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12/2/19
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The Potential and Value of Worksite Clinics
Tuesday, December 3, 2019Valencia College – East Campus, Orlando, Florida
Thank you to our sponsors:
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Thank you to our host:
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Thank you to our sponsors:
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Please silence your cell phone
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Larry BoressExecutive Director
National Association of Worksite Health Centers
Copyright (c) NAWHC 2019 5
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} The nation’s only non-profit association supporting employer and union sponsors of onsite, near-site, mobile health, pharmacy, fitness and wellness centers
} Assisting employers in developing and expanding the capabilities of onsite centers into primary care and wellness centers
} Offering educational programs, networking, benchmarking, purchasing support, vendor information and advocacy for the worksite health center employer and vendor communities
} Website offers information and resource materials on worksite health and fitness centers, on-site pharmacies and wellness centers
} NAWHC LinkedIn Group for timely updates on topics related to worksite clinics
Copyright (c) NAWHC 2019 6
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} Treatment of Injuries◦ First aid◦ Acute/urgent care
} Occupational health◦ OSHA exams, drug testing ◦ Physicals/RTW◦ Travel medicine◦ Disability mgmt
} Identification of risks◦ Health risk assessment/screenings
} Prevention of illness◦ Immunizations
} Health and Benefits Education◦ “Lunch and Learn”/health fairs◦ Online health portal
} Chronic Disease Mgmt ◦ Health/disease mgmt coaching◦ Case mgmt
} Worksite Wellness Programs◦ Weight management/coaching◦ Fitness programs/challenges◦ Incentive-based activities◦ Smoking/tobacco cessation◦ EAP/lifestyle coaching/stress mgmt
} Primary care/care coordination◦ Health advocacy◦ Telehealth
} Ancillary Services� Pharmacy services� Lab/x-ray services� Physical therapy� Vision services� Dental services� Chiropractic services� Massage therapy� Acupuncture 7
Copyright (c) NAWHC 2019
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} Patients see physicians 1-2 times a year for 7-12 minutes, but are at work 1000-2000 hours a year, offering an employer great opportunities to educate, train, motivate and inform people about their health and role as consumer
} Employer clinics offer daily, easy access to medical care for employees and dependents, for little or no out of pocket cost
} A focus on evidenced-based, necessary care can lead to lower employer costs, higher quality care, a population health approach and higher productivity
} Holistic care can be provided without incentives or demands on providers for volume and to generate revenue
Copyright (c) NAWHC 2019
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Copyright (c) NAWHC 2019 9
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Occupational Health
Acute Episodic Care
Primary Care
Patient Centered Medical Home
Non-Occupational Care and Emergency First Aid
Wellness—HRA, screening, lifestyle coaching
$ Savings Opportunity $$$
Copyright (c) NAWHC 2019 10
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
71%
75%
76%
84%
89%
Reduce member health risk
Increase employee productivity
Reducing absenteeism/presenteeism
Better manage overall health spend
Chronic condition management
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2
3
4
5
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} NAWHC-Mercer studies estimate around 25-30% of all companies and 40-45% of large firms offer some form of onsite, near-site or mobile health services to employees, dependents, retirees and others
12MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
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CONSIDERING FOR 2016 OR 2016
31%
37%
26%
0%
5%
10%
15%
20%
25%
30%
35%
40%
All employers Employers with fewer than5,000 employees
Employers with 5,000+employees
MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS13
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
CONSIDERING FOR 2016 OR 2016
45%
24% 23%
18%
12%8%
11%
42%
33%
17%15%
11%7% 6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Health care Government Manufacturing Financialservices
Services Wholesale/Retail
Transport/Comm/ U tility
Occupational healthservices
General medicalservices
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7%
5%
14%
28%
47%
MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
Managed in-house
Third-party management company
Hospital system
Provider group
Other
