, it wi...
Many employers have been baffled as they attempt to sort through the overlapping obligations created when a sick or injured worker's medical condition triggers the different rights and responsibilities under new federal laws. If businesses want to avoid costly lawsuits from disgruntled employees it is essential to understand their responsibilities under the laws. Employers must make a tw...
In order for primary care practices to be successful they have to arrange their office setting and scheduling to satisfy their consumers’ needs. Bodenheimer (2003) advocates for improving primary care accessibility by arranging their offices into teams. He explains each team would have “one primary care physician, two non-physicians clinicians (nurse practitioners or physician assistants), three nursing staff, and a receptionist” (p.797). He states patients will be greeted by their team who knows their h...
Benefits tend to give employees a sense of security. Health insurance is one of the major benefits that encourages employees to stay with an organization even in difficult situations. With health insurance companies attract and retain qualified employees. According to Optima Health (“Starting in 2015, employers with 50 or more full-time equivalent employees are required to offer affordable, minimum-value group health insurance. If they don’t, they may be assessed government penalties.” n.d.). There are other helpful health insurance benefits such as deducting 100 percent of their employees ' health insurance cost as a business expense. If the organization is incorporated the owner’s insurance cost is also deductible. But if it’s a small business with less than 25 employees, they may be able to receive a tax credit if they’re with a small group insurance. If there’s 50 or more employees the business is eligible for a larger group health insurance which offers lower rates. Also with employee health insurance employees have a bigger chance of being able to pay medical expenses. In addition to valuable benefit retirement saving plans are essential part of your future financial security. All employees are encouraged to save for retirement. Tax advantages are also accessible to business owners that offer retirement plans. All
Additional positive externalities include health affects wealth, technology, and vaccinations. “Healthy workers are absent from work less and are more productive workers. A health care market that effectively