Leveraging an Employer
Clinic to Improve
Health Benefit Value
Problem
Cost & Lack of Control
A global manufacturer and supplier faced an unsustainable
health care cost trend of 18%. Although some of the trend was due to catastrophic
cases, the company’s core inflation was driven by provider pricing and utilization
of health services.
Providers in the local health care market have consolidated and now two vertically
integrated health systems provide care to the company’s employees and health
plan members.
Management needed to take action but did not want to move manufacturing or cost-shift
to its employees because its local work force is very reliable, skilled and productive.
Further, the company reported that its employees had regular complaints about access
and service at the local providers. The service issues focused on making/waiting
for appointments, care instructions and sometimes being referred to the emergency
room and urgent care facilities for service.
Approach
Supply Chain Management
- Available Levers – Conduent Care and Quality Solutions gave the
employer a simple synopsis of the levers available to control costs without materially
impacting their employees’ pocketbook. In this case, Conduent Care and Quality
Solutions focused on their contracted in-network fees and the
coordination of care between provider & patient which ultimately
impacts utilization of healthcare services.
- In House Clinic – The employer was very interested in pursuing
an in-house clinic option to alleviate some of the access issues. However, an in-house
clinic by itself did not seem feasible because most of the employers’ healthcare
dollars were clearly not being spent in a primary care clinic setting (nor would
they be even if they were above preventative benchmark levels). Rather, most of
their benefit plan expenditures occurred in hospitals on inpatient stays and outpatient
surgeries.
Action
Listen to The Data
Conduent Care and Quality Solutions aligned the plan, providers and patients by taking
the following actions on behalf of the customer:
- Bid out and contracted an integrated employer health clinic and narrow network.
- The contract is direct between the employer and a major provider health system and
reduced the fees by 8% across all services that the system delivers – whether
services occur at the employer’s in-house clinic or in the provider’s
hospital!
- Helped customer modify its benefit plan and structure employee and provider incentives
- without shifting costs to employees.
- Integrated clinic referral, Disability and Coordinated Care
services.
- Used Conduent Care and Quality Solutions’ HP Tools©
to establish a “scorecard” that is benchmarked and updated monthly.
- Established “business plan rules” and created electronic directory and
contracts with the third party administrator by utilizing Conduent Care and Quality Solutions’
Network Management System.
Result
Sustainable Cost Reduction
- Employer met their need to improve health benefit plan results and improve access
to care.
- Partner provider pricing resulted $325,000 in immediate savings, or 3% of employer’s
benefit plan payments.
- Employer made back investment in first 9 months.
- Partner provider has gained market share over competitor.
- High Employee clinic satisfaction.