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} Onsite clinic vendors will usually charge employers:◦ PMPM ◦ Hourly ◦ Cost-Plus◦ Cost-sharing agreement
} Near-site or multi-employer clinics often bill clients based on:◦ The number of hours the clinic is operational or the portion of the schedule set
aside for each employer’s workers◦ The number of employees that are seen from each participating employer by the
health professionals◦ A membership or subscription fee per employee
Copyright (c) NAWHC 2019 16
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
RETURN PERCENT OF RESPONDENTS
Less then 1.00 7%
1.00-1.49 11%
1.50-1.99 13%
2.00-2.49 8%
2.50-2.99 3%
3.00-3.99 3%
4.00 or more 3%
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
30%
31%
36%
53%
62%
66%
68%Physician
Nurse practitioner
Medical assistant
Nurse
Office manager
Physician’s assistant
Health coach
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
10%
11%
12%
18%
19%
24%
28%Physical therapist
Wellness coordinator
Massage therapist
Mental health professional
Registered Dietitian (RD) or nutritionist
Occupational Health RN
Pharmacist or pharmacy technician
22%
3%
6%
8%
8%
8%
9%Behavioral health worker
Acupuncturist
Other
Athletic trainer
Chiropractor
Exercise physiologist
Financial advisor
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
27%
47%
49%
54%
63%
67%Employees from other locations
Covered dependent children
Retirees
COBRA participants
Employees who waived medical coverage
Covered dependent adults
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
AVERAGE MEDIAN
Employees2017 51% 50%2016 48% 50%2015 46% 48%
Dependents2017 29% 22%2016 28% 24%2015 27% 20%
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MERCER – NAWHC 2018 NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
61%
35%
5%Successful
Neither successful nor unsuccessful
Unsuccessful
Financial success: reducing cost trend
Health and wellness success: improving the
health and wellness objectives
71%
24%
4%SuccessfulUnsuccessful
Neither
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} Coordinate care for patients} Improve visibility of programs and access to services} Track patient use of service and referrals} Collaborate care management } Provide improved support for patient self-management} Get cross referrals between contracted vendors} Make greater utilization onsite fitness centers } Provide easy access to all services} Collect and measure performance } Consolidate data from internal and external sources with
health center’s EMR
Copyright (c) NAWHC 2019 23
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$0
$3,000
$6,000
$9,000
$12,000
19-34 35-44 45-54 55-64 65-74 75+
$1,776 $2,193 $2,740
$3,734 $4,613
$5,756
$1,414$2,944
$3,800$5,212
$6,636$8,110
$2,565 $3,353
$4,620
$6,625 $7,989 $8,927 $5,114 $5,710
$7,991
$10,785 $11,909 $11,965
Employers should adopt a population health strategy for theirworksite programs and clinicsCosts increase as people age and increase risk
AnnualMedical
Costs
Med
Ris
k
Age Range
Hig
h
Non
-Par
ticip
ant
*Edington. AJHP. 15(5):341-349, 2001
Low
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A patient-centered medical home is a team-based care delivery model with a primary care emphasis. It focuses on
better access and better care coordination to improve quality, effectiveness, adherence and, ultimately, health outcomes.
27%
3%
14%
52%
4%
n=80 Employers
Our clinic serves as a standalone PCMH
Not currently, but plan to evolve to a PCMH
No, and no plans
Our clinic serves as a primary care extension of a community-based
PCMH
Don’t know
Clinic Considered a Patient-Centered Medical Home (PCMH)
© Benf ield, a part of the Gallagher Human Resources & Compensation Consulting Practice. 2018 Worksite Health Clinic Report. All rights reserved.
Source:2018 NAWHC-Benfield Survey
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79%
77%
65%
65%
61%
61%
51%
47%
44%
42%
39%
30%
23%
16%
Importance of Factors in Selecting Clinic Provider Partners(among clinics with a third party clinic provider)
n=57 Employers
Ability to improve population health
Ability to hire high quality providersStrong integration of service with our existing
programs and/or health planData/reporting capabilities
Transparency of cost and performance
Flexibility/ability to customize offerings
Ability to integrate care with community providers
ROI measurement
Price of serviceAccountability, including risk-based payment
contractingCommunication capabilities and marketing
materials to boost utilizationRecommendations from peer companies
Third party organization’s size
Consultant recommendation
© Benf ield, a part of the Gallagher Human Resources & Compensation Consulting Practice. 2018 Worksite Health Clinic Report. All rights reserved.
Source:2018 NAWHC-Benfield Survey
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66%
45%
28%
21%
15%
15%
Communication Channels Established Between Worksite Clinic and Community-Based Healthcare Providers
n=80 Employers
Referral to community providers
Referral system to a clinic-defined network of high quality providers
Integration of electronic medical records
Periodic meetings
Other information sharing
No communication channels in place
© Benf ield, a part of the Gallagher Human Resources & Compensation Consulting Practice. 2018 Worksite Health Clinic Report. All rights reserved.
Source:2018 NAWHC-Benfield Survey
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56%
40%
4%
Integration of Clinic Data with Health Plan Data
n=80 Employers
Yes
No
Don’t know
© Benf ield, a part of the Gallagher Human Resources & Compensation Consulting Practice. 2018 Worksite Health Clinic Report. All rights reserved.
Source:2018 NAWHC-Benfield Survey
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1. What is the current health status of the covered population?2. What are the current health behaviors?3. What is being done in regards to preventive care and to reduce risks?4. What is the current utilization of the clinic and health benefits and programs?5. What are the demographics of the population?6. What are the current eating habits?7. What is the current alcohol/tobacco usage?8. What are the overall stress/anxiety levels?9. What is the current level of physical activity?10. What is the overall culture of health – employee and employer view towards health
and wellness?
Copyright (c) NAWHC 2019 30
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} Ensure clinic activities are integrated with all wellness programs } Collect data from external and internal sources} Require vendors to share and utilize population’s data} You need a great provider staff that cares } Promote confidentiality and privacy} Offer services for free or lower than outside services} Use a vendor with state of the art ROI tools} Set expectations of senior management} Ongoing communications, promotion and visibility is key to
increased and sustained use} Focus on prevention and close management of chronic illnesses
Copyright (c) NAWHC 2019 31
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} Larry Boress◦ lboress@nawhc.org◦www.nawhc.org
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Innovative and Unique Approaches to Onsite and Near-Site Health Centers
Ashley BacotRosen Hotels &
ResortsBill Dinger
The Walt Disney Company
Dave BlasewitzCity of Tampa
Linda KingPolk County
School Board
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Please visit with our sponsors! 34
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Potential and Value of Worksite Clinicsby Sherry McAllister, DCExecutive Vice President
Foundation for Chiropractic Progress
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Training of Today’s Doctors of Chiropractic
Doctors of Chiropractic (DCs)
DCs are primary contact health professionals for spinal health and well-being.
They receive extensive clinical training and specifically trained to evaluate, diagnose, treat and manage neuro-musculoskeletal disorders, particularly of
the spine, using non-drug, non-surgical approaches to care and rehabilitation.
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Training of Today’s Doctors of Chiropractic
Doctors of chiropractic go through rigorous training and education to receive a doctor of chiropractic degree. Their collegiate agenda is as follows:
•The majority graduate from a four-year college with a preferred focus on health sciences.
•Four years of chiropractic education.
•After graduating, pass written and oral board exams, at national and state levels.
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General DC Training
• Neuroanatomy• Spinal Anatomy• Gross Anatomy• Embryology• Biochemistry• Physiology• Chiropractic Philosophy• Endocrinology
• Organ Histology• Pathology• Immunology and Communicable
Diseases• Microbiology• Palpation• Physiotherapy I-Passive Care• Physiotherapy II-Active Care
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Chiropractic Sciences
• Public Health• Systems Pathology• Digestive Physiology and Nutrition• Physiology• Chiropractic Philosophy• Radiology• Toggle Recoil Technique• Thoraco Lumbar Technique• Neuromusculoskeletal Diagnosis• Toxicology
• Physiotherapy• Cervical Technique• Biomechanics• Intro to Clinical Practice• Obstetrics & Pediatrics• Pelvic Technique• Clinical Nutrition• Differential Diagnosis• Misalignment Analysis
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Clinical Sciences
• Chiropractic Practice Marketing• Clinical Methods• Emergency Procedures• Visceral Disorders & Laboratory
Interpretation• Clinical Psychology• Radiology• Technique Principles & Practice• Planning for Practice Success
• Extremity Adjusting• Financial Management Strategies• Legal Issues• Gender-Related Health• Chiropractic Philosophy• Practice Management Strategies• Geriatrics• Evidence-Based Chiropractic
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Conditions Commonly Treated by DCs
• Disc Herniation• Sciatica• Muscle Strain/Sprain• Nerve irritation• Tendonitis• Stress Related MT
• Fibromyalgia• Arthritis• Curvature of the Spine• Carpal Tunnel Syndrome• TMJ Syndrome• Headaches
Many DC’s go on after graduation to get diplomates in a variety of subjects from Sports, Radiology, Neurology and more.
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Benefits of Chiropractic
Scientific evidence and clinical experience indicates that chiropractic care offers the following benefits for many patients:
• Reduction of acute, subacute and chronic back and neck pain with improved function.
•Reduction of upper and lower extremity pain with improved function.
•Relief from certain forms of headache.
•Relief from pregnancy-related backache.
•Amelioration of many hip, gait and foot problems.
•Improvements in general flexibility, stability, balance and coordination.
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Supporting Research
In the U.S., back injuries are the most prevalent occupationalinjury. A study examined the early predictors of lumbar spinesurgery within three years among Washington State workers,with new workers’ compensation temporary total disability
claims for back injuries.
Approximately 42.7 percent of workers who first saw asurgeon had surgery, in contrast to only 1.5 percent of those
who saw a doctor of chiropractic. There was a very strongassociation between surgery and first provider seen for theinjury even after adjustment for other important variables.
Early Predictors Of Lumbar Spine Surgery After Occupational Back Injury: Results From A Prospective Study Of Workers In Washington State
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National Guidelines Overview Support
The Institute of Medicine (IOM), U.S. Food and Drug Administration (FDA) and The Joint Commission have noted the need of nonpharmacological
options, such as Spinal Manipulative Therapy (SMT) , as a first-line approach to manage pain
94% of spinal manipulations, also known as spinal adjustments, performed in the U.S. are executed by a doctor of chiropractic.
Shekelle, et al. (1992). Spinal Manipulation for Low-Back Pain. Annals of Internal Medicine, 117(7), 590. doi: 10.7326/0003-4819-117-7-590
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National Guidelines Overview Support
The Lancet published a three-part series on low back pain,which addresses the issues around low back pain and calls
for worldwide recognition of the disability associated with thedisorder and the removal of harmful practices. In the secondpaper, recommendations for the treatment of low back pain
are outlined, including spinal manipulation, which is mostoften performed by a doctor of chiropractic, and the scarcity
of research into prevention of low back pain.
The Lancet, Vol. 391, No. 10137. Published: March 21, 2018 https://www.thelancet.com/series/low-back-pain
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Team-Based Care with Chiropractic is Less Costly
The United States spends more on healthcare per capita than any other economically developed country.
Findings presented by Optum, the health services subsidiary of UnitedHealth Group, showed that a conservative care approach involving chiropractic care or physical therapy for LBP costs the insurer approximately $619 per episode, while primary care costs $728 and care from a specialist costs $1,728.
The insurer expects it could save $230 million and reduce opioid prescribing by 26 percent over two years if half of their members would first pursue a conservative approach for their LBP.
National Academies of Sciences, Engineering, and Medicine 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25406
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New UnitedHealthcare Benefit for Low Back Pain Helps Reduce Invasive Procedures and Address the Opioid Epidemic
10/29/19
Encouraging people with low back pain to access physical therapy or chiropractic care, the benefit design is expected to reduce the number of imaging tests, spinal surgeries and opioid prescriptions.
UnitedHealthcare modeling, 2019. https://www.unitedhealthgroup.com/newsroom/2019/2019-10-29-uhc-benefit-low-back-pain.html2
Chiropractic Yields Improved Outcomes
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National Guidelines Overview Support
UnitedHealthcare modeling, 2019.https://www.unitedhealthgroup.com/newsroom/2019/2019-10-29-uhc-benefit-low-back-pain.html
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National Guidelines Overview Support
UnitedHealthcare modeling, 2019.https://www.unitedhealthgroup.com/newsroom/2019/2019-10-29-uhc-benefit-low-back-pain.html
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Rise of Chiropractic Care
Lancet/WHO
Guidelines
Joint Commission
Qaseem A, Wilt TJ, McLean RM, et al, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:514–530. doi: https://doi.org/10.7326/M16-2367
The Lancet, Vol. 391, No. 10137. Published: March 21, 2018 https://www.thelancet.com/series/low-back-pain
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Rise of Chiropractic Care
Cost and Absenteeism
Utilization of imagingEmergency Settings
Retention and Presenteeism
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Rise of Chiropractic Care
Quality
Education
Care & Referrals
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Rise of Chiropractic Care
Relief
Function
Opioids Use
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DCs Offer Value
According to the University of Southern Florida’s (USF) Chair of the College of Medicine Neurosurgery Harry Van Loveren, MD:
“USF Department of Neurosurgery employs chiropractors for evaluation, treatment and research as one of its tools to aid patients with spine-
related conditions. We work in a comprehensive, compassionate and safe manner with avoidance of opioids and limited use of surgery. We work
together for the well-being of our patients.”
Susan Welsh, DC, DACBSP, USF College of Medicine Neurosurgery:
“Our department of Neurosurgery and Brain Repair includes chiropractic care and research to emphasize that doctors of chiropractic are front runners for neuro-musculoskeletal and spine care in our fully integrative patient-centered clinics. We have over 750 providers in the Morsani College of Medicine at USF and chiropractic is included as a
first-line of treatment.”
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Dr. Sherry McAllister, Executive Vice PresidentFoundation for Chiropractic Progress
dr.mcallister@f4cp.com
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z
Potential and Value of Worksite Clinics
Use and Integration of Chiropractors in Worksite Health Centers to Reduce
Costs and Improve Quality
December 3, 2019
Orlando Florida
William Updyke, D.C.
Physical and Complementary Medicine, Cisco LifeConnections Health Center, San Jose
Stanford Healthcare / Premise Health
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zIntegrating Chiropractic Services into Your
Worksite Health Program and Clinic
§ Why utilize a doctor of chiropractic?
§ What are you looking for in a doctor of chiropractic?
§ How to incorporate a doctor of chiropractic
§ Metrics to evaluate a doctor of chiropractic
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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z Why utilize a doctor of chiropractic?
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zWhat are you looking for in a doctor of
chiropractic?
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zWhat are you looking for in a doctor of
chiropractic?
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zWhat are you looking for in a doctor of
chiropractic?
Medicine
Acupuncture
Chiropractic
Mental health
Physical Therapy
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zWhat are you looking for in a doctor of
chiropractic?
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zWhat are you looking for in a doctor of
chiropractic?
§ Experience of 3-5 or over 8 years
§ It can take years to develop manual and patient communication skills along with skills to deal with complicated conditions and high level patients
§ Integrated practice experience if you have an integrated clinic
§ Medical practice, VA practice or residencies, integration exp.
§ Built their own private practice; practice style/techniques; professional leadership; publications; etc.
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zWhat are you looking for in a doctor of
chiropractic?
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zHow to incorporate a doctor of chiropractic
§ Directly contract in California
§ D.C. must work for a D.C . (D.C. corp.) or M.D.
§ On-site practice extension single line of service
§ Billing insurance or charging patients cash
§ Contract with small, medium or large onsite clinic vender
§ D.C. is employee of a chiropractic or medical group
§ Integrated with insurance plans or not
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zMetrics to evaluate a doctor of chiropractic
§ Internally generated data
§ Chart review for quality done by another D.C. provider
§ Outcomes measured of patient - condition & episode based
§ Potential EMR generated data
§ Number of patients
§ Capacity
§ Conditions treated
§ Visits per condition
§ Imaging and referrals to specialists
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zMetrics to evaluate a doctor of chiropractic
§ Externally generated data
§ Patient satisfaction onsite by D.C. / onsite vender or client
§ Patient satisfaction through outside communication
§ Outcomes for episodes
§ FOTO/Spine IQ: benchmarks your episode based outcomes vs. national benchmarks
§ Insurance carrier data on treatment patterns
§ Big data third party data management companies
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zRecent Research Results Supporting ROI
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z
Thank you!Questions?
§ Bill Updyke, D.C.
§ 415-279-9471
§ wupdyke@stanfordhealthcare.org
§ Surfdoc1@aol.com
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Digital Tools to Support
Population HealthLaurel Pickering, MPH
EVP, Enterprise SolutionsWelldoc, Inc.
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Agenda
• What problem are we trying to solve?• The new consumer• Types of technology• Applications of technology in population health and onsite clinics• Practical considerations• Digital landscape• A diabetes example: BlueStar
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What problem are we trying to solve?
• Increasing chronic disease, increasing costs• Lack of engagement in programs• Traditionally pop health programs have been human resource intensive telephone
and face to face• Not scalable or financially sustainable • As we attempt to reach ever growing numbers of individuals who are constantly
on the move, new approaches must be used.
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People Are Changing And So Is Healthcare
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Meet Lara
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Music
MUSIC SPOTIFY
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Music
COMMUTE UBER
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Music
EXERCISE PELOTON
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Music
DOCTOR TELEDOC
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Characteristics of Lara’s Tools
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©2018 WellDoc, Inc. Intellectual Property. All rights reserved
Personalized
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©2018 WellDoc, Inc. Intellectual Property. All rights reserved
On-Demand
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©2018 WellDoc, Inc. Intellectual Property. All rights reserved
Virtual
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©2018 WellDoc, Inc. Intellectual Property. All rights reserved
24/7
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How do your programs fit into Lara’s expectations?
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Technology and Population Health
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“I don’t see a viable way to effectively and efficiently manage a population of patients with diabetes, without a digital solution."
-Damon Tanton, MD
Medical Director | Clinical Practice for the AdventHealth Diabetes Institute
and AdventHealth Diabetes & Endocrine Center
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Moving from the Individual to the Population
30.3 M with
diabetes
©2019 WellDoc, Inc. Intellectual Property. All rights reserved
86M with pre-
diabetes
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Generating economies of scale through progression in technologic spectrum
Traditional Mail
Telephone
Automated Telephone
Interactive Voice Response
Text Notifications
Push Notifications
©2017 WellDoc, Inc. Intellectual Property. All rights reserved
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101
Applications of Technology in Pop Health
©2017 WellDoc, Inc. Intellectual Property. All rights reserved
Communications
Patient identification
Clinical decision support
Patient decision support
Health coaching
Connected health and personal health IT
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Practical Considerations
Population Health Alliance (2016). Technology and Engagement: How Digital Tools are Reshaping Population Health.
©2017 WellDoc, Inc. Intellectual Property. All rights reserved
Privacy
Digital divide
Age-related considerations
Cost
Integration with overall engagement strategy
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©2019 Welldoc, Inc. Intellectual Property. All rights reserved
Progression to Clinically-Driven Consumer Health Solutions
Remote Monitoring 1.0(2010-2014)
Fitness/Wellness(2012-2016)
Disease Management(2014-2018)
Digital Therapeutics(2016-2020)
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A New Category of Medicine: Digital Therapeutics (DTx)
Must be designed using user experience best practices and engaging to end users
Must bust be reviewed and cleared or certified by regulatory bodies as required to support product claims of risk, efficacy, and intended use
Clinical evidence and real world outcomes are required for digital therapeutic products
Digital therapeutic (DTx) products deliver evidence-based therapeutic interventions to prevent, manage, or treat a medical disorder
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A New Category of Medicine: Digital Therapeutics (DTx)
Must be designed using user experience
best practices and engaging to end users
Must bust be reviewed and cleared or
certified by regulatory bodies as required
to support product claims of risk,
efficacy, and intended use
Clinical evidence and real world
outcomes are required for digital
therapeutic products
Digital therapeutic (DTx) products
deliver evidence-based therapeutic
interventions to prevent, manage, or
treat a medical disorder
Connect User to
Care Team
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DTx Member Companies
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Digital Therapeutic
Telehealth
Human Coaching
Keto Diet
More ScalableBroader Applicability
Less ScalableNiche Applicability
DTx to scale your population health reach
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Case Study: Diabetes andBlueStar
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*Turning the tide on diabetes management: How leaders in health care are using multi-faceted approaches, Deloitte, 2016
*
People With Type 2 Diabetes Need A 24/7 Personal Assistant
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Tailored, Comprehensive ExperienceTracks and analyzes the 6 critical dimensions impacting diabetes, including hypertension & weight management
Symptoms(Surveys, Notes)
Psycho-social(Distress, Disability, Economic
Conditions)
Labs(BG, BP, Weight)
Activity(Sleep/Exercise)
Meds(Adherence, Insights)
Diet(Carbs, Calories, Sodium, Water)
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A Closer Look at BlueStarProvider Smart Visit Report
Weekly Insights Longitudinal Patterns
Medication Reminders
Real-time Feedback
Plan & TrackConnect
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Two-way chat & video visits
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Integration with Onsite Clinic leads to Better Outcomes
→ Remote Access to Data
→ Medication Reconciliation
→ Blood Glucose Summary
→ Self-Management Summary
→ Secure Messaging
→ Patient Surveys & Reports
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In and Out of App Methods of Keeping Users Engaged
“In-App” Engagement
“Out-of-App” Engagement
Dynamic Emails
Mobile Notifications
Targeted Re-Engagement Emails
Phone Outreach
Real-Time Feedback Messages
Longitudinal Feedback Messages
Weekly Challenges
Weekly Summaries
Diabetes Curriculum
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1.9 Point A1C Improvement (mean)12 month RCT
2.0 Point A1CImprovement (mean)3 month RCT
58% Reduction in Hospitalizations & ER Visits
Peer-Reviewed Journals
Outcomes
Over 45+ peer reviewed
posters and presentations
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Comparison of A1C Reduction
• BlueStar is second only to insulin in terms of ability to reduce A1C
• No side effects• Fully scalable
T2D Treatment Average A1C Reduction
Insulin 1.5 - 2.5
BlueStar 1.7 - 2.0
Metformin 1.5
Sulfonylureas 1.5
SGLT-2s .5 - 1.0
GLP-1R Agonist .5 - 1.0
DPP-4 Inhibitor .6 - .8
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Financial OutcomesWellDoc has Demonstrated Potential of Its Digital Therapeutic, BlueStar®, to Significantly Reduce Healthcare Costs. Cost savings based on reductions in:• Hospitalizations• Emergency room visits• Supplies and medications• Burden of co-morbid conditions
Starting A1c > 8
Estimated Savings: $3,048 - $3,252 per patient, annually*
Can your partner show validated outcomes, accurately estimate impact and put fees at risk?
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Case Study: Self-Funded EmployerMIDWEST BASED CREDIT UNION
250+Employees with type 2 diabetes
400Covered lives with type 2 diabetes
A1C > 8Majority of population had out of target A1C
ENGAGEMENT WITH BLUESTAR
6K+Total user engagements with the product
60%Activations
50%Sustained user engagement after six-months
OUTCOMES
15%Increase of BG readings in target-range
$1KReduction in annual cost per user (estimated)
3 Point A1C Several reported 3 point A1C reductions
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Case Study: Clinical Setting in the Mid Atlantic
©2018 WellDoc, Inc. Intellectual Property. All rights reserved
1,036 patients
# E
NG
AG
ME
NT
S P
ER
US
ER
M O N T H S
12 months
161,602 total entries
Change in A1c: -1.1%
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Engagement in one’s health is where an individual performs sustained actions toward achieving optimal
health and well- being.
“……..teach a man to fish”
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©2017 WellDoc, Inc. Intellectual Property. All rights reserved
Mass General Ambulatory Practice of the Future (APF)
• Incorporate virtual care into the practice
• Provide a clinically validated plan for practice-based reimbursement in the evolving value-based payment that can be extended nationally.
• Provides a new mechanism for primary care to embrace population health
• Build evidence for the integration of digital health in a value-based practice with a pathway to broad adoption throughout the health system.
Expansion Goals
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What Patients Say
©2017 WellDoc, Inc. Intellectual Property. All rights reserved
What Providers Say
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©2017 WellDoc, Inc. Intellectual Property. All rights reserved
Key Lessons
• How we interact with the world is changing• Healthcare is moving to virtual channels. In-person healthcare as
“Option B”• Are you innovating to meet your employees where they are?• Digital is the next innovation in population health. We must try it.
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The Potential and Value of Worksite ClinicsThank you to our sponsors and host:
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